Not so novel coronavirus: A fresh perspective on the pandemic
The piece has been authored by Dr Dileep Mavalanka, director, Indian Institute of public Health, Gandhinaga, & Dr Mukesh Maheshwari, senior histopathologist and Media convener at the Gujarat state branch of the Indian Medical Association.
The world has been grappling with the pandemic for over two years. There has been lot of research on the virus, its epidemiology, pathology, clinical progress and therapeutics. More than 10,000 research papers have been published. Several new vaccines which are successfully deployed. hence novel corona virus is not so new. We know a lot about the virus and its behaviour after five variants. We have coped with it quite well when compared to the 1918 influenza pandemic. The pandemic has been a political issue in many countries.
The current variant Omicron seems to be quite mild as of now. We still need to wait a bit longer to see how it turns out. It is highly infectious and hence cases will rise rapidly. But hopefully hospitalisation and mortality will be much lower than the Delta variant – partly due to mildness of the Omicron variant and partly due to vaccine- and disease-generated immunity.
We advise to stop paying so much attention to daily new case numbers. Now the test positive “cases” should be called “infected persons”. The current definition of each infected person as a “case” may have been fine in January 2020 when we did not really know the full impact of the virus on human beings. Now the virus is not so novel. We know much more about it. So we should really focus on “symptomatic cases” – and call only symptomatic Covid positive individuals as “cases” of Covid.
Second, we should count more closely moderate and severe infections needing hospitalisation, oxygen therapy, ICU, and ventilator support. The disease has spread in the population like a pyramid. The base of the pyramid is the number of newly infected individuals, then next level is symptomatic infected cases, then hospitalised cases, then patients on oxygen therapy, ICU and ventilator therapy. As long as the hospitalisation and severe cases are limited there is no reason for panic. So projections should be done of hospitalisations, ICU and ventilator use, not just cases. This is not to say we should reduce the testing or surveillance – on the contrary, we should increase the testing and make it smarter and focused on symptomatic individuals – Indian Council for Medical Research’s new policy has advised this. Testing in greens zones with very low positivity should be drastically reduced as it is a waste of resources.
Third, let all pathology labs with appropriate equipment conduct the RTPCR and rapid antigen tests. The need for special permission to carry out Covid virus tests should be removed. Similarly, let all doctors and hospitals treat Covid patients without any need for any special permissions. Of course, they should ensure that the staff are protected and proper protocols are followed, including reporting. This will increase the bed capacity to treat Covid many fold.
Fourth, make Covid data from all hospitals, testing sites and CT scan facilities readily available for further epidemiological research and development of better clinical protocols. Encourage universities, and research institutes to analyse this data to find new ways to treat cases and improve the outcomes. India should fund at least 500 studies from secondary data of Covid, 50 new drug and prevention trials and five new variant-based vaccine development efforts from public funds. Then upcoming budget should make specific provisions for this. This is the way to be a real “vishwa guru” in health as we have so many of clinical cases. This will need a quantum improvement in our health data systems and and increase in data scientists, biostatisticians, epidemiologists and clinical researchers. Currently we are too dependent from research from the West.
Fifth, be realistic on vaccination. Many senior scientists, and administrators from various countries and WHO have repeatedly said, “No one is safe till whole world is vaccinated”. But in the 200-year history of vaccination, there is not even one disease where the whole world is vaccinated in such a short span of time. We failed to vaccinate that whole world against smallpox from 1960s to 1970s till we found out that we needed ring vaccination around the cases of smallpox. And that is how world eradicated smallpox. We have not yet eradicated polio from the whole world even after 50 years of efforts. Even with very effective vaccines, we have not been able eradicate measles from the world. So use vaccines wisely, focus it where there are very dense populations with high risk of disease and mortality.
Of course we need to be on lookout for new variants. But, humans and animals have faced many viruses for thousands of years and still survived. So we need continue our lives with precautions for a while – vaccination, masking and social distancing.
(The piece has been authored by Dr Dileep Mavalanka, director, Indian Institute of public Health, Gandhinaga, & Dr Mukesh Maheshwari, senior histopathologist and media convener at the Gujarat state branch of the Indian Medical Association.)