The government’s point man on the gravest health emergency confronting the world and India is Dr Harsh Vardhan, our very own Health Minister, a Chandni Chowk MP. A doctor himself and in the main an Otorhinolaryngologist, he has risen from a doctor to a well-regarded politician. Extremely soft-spoken, he has been a minister in the Delhi government and headed the Delhi BJP and was its CM candidate. Prime Minister has a special bonding with him. And as such he heads what has turned out to be the most sensitive ministry in these challenging times.
He also heads the Science and Technology and Earth Sciences Ministry. With the world witnessing the worst ever pandemic, Dr Harsh Vardhan has now been elected to head the WHO executive board. Arguably one of the busiest persons in the country currently, he took time off to speak extensively with IANS. Here is everything that you wanted to know about the coronavirus, but were afraid to ask. Excerpts:
Q: What is the situation of the COVID-19 cases in India compared to other countries like US, UK and China? Some research is showing that deaths in tropical climes is only 6 per cent, will rising temperatures kill this virus?
A: In India, definitely, due to the timely decisions taken by our government under able guidance of our Prime Minister Narendra Modi ji, the situation is better. As on May 26, in terms of confirmed cases per lakh population, India has so far about 10.7 cases per lakh population as against global average 69.9 cases per lakh population, 486 cases per lakh population in USA, 390 cases per lakh population in UK and 5.8 cases per lakh population in China. Further, in terms of case mortality per lakh population, India has so far about 0.3 deaths per lakh population as against a global average of 4.4 deaths per lakh population; 29.3 deaths per lakh population in USA; 55.3 deaths per lakh population in UK and 0.3 deaths per lakh population in China.
As I have been saying all along and which has also been informed by various studies, there does not appear to be any correlation between the rate of infection and atmospheric temperature. The spread of COVID-19 outbreak around the world does suggest a preference for cool and dry conditions; although it is worth noting that the virus has appeared in countries with a wide range of climates, including hot-humid ones. The low death rate of COVID-19 in tropical countries compared with the Western world could be due to various reasons such as lower population density, younger average age of people, and lesser number of international travels in tropical countries as compared to Western countries.
Q: You have been saying that people have to learn to live with the virus. How is it possible for the government to implement the task of distancing and yet continue the process of opening up? Is it Catch-22?
A: I say that with my experience. This new virus, SARS-CoV-2 that causes COVID- 19, has an incredibly fast rate of spread, but at the same time, it has a low fatality rate. In fact, in India it is due to complete lockdown as well as focus on augmenting public health infrastructure that has placed us in a good stead and helped contain the fatality rate. However, it is too early to say when the virus will be completely eliminated. Just like any other virus which remains in populations and ebbs over time, this virus may also become part of our lives in times to come.
Given this uncertainty, we have to find ways and means to enable us to restart our social and economic activities that have been brought to a standstill due to the lockdown. We should remember that lockdown has not been an easy decision. This is because socio-economic and psychological costs are associated with it. Despite this our Hon’ble Prime Minister took the decision of complete lockdown as we had to prioritize lives of our citizens. Today, when we are fully prepared to tackle the spread and have made our best efforts to tackle the disease, we are mindful of the fact that this lockdown, this fight has impacted the livelihoods of a large number of our people. We cannot let our economy slow down as it would be catastrophic in the long run. That is why to reboot our economy, our Prime Minister has brought this economic package of Rs 20 lakh crore.
Moreover, with every new phase of lockdown, we have been opening up the economy. We are starting activities in such a way that the relaxation allowed does not interfere with the containment measures and a balance is achieved between containment measures and the activities allowed.
Moreover, unlike previous viruses, we need to remember that this corona virus spreads through lack of observance of personal hygiene and maintaining physical distancing. So, these should become part of our lives to check not only the spread of this virus but other similar infections in future. In fact, this would spur us further to develop innovative and safer ways of interaction with each other in the society.
The onus of maintaining this balance also falls on all of us. Each one of us has to follow all necessary guidelines and advisories issued by the government from time to time in true spirit — use of face covers, regular hand washing, cough etiquettes and use of sanitizers both at home and workplace regularly is essential. Crowded places and gatherings need to be avoided. Let us follow our Prime Minister’s clarion call of eJaan Bhi Jahan Bhi’.
Q: Do you think that the cause of worry is asymptomatic patients who are potential virus carriers and they may take the virus deeper and deeper into rural India?
A: I am aware about WHO’s mention of some laboratory-confirmed cases that are truly asymptomatic. It is equally true, that as on date, there has been no documented asymptomatic transmission. Recently, more symptoms like headache, muscle pain, pink eye, loss of smell, or loss of taste, intense chills, rigors and sore throat have been included in the list of COVID-19 symptoms by Centers for Disease Control and Prevention (CDC), USA. It will require more studies before these symptoms are finally included in our list in India.
As you will notice, these are very subjective and vague symptoms which may go unnoticed, may not be remembered by the patient and, thus, may not even be reported.
Even today, in almost 80% of the cases of COVID-19, which are being reported in India, the patients tend to exhibit either nil or mild symptoms. These patients are mostly contacts of confirmed cases. Interestingly, had it not been for our contact tracing efforts, and if left to their own in isolation, these patients may not have even remembered or reported their infection.
Moreover, if for a moment we talk of testing such asymptotic patients, identification of all these asymptomatic cases will require repeated testing of 1.3 billion population which is a resource expensive exercise for any country and is neither possible nor recommended because of its feasibility.
Q: What do you think about worsening situation in Delhi, Mumbai, Agra, West Bengal, Indore and Ahmedabad?
A: I have been in regular touch with the Health Ministers of Delhi, Maharashtra, Uttar Pradesh, West Bengal and Gujarat. States have been trying their best to contain the disease. In the absence of drugs or vaccine for treatment of COVID-19, our emphasis has been on early detection of cases especially through meticulous contact tracing of confirmed cases and active case search through house-to-house survey as well as on provision of optimized care to patients.
You would appreciate that effective containment of COVID-19 depends on the successful collective outcome of the various interventions taken to contain the outbreak. It also depends on the level of community ownership and dedication in discharging the social responsibility by its members. Any deficiency in efforts may result in worsening of the situation.
Q: What is the status of testing and can more testing curb the disease?
A: The current testing strategy is need-based and gives priority to individuals who are primarily at risk or have symptoms. It is revised regularly according to the evolving situation.
From one laboratory at NIV, Pune in the first week of February 2020, the number of facilities has increased to a total of 624 which include 435 government labs and 189 NABL-accredited private laboratories are involved in testing at present.
As on May 27, our testing capacity is 1,60,000 per day and we have done 32,44,884 tests to date. On May 26, itself, we have conducted 1,15,229 tests. As I said earlier, if for a moment, we talk of repeated testing of 1.3 billion population to curb the disease, you would appreciate that this is not only a resource expensive exercise but also neither possible nor feasible.
Therefore, I am still of the view that priority-based and targeted testing will be helpful in detecting more cases for COVID-19 and curbing the disease. With our efforts at sustained and quality assured scaling up of the testing facilities, I am sure, we shall be better placed for maximum case detection.
Q: When do you expect the curve to flatten since AIIMS Director Guleria has said that the situation may worsen in the next two months?
A: Right now, we have a steady curve. It has never shown any exponential rise. We are now trying to bend the curve downwards. The trajectory of the outbreak is decided by a number of factors such as pathogenicity and transmissibility of virus; availability of specific treatment or vaccine; as well as collective performance of all public health interventions undertaken to contain the outbreak such as testing and early case detection, isolation, quarantine, contact-tracing, optimum care of cases and surveillance.
As you know that COVID-19 is a new disease and the behaviour of this virus in evolving outbreak is unknown. We have isolated the virus and our scientists and epidemiologists are studying it with the help of gene sequencing. Not much data about the virus and the disease is available at the moment.
Further as far as the issue of predictions of the further spread of the disease is concerned, let me tell you that I keep on hearing about one mathematical prediction model or the other. There are so many such models giving so many predictions round-the-clock that it is difficult to track them or justify them. But just like any mathematical model, these models are based on a number of assumptions and presumptions which may or may not match with real ground data because the data is still being generated each day and the disease has not matured across the world.
Therefore, it beats me as to with so much uncertainties, whether it is possible to make accurate predictions about future scenario of the disease.
Q: What is the status of vaccine in our country, how is the government coordinating the research with the private sector and by when can we expect something positive on this front? The CSIR is also working in this as are others?
A: As far as India is concerned, it is among the largest manufacturers of vaccines in the world. About half-a-dozen major vaccine makers are in India and make doses against polio, meningitis, pneumonia, rotavirus, BCG, measles, mumps and rubella, among other diseases.
Since the onset of COVID-19 in India, scientific community and the vaccine manufactures are working closely to bring out an effective vaccine against the viral infection. Government of India through the Ministry of Science and Technology and the Department of Biotechnology, Department of Science and Technology, CSIR, and through their Autonomous Institutes and agencies like BIRAC, TDB and SERB have been supporting academia and vaccine industries to develop an efficacious vaccine against SARS-COV-2.
A multifaceted approach is being adopted to ensure that vaccine candidates utilizing different platforms and at different stages of development are fast-tracked through the COVID-19 Research Consortium under funding from Department of Biotechnology, BIRAC and National Biopharma Mission. Both, repurposing of existing vaccine candidates for immediate protection of high-risk groups and novel vaccine candidate development have been considered.
Currently over 14 vaccine candidates are in different stages of development. More than 4 are in an advanced stage of preclinical. Nearly 10 have been recommended for funding support by Department of Biotechnology.
Serum Institute of India Pvt. Ltd is being funded for a Phase-III human clinical trial of a recombinant BCG vaccine candidate. Cadila Healthcare is being funded for a DNA vaccine candidate, Bharat Biotech International Ltd for a safe inactivated rabies vector platform while Gennova Biopharma Ltd for an m-RNA vaccine candidate. Besides these, the National Institute of Immunology is developing a novel vaccine evaluation platform to support SARS-CoV-2 vaccine development in resource-limiting settings.
The CSIR has funded Monoclonal antibody program through NCCS, Pune in collaboration with IIT, Indore and Bharat Biotech.
Q: What is the preparation in the country vis-a-vis beds, ventilator and PPE kits? Are we adequately fortified against the inordinate rise in cases?
A: Yes, the country is well prepared to face the challenge of inordinate rise in cases with the available infrastructure. As on May 27, the number of beds in dedicated COVID hospitals is 2,49,636, and dedicated COVID health centers is 1,75,982, making a total of 4,25,618. Further, we have identified 6,50,173 beds in 7,202 COVID care centres and 5,09,690 beds in 10,345 quarantine centres. Several domestic manufacturers for ventilators have been identified and orders for 60,848 ventilators have been placed which will be received in a phased manner in this month and June.
Many hospitals and medical colleges are increasing the number of ventilator beds. Several hospital owners in the private sector are also coming forward to dedicate their facilities for the cause of the nation.
As regards PPE, as on date 32.54 lakhs PPEs are available with states &UTs. With the help of Ministry of Textile, 109 domestic manufacturers have been identified and orders have been placed for 2.23 crore of which 89.84 lakh have already been supplied. Today we are manufacturing 3 lakh PPEs every day and distributing to states.
49.06 lakh N 95 masks are available with states, the order for 2.29 crore is placed and 114.02 lakh have already been received. Further ten domestic manufacturers have been identified for in-house production.
As regards sufficiency of the infrastructure, I have said time and again that this virus, even though having a faster spread rate, has a low fatality rate. Normally, 80% of the infections of COVID-19 are mild or asymptomatic, 15% are severe infections requiring oxygen and only a maximum of 5% are critical infections requiring ventilator support. Moreover, analysis of recovery data, as on May 27 indicates that about 1.9% of all active cases under management require oxygen support; about 2.3% of the active cases under management require ICU support and 0.41% of the active cases under management require ventilator support.
Q: Being a doctor yourself, how do you think people should contain the disease and which are the most vulnerable sections? For most part PM Modi’s resorting to old style Indic shut down has saved India?
A: As I told you earlier, the complete nationwide lockdown was a great success in containing the spread of the COVID-19 but at the same time, it is also important to note that lockdown has socio-economic costs and needs to be used very judiciously. You already quoted me earlier and I say again: We must learn to live with the virus while continuing with our economic and social activities. Employers should provide a safe environment and make arrangement as per the prescribed guidelines to prevent the spread of disease at workplace while it is incumbent on the employees to ensure that they follow the physical distancing measures and personal hygiene. With these measures in place, it will be reasonably safe to go for work. I have said it time and again that social and physical distancing is the most potent social vaccine available to us.
Talking of the most vulnerable sections, I must say, these include the industrial and construction workers, in addition to people living in slums and other overcrowded areas where observance of personal hygiene and physical distancing measures is not satisfactory.
Q. Was the government blindsided by the migrant issue? Did the sheer numbers overwhelm the government machinery?
A: Migrants are not foreigners. They are our people. Why would their numbers overwhelm the government? Shri Narendra Modi ji’s government works for the last man in the society. We have been aware of the costs that lockdown has imposed on us but lives of our people are far more precious.
The government has been aware of their plight right from the first day when we imposed lockdown. With lockdown, their livelihoods have been affected. From time to time it was ensured that they had access to food, medicines and basic amenities. Orders were also issued to ensure that they were not evicted from their residential premises or from their places of work. During the lockdown, our government announced economic package of Rs 1.70 lakh crore to distribute food-grains and pulses to them through fair price ration shops apart from disbursement of cash in their accounts. The new Rs. 20 lakh-crore economic package also has a component to alleviate their sufferings.
We have also tried to ensure smooth movement of migrants from their places of work to their place of residence while at the same time ensuring observance of social distancing guidelines. Instructions have also been issued for not allowing migrants to travel on foot or other unsafe mode of transport. In such cases they should be lodged at suitable places with arrangement of food and other essential facilities and register for the next train available from the place.
We have tried to ensure that the migrants are kept under watch with periodic health check-ups. When all hygiene and physical distancing measures are undertaken by migrants properly and the public health procedures are followed by all concerned, risk of spread of disease is reduced and the situation does not worsen in the near future.
Q: The curve had more or less been flattened till the Tablighi Jamaat carriers created a brand-new challenge?
A: You are right that the curve of emerging cases had started to flatten when the Tablighi Jamaat incident happened. While 1.35 billion Indians had been placed under a three-week lockdown, large numbers of attendees at the Tablighi Markaz, with a history of foreign travel, defied social distancing norms and continued to stay there despite appearance of symptoms among few of the members. Many of these participants later travelled to various states and became a key source of transmission and spread of COVID-19 across the country.
This no doubt had serious implications on the spread of the disease in the country across 24 states including Andaman and Nicobar, Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Delhi, Himachal Pradesh, Haryana, Jammu and Kashmir, Kerala, Jharkhand, Karnataka, Maharashtra, Madhya Pradesh, Manipur, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Uttar Pradesh and Uttarakhand. There was an increase in cases over the weeks following the event.
Intensive tracking of Tablighi Jamaat participants and their contact-tracing across the country and appropriate care to affected persons remained the most important issue to contain the disease and was undertaken on a war footing. This is an example of how negligence on the part of a few persons can undo the praiseworthy national efforts in no time and destroy the containment achievements.