The speed and scale of the Covid-19 pandemic was surprising, Dr Gagandeep Kang, the
country’s
foremost vaccine expert and professor of microbiology at the Christian Medical
College-Vellore,
told Anonna Dutt. She said India needs to invest in creating clinical trial
networks
to prepare for future pandemics.
Did
you imagine the emergency would be this big when we started seeing the first
few
cases?
All
through March (last year), I was getting increasingly worried that it wasn’t
something that
was
being taken seriously. What surprised me was the speed and scale of the spread.
It moved
much
faster than I anticipated. And that I think is reflection of the reproductive
number. We
probably
underestimated it early on because we were relying on Chinese data. We got a
better
handle
on it when we started getting data from Europe.
Was it
also because we were looking at data from the SARS outbreak?
The
difference between SARS and Sars-CoV-2 – the good thing is it does not kill as
much as
SARS
does. The SARS case fatality rate was close to 10%. Only 8,000 people got
infected but
almost
800 of them died. Whereas with Covid-19, we are having trouble what the case
fatality
rate
is. It looks like among the symptomatic, it is one in 100. But there are so
many people
without
symptoms that the infection fatality rate is lower than 1%. Sars-CoV-2,
however, is
more
transmissible because of asymptomatic infections.
What
are the policy implications of this difference between Covid-19 and SARS?
In
January (last year), we saw that they (the viruses) were similar. Initially,
theWHO and China
were
saying that there was no person-to-person transmission, which was quickly
discounted by
the
third week of January. Then, they were also saying that there were no
asymptomatic
infections.
And, that was something I was waiting for. Because, once you have a disease
that
can
spread asymptomatically, your methods for controlling the disease need to
change
completely.
Towards
the end of February, it became clear that this was happening and it could not
be
handled
the same way as SARS had been. All of the initial recommendations of
hand-washing
and
social distancing came from our understanding of SARS. But, asymptomatic
infection is
when
masks enter the picture and become even more important. Now we also know that
it is
not
just a droplet infection, you produce aerosols as well.
Was
the lockdown necessary?
If we
had a situation where everybody followed government instructions, then there
would
have
been no need for a lockdown. Countries such as Vietnam, Thailand, and Japan
have all
shown
that it is possible to manage without the lockdown as long as you have the
resources,
the
ability and the commitment. I think the lockdown was necessary because it
conveyed to the
people
that it is a serious issue and it stopped the movement of people. It also had
many
unintended
consequences like what happened to livelihoods, what happened to migrant
workers.
It also created a fear in the minds of people, leading to stigmatisation.
I was
really worried about the government-controlled testing of Sars-Cov-2. When they
set up
testing
in January, it was only NIV doing the testing, only NIV confirming it. And,
that is
impossible
for a country the size of India. Private labs were not even allowed to
establish testing
until
the end of March with the lockdown. So, you say you can start the testing now
and you
lock
the country down when all the kits are imported. Fortunately, testing has
opened up.
All
kinds of things were done which were a waste of effort and a divergence from
the critical
issues
like ramping up testing as quickly as possible. If the lockdown had been a
lockdown
where
imports were still allowed, it would have been better. I think now the
government is
clear
that it does not want to be caught in that situation. Diversification of the
supply chain is
definitely
something we should be thinking about.
What
do we need to do to prepare for a future pandemic?
The
one thing that we should learn from this pandemic is the value of large
clinical trials. If
you go
to the clinical trials registry of India, currently, there are hundreds of
trials for different
drugs
registered. All of them are recruiting just about 100 patients. If you take a
tiny number
of
people, you have a bad study design, you know what you what to prove, and guess
what,
your
study actually proves what you want it to.
We
need to create clinical trial networks for drugs, vaccines, and procedures not
just for
infectious
diseases, but cancer, orthopaedics, cardiology and so on. We should fund one
large
study
rather than 30 smaller studies.
Then,
there is surveillance. We need “one health” surveillance looking at both
animals and
integrated data system.
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