The question on everybody's mind is ostensibly this: Is this lockdown working? If you were to ask Professor Satyajit Mayor, Director of the National Centre for Biological Sciences (NCBS), where the virus sequence released by the ICMR is being studied, he would tell you that the answer lies in the data. Or the current lack of it in India.
"As the testing expands, we will have better estimates of whether the trend is flattening out. ICMR is expanding their testing capacity quite rapidly and once that is fully available there will be an indication if the lockdown is having the desired effect," he explains, adding that smaller geographically-centred lockdowns may be effected after the 21-day period ends.
In an interview with The New Indian Express Editor GS Vasu, Mayor, who is a distinguished alumnus of IIT Bombay and did his PhD at The Rockefeller University, New York, spoke about how he felt the spread of the disease would "play out" in India. Excerpts:
You must have observed the way the virus is being handled elsewhere in the world and in India. Do you see a difference in approach?
I think the approach has been more proactive in terms of organising the deterrents for the spread of infection - the social distancing measures and also creating large-scale awareness. We have been more proactive than other countries in creating the lockdown measures. In some ways, it had to be implemented with better planning. But we have been early in this game.
The other difference, which is perhaps not in line with what the WHO is recommending, is to conduct large-scale testing. That is very necessary to understand how long this lockdown needs to continue and to learn the real extent of this spread. ICMR has other strategies, where they are testing people who are in respiratory distress across the board to see whether there is any general transmission among the public. Nobody has an idea if those measures are adequate.
There are two arguments that have been courting controversy in recent times. One is that the strain of the virus that travelled to India is less virulent and then there is this MIT study that suggests that the virus may not survive in hot climates. Is there enough scientific data to back these claims?
No, I think there isn't. One because we don't have the sequences of the virus currently circulating in the Indian population. What we do have is many imports, which means that people would have brought strains of the virus from various countries. I don't think we have any singular variant that is likely to be circulating. We don't know and we don't have enough sequences of the virus that is in Indian patients. That data is not in the public domain.
Is a complete lockdown the only way to deal with this pandemic?
I am totally incompetent to answer this question. This is a matter of how to deal with a population of this size and level of inequity and level of distribution. In my simple-minded view, I would say that we do need to prevent the spread of this virus by all means. If the virus were to spread like wildfire - like it did in New York that has one of the largest number of hospitals anywhere in the world and is creaking at the seams for emergency help - I shudder to think what would happen in our cities.
At some point, the lockdown needs to be lifted...
Whether it is three weeks or more will depend on what we know on the ground at that stage. It's going to be somewhat of a challenge if we don't have information at that point.
When can we safely assess that there is no risk of community spread in a country like India?
We need better models with better information and I think some attempts on making such predictions based on our local conditions are on. These will take some time because they need information. We may see extremely geographically specific responses based on locations. We may not need to have lockdowns everywhere. We may need to have it in a more dispersed manner. In cities and low-income communities where there is high-density population, it is a terrific imposition and that should be our prime concern.
Is there anything to suggest that the virus affects people from different races differently?
The virus binds to a particular receptor on the lungs or the nasopharyngeal tissue and these receptors carry the virus into the cell. There has been some discussion about the variations of these receptors in the Indian population. But you know India is a such a vast country that we still don't have a full appreciation of the variation of the sequences of this receptor. It is possible that there are some receptors that are not good binders, in which case some people would be more susceptible? Honestly, we don't know enough.
Going by what we have seen thus far, how do you rate the risk?
Very high, I think. It is following a trend that one sees in other places. One has to see what happens, whether the trend tapers off substantially because of the lockdown. As the testing expands, we will have better estimates of whether the trend is flattening out. The ICMR is trying to ensure that the rate of the rise is not as steep as in other places. They are expanding their testing capacity quite rapidly and once that is fully available there will be an indication if the lockdown is having the desired effect.
The general opinion is that if we don't see a rapid spike in the coming couple of weeks, India may not see the same spread that other countries have seen. Do you concur?
If it happens, that will be great. If it doesn't, there will be many explanations. We have to keep our fingers crossed because there are so many unknowns.
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There is a perennial argument about the health cost and the economic cost. Which should take precedence in your view?
One cannot have one without the other. It is an extremely difficult balancing act. There needs to be immediate relief, even if the virus is only spreading in limited numbers. The lockdown has huge economic consequences and poses incredible hardships for the people. If one doesn't do anything, the health cost will be enormous if the virus plays itself out. I don't see why the virus will not play itself out like it has done in other places, because at the end of the day we are all the same species. If we let that happen, the economic cost of that will also be humongous.
I am certain your institute is working on research to understand this virus?
Just before the country ordered the shutdown, many of our institutes were shutting down. But the Principal Scientific Advisor issued an order that indicated that many of the national institutes could devote themselves to respond to the COVID situation. So, we decided to work along those lines and do whatever we can and direct years of scientific knowledge to this cause. We are doing literally whatever we think is best in the immediate run and best for the long term. This is one way how investing in science in this country can pay back at a time like this.
