We may have to learn to live with the novel coronavirus, because it can last a lot longer than predicted if people fail to follow Covid guidelines and get vaccinated, and the spread of the virus is not contained, emphasised Dr Neeraj Nischal, Associate Professor, Medicine, All India Institute of Medical Sciences (AIIMS), Dr Anjan Trikha, Chairman of Clinical Managerial Group, Covid Centre at AIIMS, and Dr Arunesh Kumar, HoD, Respiratory Medicine at Paras Hospital.
Dr Arunesh Kumar
Dr Anjan Trikha
Dr Neeraj Nischal
Q: A study that says that the second wave of Covid-19 is going to continue for 100 or 150 days. How would you comment on this?
Dr Trikha: Yes, I think it could go on for 100 or 150 days. It is all speculation. Studies like this have a lot of mathematical equations with which they make such predictions. But what is important is that we are having a second stage and unless we take care we don’t know what is going to happen. So let’s not try to predict how many days it’s going to last, let us try to see how we can shorten it. If I say it is going to last 200 days, would people start wearing masks? No. So, the idea is not to predict the number of days, but to see how we can stop it. We have already lowered our guards. Each one of us has attended weddings or religious ceremonies or parties. We have seen the cricket matches – there were about 20,000 to 50,000 people there.
Q: People are not ready to follow guidelines. Do you think this is one of the biggest reasons for the mutation of this virus?
Dr Nischal: First of all, I would like to echo Dr. Anjan’s comment. You can make a prediction, but we all know that how long this particular infection or wave continues for will entirely depend upon how we react to this situation. Even last year, many doomsday predictions were made. Some rosy pictures were painted. All were proven wrong because of the behaviour of the people. So, this 100-day prediction may not come true if we behave properly, and if we become irresponsible, it could last for 1000 days. We have been discussing this thing for almost a year now, so it all depends on our behaviour. If you ask who is responsible for the mutation of this virus: we all know this virus uses a human host for multiplication and if we are not going to rent out our body as an experiment lab for this virus, we are not going to see any mutant variants in our country. But if we keep on providing our bodies for this virus, if the population keeps getting infected, this virus will mutate. These mutations could be fatal too because the virus is trying to evolve so as to survive. Though most species try to coexist with its source – maybe this virus is trying that too – but since this mechanism is not foolproof, there could be a variant which could be fatal for humans. And till it achieves that, we are at risk of catching a dangerous strain which may cause complicated diseases. So it all depends on us and our behaviour. If we behave properly and responsibly, we can control it. Or else, we will keep seeing these mutant strains frequently.
Q: What is the double mutant variant?
Dr Kumar: We know about mutation, it is nothing new about this virus or any virus. All viruses are mutated now and mutations sometimes happen for good because the virus becomes less effective. But sometimes mutations can be bad because they become more virulent. That’s what this double mutation is. There are the South African and Brazilian variants, soon there will be an Indian variant as well because the virus will mutate. As we do genetic studies, we find out a new name for it. But even the mutated variants have the same mode of transmission as the native mutant. They are transmitted by secretions or droplets when you cough and don’t wear masks. So, whatever the virus, people should be tested and treated and we should contain the spread. The principle remains the same. I think let us treat it as any other virus. It is no different and it also behaves in the same way. The good thing is that we are not seeing many sick patients as we were a year back. Believe me, there are hardly 2%-3% of patients who are very sick. The rest are the same, so we are actually seeing a better trend. As the vaccinations are being rolled out, I appeal to people to come get themselves vaccinated. Let’s use the knowledge which we have and not be alarmists about double or triple mutations. Let this be for biologists to deal with. Let’s take the positives and move forward.
Q: Do you think this variant is the reason behind the increasing number of Covid-19 cases in India or the ‘second wave’?
Dr Kumar: There is no such evidence. We need to wait further. You know there was a dip 2-3 months back because people were a bit more disciplined and started putting on masks and observing all the Covid-appropriate behaviours. So, I don’t think this surge is because of a particular strain and that’s why I want to downplay the mutations. Let virologists think about that. For the public, let us treat this virus the same as it was a year ago. Even for us general physicians and practitioners, we don’t treat anybody differently according to whether it is a variant from the UK or Hong Kong or Africa. They just have Covid-19. I’m saying it again, emphatically, that there is no evidence that this increase is related to the new mutant variants. In the coming days, we’ll have more information. More genotyping and molecular studies will be done. But the treatment remains the same, the precautions remain the same, and the mask remains of the utmost importance. To reduce the chain of spread, we have to contain it. If you are sick, you stay home, quarantine yourself for 17 days, and you’ll be alright. If you are breathless or have a bit of fever, you need to seek early help. If you have co-morbidities, you should be extra careful. That’s what we have been saying for the last one year and we are still saying the same. Do not take it for granted because we don’t have a treatment for this condition. All we are doing is symptom control. There is no accurate antiviral. The onus is on the people to follow Covid guidelines. Vaccine skepticism also has to go down. This is the only way out.
Q: Do you think it is high time to start mass vaccinations in India?
Dr Trikha: That is easier said than done. We must not forget that we are a 1.4 billion strong country. I think the vaccination program of the government is doing excellently. It is seamless. I have seen it in Delhi – you can go anywhere, there is no rush, and they are doing an excellent job of it. The government is doing its job. But the government cannot come to my house and put a mask on my face or stop me from going out. This is what you and I have to do. Sarojini Nagar, Lajpat Nagar, Chandni Chowk, Karol Bagh – the markets are all overflowing because people think Holi will never come back again. Chances are, if they get a virus and become very sick and land with a ventilator, Holi might never come back. Meanwhile, there is such a big discussion about the vaccines going on in our country. People who are not even graduates are trying to discuss whether they should take Covishield or Covaxin. Let the government decide that. There are knowledgeable people sitting in the planning commissions at various hospitals. Let them decide what is good or bad for the country. There will always be grey areas in a pandemic, especially with a disease which is evolving like this. The virus will mutate but that’s not a problem. Hopefully, it will mutate and become non-infected, which we are already seeing. But that doesn’t mean people are not dying.
Q: Do you think we need more vaccines?
Dr Nischal: As sir said, it’s a pandemic and we cannot be choosy. They may be more than sufficient to save your life. We don’t know who is going to land up on a ventilator. Many people over 90 years have come out without any problems, while we have also not been able to save somebody in their 20s. The blame ultimately lands on healthcare workers but there is nothing we can do about this virus, apart from providing support and care. For the two vaccines which are available, even if the efficacy is between 60% and 80%, as long as they are safe, one should not hesitate and come forward and take it as soon as possible. You cannot generate a vaccine overnight. These vaccines have come very fast but they have taken at least one year. Of course, there are a number of other vaccines in the pipeline. One of the most promising is the nasal vaccine, and once it is launched the immunization program will be easier to carry forward. But till the time we have other vaccines, we have to rely on what we have and I think these two are perfect and one should not delay or hesitate about taking them.
Dr Trikha: I would just like to add that Neeraj and I work at the same place and he is totally right in saying that, from 1 April 2020 to this year, we have had about four people above the age of 90 who have gone back home, while some of the most powerful or rich or youngest people have died. So, this can happen to each one of us. That kind of feeling should be there – you can call it fear. It is something like thinking “I won’t get cancer”. Anybody can get cancer. So, precaution and treatment and prevention is the thumb rule.
Q: Do you think a time will come when this particular virus will become like the common flu?
Dr Trikha: I am telling you today that we’ll have to live with this virus like we live with so many viruses. The last pandemic took about two to three decades to go. I know science has improved, but this pandemic is just one year old. A time will come when we will live with it and we will get used to it. It will be like getting our jabs every year. There is already a jab by Johnson & Johnson who have brought out a single short vaccine in the USA, where it has been given to homeless people because they can’t be traced for the second shot. So there will be many options available. Neeraj has talked about a nasal drop that will also come. Maybe every one year or 14 months, we will get a shot like you do for influenza. Not many people in India take an influenza shot, but if you go to an office in Europe or America, they advise you to take an influenza shot because that is what prevention is. Even if you get influenza after that, the severity will be less. The same is true with vaccines. Let’s not talk about efficacy in terms of 74% or 82%. These are numbers that pharmaceuticals will push. Let us be honest. If you have had the jab and have the antibodies – and it takes some time after the second jab – and you contract the disease, it is likely to be less severe.
Q: Are you getting Covid-19 patients with any different symptoms?
Dr Nischal: I will carry forward the discussion about mutations. One has to understand that you can’t just blame mutations for the rise in cases. If there had been an increase in cases of re-infection among patients who already had the infection in the past, we could have blamed the mutant variants as a cause. But we believe it’s the mutation in the behaviour of people which is the prime reason for this increase in the number of cases. What we had been seeing in the past, it has been almost the same. Luckily, to be very frank, we are not seeing much sicker patients. Many people are also opting for home isolation which is why the rise in cases is not reflecting in hospitals. But it may increase because if we are not careful and do not monitor our disease progression, we might get sicker patients. The rise in cases and the number of patients in hospitals takes some time to reflect. So if we don’t follow Covid-appropriate behaviour then more cases will start coming after two to three weeks. If we start behaving properly now, the effect will start somewhere in April. This is the only way we can fight this pandemic.