India’s priority must be to prevent the spread of Covid-19 through social distancing and then lockdowns till science expands our toolkits, says Dr Anurag Agarwal, director of the Institute of Genomics and Integrative Biology.
He is a pulmonologist and known for his research on lung diseases. Dr Agarwal says that more testing will tell us more, but the strategy to combat the disease will remain the same.
He speaks to Hindustan Times on the coronavirus outbreak.
Q: India has submitted two gene sequences, what have we learnt from it?
Dr Agarwal: When you look at the two sequences that have been submitted by the NIV (National Institute of Virology in Pune) to the global database, you can see on the tree that the sequences are different from everywhere else. So we do not know what it will do.
Also, there is not one single strain in India; people who have come back have flown through a bunch of places. If you are coming back from Italy, it doesn’t mean you have picked up the infection there, there are transit points and so many people at the airports.
But, the most important thing to my mind it that so far for every case we have been able to trace the reason for that person to be infected. Till that continues, we are not looking at a background community transmission.
The 11 other strains are currently being sequenced, and nobody wants to hoard on to these. Whenever they feel comfortable, when they have gone through all the scientific checks, they will release it.
Q: Do we need to test more?
Dr Agarwal: The only thing that we can do is physical distancing. There has been a lot of questions about should we be testing more people. And, of course, if you test more, you know more. But even if you knew more what would you do? You would do physical distancing.
I mean, do you start telling people whose blood sugar tests are normal, jao jake ladoo kha lo (Go have laddoos)?
While I know ICMR has been the favourite target, the fact remains that if we allow too many of these tests to be done by too many players, there will be bad data. More tests will happen and more scientific data will come in, but none of this will change what we have to do – we have to prevent it.
Q: What will be the role of the science and tech group set up by the Principal Scientific Advisor that you are a part of?
Dr Agarwal: The group will look at the science and tech preparedness for this and future pandemics. Covid-19 is the key focus; the group starts by assuming that this is not a virus that will disappear in a month, so even if it goes down it can easily come back again in the winters or some other time.
So, what does one need? One always needs better prevention, better diagnosis, and better therapy.
Now, the prevention can happen through vaccine, for diagnosis there are two problems who to test, how early can you find out people need testing, and how to test. There are technological aspects of each of these starting from digital surveillance to test kits. And, last part is the management – ancillary things like ventilators, and technologies for home care etc and then the real treatments, molecules that can work against the disease.
Then, we can find antibodies from people who have got better and use the blood from these people to treat others. It is being done in China, by the way, hyper immunoglobulin therapy. You take the blood plasma from people who have recovered and inject in people who are doing badly.
Next will be to isolate the blood cells producing those antibodies and use it to create active vaccination. To that end, someone is in-charge of putting together a group on everything. None of the advisory group people cannot do all this themselves, but we can help enable the best brains to come together and ensure they jump over any hurdles that come.
The ICMR tells us what to do with what we have, we are supposed to change that line of what we have to what we should have few months from now, then it goes back to them.
Q: Knowing what we know about the virus, how can we stop its spread?
Dr Agarwal: The priority right now is to contain the spread of the virus and protect those vulnerable. As per their surveillance data of ICMR, it does not seem like there is a huge amount of background infection in our community. But we are already in stage II of – when there is local transmission to people who came in contact with Covid-19 positive cases – and the only way to prevent going into stage II is to break the transmission through social distancing; I prefer calling it physical distancing because we are still socially together but physically distant.
What to do is very clear. Now, the question arises do we stick to simple distancing or go for complete lockdown. Lockdown has huge implication not just in terms of health, but economics, essential services, and then there is social panic. So, now is not time for a lockdown and when it is, we will get to know.
This is all based on the ICMR surveillance data. If it was time to panic and go into lockdown the surveillance data should have shown more positivity. Given what it is simple distancing and shutting down schools, cinema halls, large function are critical.
But it is essential that the response in the government system must continue to go on, otherwise we are looking at a problem. Because, how long can you shut everything down? Its not like March 31 is a magic number.
The government is acting, but a lot of it will be luck. I mean, will we have a mild strain or will we have a bad strain? Look at Italy, so many people have died but if you go a little bit north to Germany, the death is very low. They are both European countries, they both have elderly people.
