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2020-04-12

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Developmental Issues
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Dr. Soumya Swaminathan, Chief Scientist at the World Health Organisation, says in an interview that the fight against COVID-19 is likely to be long-term, and lockdowns alone cannot be effective unless combined with other health measures. Dr Swaminathan, who has worked in research on tuberculosis and HIV for 30 years, was Director- General of the Indian Council of Medical Research from 2015 to 2017. Edited excerpts:

What do we know so far about how SARS-CoV-2 is spreading around the world?

Viral evolution and transmission dynamics can be studied by analysing genetic sequence data. There are over 4,500 viral sequences currently deposited in the GISAID platform, with around 10 Indian strains. What we see is, that over time, there is some variability in the strains. That is to be expected, as all viruses develop mutations as they transmit from person to person. What is not being observed so far is any mutation on any of the important sites of the virus, such as the spike protein or in the RNA polymerase or protease enzymes, which are relevant for drug targeting and vaccines. So we believe whatever strategies are now being used to develop both therapeutics or vaccines are not threatened by any changes in the virus.

What does the evidence tell us about the effectiveness of lockdowns as a strategy?

The WHO has laid out quite clearly that physical distancing, of which one extreme form is a lockdown, does help bring down the transmission of the virus in the population. What they saw in China [after locking down] was transmissions within households were still going on, so they then took an additional step that was basically testing everyone with symptoms, and taking those who were positive to a separate facility where they could be kept and treated, and the exposed persons to a separate quarantine facility. We need to think about this in terms of the logic for doing that, which is if you are living in a crowded setting, chances are you are more likely to transmit to others.

Other public health interventions that are shown to be effective like hand-washing, disinfecting surfaces, covering the face and mouth when coughing, and usage of masks need to be all implemented together, to be effective. We also need to remember that we are going to be facing this infection for a long time, and will need to think of sustainable strategies, as we exit lockdowns eventually. People will need to change behaviour — continue to follow physical distancing, isolate if sick, improve personal hygiene, while the public health system will need to detect, isolate, treat and track cases.

Should everyone wear a mask?

Anybody who has symptoms should be wearing a mask. There is also no doubt that healthcare workers need to wear masks and proper Personal Protective Equipment (PPE) as they are the ones likely to see a lot of patients. When we are talking about the general population, the logic there is if you don’t show symptoms but you still have the infection, you can still be spreading it. That is the logic for everybody wearing a mask. Asymptomatic people spreading infection is not the bulk of transmission and whatever studies we have seen till now suggest it is not more than 10 to 15%. Wearing masks does not protect the wearer. You are wearing masks to protect others, so it’s more of a social good.

Should India be testing more broadly?

Data is key to the control of this pandemic. We need to expand the number of people who are being tested. The fact is, because of shortage of testing kits, we cannot simply test everybody. One way is looking at sentinel surveillance where you test a proportion of people with influenza-like illness (ILI) or Severe Acute Respiratory Infections (SARI), which the ICMR is already doing. Serological testing is also beginning to be used in many countries, from which you can get an idea of the extent of the population exposed and also the geographic spread of the virus.

Is there any evidence to suggest Hydroxychloroquine should be included in the treatment protocol?

The Solidarity trial launched 10 days ago is comparing Hydroxychloroquine, Remdesivir and Lopinavir/Ritonavir with and without interferon beta. The goal is to include more treatments as they come through and collaborate closely with groups around the world as they develop new therapies. The approaches are to find an antiviral drug, monoclonal antibody treatment or an adjunct therapy that helps modulate the body’s response to the virus. There is currently no drug with proven efficacy against COVID-19. Some are being used on a compassionate-use basis, and not based on scientific evidence. Soon, we will get results from clinical trials which should inform us.

( Full text at

bit.ly/SoumyaWHO )

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