Community transmission has started in India: Virologist Dr Jacob John

Dr T Jacob John speaks to Hemant Kumar Rout on the coronavirus behavior and challenges posed by the return of migrants.
For representational purposes (Photo | PTI)
For representational purposes (Photo | PTI)

Renowned virologist and former Professor of Virology, Christian Medical College (CMC), Vellore, Dr T Jacob John urges Centre and state governments to acknowledge community transmission and implement strict measures. He speaks to Hemant Kumar Rout on the virus behaviour and challenges posed by the return of migrants

Several persons in Odisha have tested positive more than a month after their return from virus-hit states. Surprisingly, they all are asymptomatic. Does the novel coronavirus still have an incubation period of 14 days or it needs a relook?

We cannot assume that they were infected in the states, they travelled from. They could have, each one of them, got infected anywhere after they started their journeys. Community transmission it is.
As for the incubation period, it means interval in days from the time of infection to the time of start of symptoms. Yes, 3 to 14 days in most cases. Rarely longer - three weeks or a bit longer even.

The Centre and ICMR continue to evade the issue of community transmission. What is your view? When did the community transmission start in India? 

Dr T Jacob John
Former Professor of
Virology, CMC, Vellore

In my view, the Tamil Nadu case, detected on March 18, points out the community transmission. A 20-year-old man travelled by train from Delhi and had no contact with any known infected person. He developed symptoms in Chennai and tested positive.  On March 19, a 52-year-old man died in Kolkata with lab confirmed Covid-19. His family denied any travel history or contact history. Another example of proven community transmission. 

There are several other cases too. As an independent observer I know community transmission was inevitable, but evidence was documented by mid-March. The Government should acknowledge community transmission and implement appropriate personal protective measures strictly. 

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India crossed 50,000 cases mark in three months. Do you have any projection? Any estimation in terms of cases and death?

The detected number is a ‘part’ of the ‘whole’. We cannot know the ‘whole’ or the actual burden of infection unless special studies are done. We have detected a small proportion the way we were testing - perhaps only 10 per cent (pc). Had we gone after clinically diagnosed Covid cases for lab testing, we would have detected far more infections. If 10 pc, then the whole is five lakh. If five pc, then the whole is 10 lakh. If 20 pc, then it is 2.5 lakh. The likelihood is between five and 30 pc - just on guess. 

Have the lockdown and the containment measures initiated by the Centre and states been effective in containing the spread? What more needs to be done?

Social mobilisation was the most crucial part of the exercises. But, even now it is the major missing part of overall strategy. It means full transparency and effective information dissemination to evoke spontaneous people’s participation. Provide authentic information, details of epidemic, responses, what is mask for and what is lockdown for, etc. Then ask citizens to be partners of interventions along with Government. Learn from Kerala model. People still continue to flout norms with impunity. If universal mask is rule, then Government could ask citizens to police each other. The prevailing situation is quite alarming to watch.

Over 85 per cent of Covid positive people are asymptomatic in Odisha. Why so? Has the virulence weakened or virus mutated into a less potent strain in the State? Are people having better immunity to ward off the viral impact?

Nothing of that sort. That is the true nature of this infection. Globally 80 pc of all infected are asymptomatic. The extra five pc may be ‘pre-symptomatic’ meaning in incubation period and may develop fever and cough in the next one week or two. There is no evidence of discernible mutations in Indian conditions to affect virus behaviour. So far, all are one clade or one genotype. Mutations so far have not affected virulence.

SARS-CoV-2 infection is not as bad as people think. Death rate is less than 5 pc. Death is mostly in old people and those with chronic heart, lung or kidney diseases - called co-morbidity. Since Indian population is predominantly young, most people are safe.  However, since pandemic flu death rate was only 0.1 pc, Covid is 10-50 times more killer.

Migrants are set to pose a huge challenge for Odisha, which had reported less than 100 cases until returnees from West Bengal and Gujarat swelled the numbers. What would be your suggestions for dealing with it?

The Central Government promoted the growth of infections and the epidemic, by not realising the problems of migrant labour. A simple solution was to give four days of warning and arrange home return in orderly and planned manner before lockdown was enforced. 

If that was not done, the unfortunate fact remains that someone at the top was not competent enough to advise the Government or was afraid to tell the facts fearlessly or advice was rejected. Under these circumstances, I think only all persons with ‘fever and cough’ need be tested and if positive strict home quarantine and compassionate financial and food support. Daily phone contact for immediate hospitalisation if breathing difficulty develops and becomes severe.  Whoever is infected must be under strict home quarantine with daily once telephone reporting to the relevant doctor, Government or private.

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