Professor of Global Health Ashish Jha’s special interview

New Delhi: Karan Thappar, conducts a special interview on the spread of Coronavirus for The Wire with Ashish Jha, who is a Professor of Global Health and Director of Harvard Global Health Institute. He is a man of international repute. Prof. Jha born in Mahdubani district of Bihar state.

Thappar asks Prof. Jha that India has 380,000 cases and it is growing around 13,000 a day. People are alarmed and questioning themselves whether we are losing the battle against the virus?

Minimizes loss of life

Prof. Jha replies it is very early to say that, because we have to fight this pandemic until the middle of next year. we need not worry about whether we are losing or winning, the question is how do we go through this entire pandemic in a way that minimizes loss of life and minimizes the harm to the economy.

Thappar invites Prof. Jha’s opinion on government’s statement that India is not in a community transmission stage in spite of 380,000 cases. Prof. Jha asserts it is a community transmission, he further adds, people are getting infected from within the community and not from a source that has come from abroad. According to his calculations, India probably has already reached 40,000-50,000 new infections a day. Prof. Jha says India’s testing pattern is such that approximaely13,000 cases are detected and 26,000 are going undetected. He says, according to a modelling date that he has seen, the cases may increase to one lakh or even two lakhs a day in August, if the spread of virus goes unchecked. Because, he says the virus grows exponentially.

Thappar says millions of migrants may have taken the virus with them to rural areas where the health system is very weak or infrastructure is probably missing all together. He questions about the impact as the focus of the virus will never move to rural India when the capacity to tackle it will be at its weakest.

Prof. Jha replies, currently the focus is on the hot spots of India like Mumbai Delhi, Gujarat. These are the places of international trade hub and prone to be hit by global pandemic. When the virus spreads, small cities and villages will also get infected. In case of migrants it has accelerated, in coming weeks there would be more cases, it may take a little bit more time though.

Thappar quotes Health Minister Harsh Vardhan’s statement that the disease is not virulent in India, to which Prof. Jha replied ‘no’ without any hesitation.

BCG vaccine

When Prof. Jha was asked whether the BCG vaccine boosts the immunity in Indians, he replied it may be possible, but there is no such evidence, the research is still going on and we may have the results in a month or two. He added, Indians may have a sort of natural immunity to this virus. Prof. Jha says he and other researchers are of the opinion that the virus is less now as it was one month ago.

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Regarding the precautions, he says an affected person will infect three other people and that those three will infect 9 and 27. Thus the rate of infection grows exponentially if this massive growth left unchecked.

Precautionary measures

When asked about the precautionary measures, he insists on the following four:

1) Social distancing: Prof. Jah says, people should not spend a lot of time together in close proximity. Minimize large gatherings, if the gathering is inevitable, he then advises to conduct them outdoors by strictly observing the precautionary measures. He emphatically says to avoid large gatherings for another 12 months, whether they are in religious or entertainment places.

2) Being outdoors is better than being indoors: He says that there is emerging evidence that large crowd indoors is much more dangerous than a large crowd outdoors. Large crowd outdoors is still dangerous because of close proximity. but being outdoors is safer than being indoors.

3) Mask wearing: There is a good evidence that wearing mask dramatically lowers infection and severity of infections. It is relatively cheaper and effective.

4) Aggressive testing, tracing, isolation strategy can work to bring the level of virus down in a community and bring the virus outbreak under control.

He further adds, that the extreme form of social distancing is a lockdown. He appreciates the Indian policy of implementing the lockdown. He appreciates the Indian government for its right decision and aggressive policy, which in many ways is bolder than what most other countries have done.
When he was asked whether India needs to revamp the Reverse Transcription Polymerase Chain Reaction (RT-PCR) already existing hotspots or does it also require in the rural areas where migrants might have taken the virus.

Prof. Jha replies that RT-PCR has to be done in both the areas to bring the hotspots under control. He says a key part of the strategy is surveillance and testing. It should be widely deployed even in areas with small number of cases. Because, the migrant workers who returned to their villages can spread the virus for many weeks. Those cases may go undetected unless there is a good testing in district and towns. Otherwise, by the time the new cases are detected, there will be a massive outbreak.

Thappar askes Prof. Jha can Indian healthcare system cope in a situation where there would be one lakh or two lakh infections every day and that might be happening in two or three-month’s time?

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Prof. Jha replies, India for decades has under invested in health care, work force is not developed and trained, public hospitals are often quite weak. Private hospitals have done well and are growing, but the majority of Indians cannot afford to get care in these private hospitals. We did not put in the time and energy to develop a finer health system that India needs.

He is worried that many doctors and nurses are getting sick which is calamitous for India, because, India already does not have enough doctors and nurses. If the majority of them get sick or die it would be devastating for the system. If we lose them, then our ability to fight this virus becomes quite problematic. So, the priority should be to protect health care workers because they are very precious.

Thappar asks him about the acute shortages of doctors and nurses and ventilators, oxygen and Personal Protective Equipment (PPE). Can this be wrapped up expeditiously between now and November when peak may happen?

Prof. Jha replies, one part of the problem is we are in a global pandemic so it is not so easy for India buy ventilators from China or buy it from other country. It is very difficult. Because, everybody is looking ventilators, so India has to do with whatever it has; more or less through self-reliance.

He further adds, India has a very strong industry in bio and pharmaceutical, etc. so there are advantages in India.

Production of ventilators, PPE

India has to revamp up production of ventilators, personal protective equipment (PPE) and production of medicines. It’s going to be difficult but it must be a number one priority. Because if the health system collapses there will be many more deaths-not just because of coronavirus but from everything else.

When Thappar asks about the introduction of telemedicine for running of ICUs and 30 to 40 hours of training by the government so that doctors could become intensivists.
Prof. Jha says, it won’t be a perfect solution but it can be helpful. Both telemedicine and training up intensivist are good ideas and he support them even if they are not perfect.

Thappar asks: Usually vaccine normally vaccine takes 2-3 years as it is a pandemic people are expecting it in a year to two. Do you think that a realistic expectation or is that just a hope?

Prof Jha says, he agrees that vaccine may take many years to develop but he is optimistic to have one next year. He further adds, that 12 vaccines are already in clinical trial

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