Possible that COVID-19 cases will continue to climb, says virologist Gagandeep Kang

This second wave is very serious because the very large numbers of infections mean that even if it is a small percentage of infected people who get very sick, the absolute numbers will be big and can overwhelm the healthcare system.

Hyderabad: India continues to break its daily record of COVID-19 cases as cases are rising exponentially across the country. On Wednesday, India reported 2,95,041 new COVID-19 cases, highest till date. With the new additions, the total tally of cases in the country has increased to 1,56,16,130 with 21,57,538 active cases. In light of the spike in infections and deaths across the nation, ETV Bharat held a conversation with virologist Gagandeep Kang.

ETV Bharat:Cases in the second wave have increased rapidly compared to the first wave. How can India contain this wave? How serious is the second wave? What do you think is the reason for such a rebound of the covid wave? Some say it may go up to four lakhs a day, what is your view?

Gagandeep Kang:In the second national wave, cases increased much faster than the first time. This is because, unlike the first wave, we had not been following Covid appropriate behaviour and also possibly because the virus variants are more infectious than we saw previously. Since we cannot instantly vaccinate everyone, the wave can only be contained by ensuring that people don’t come in contact with each other without appropriate precautions. This means using good quality masks, maintaining distancing and ensuring good ventilation when indoors.

This second wave is very serious because the very large numbers of infections mean that even if it is a small percentage of infected people who get very sick, the absolute numbers will be big and can overwhelm the healthcare system. It is very possible that the cases will continue to climb if we do nothing, but fortunately, states have begun to impose restrictions now, so I hope that our pessimistic estimates of 4 lakhs and over which are possible, can be prevented.

ETV Bharat:We boasted about our vaccine production capabilities but finally landed in a huge shortage. What led to this situation?

Gagandeep Kang:There are three main reasons. First, while India’s manufacturing capacity for vaccines is large, the materials needed to make vaccines are not all available in India. We have to compete in the global supply chain and every vaccine manufacturer in the world is trying to buy what is available.

Secondly, our vaccine manufacturers projected very optimistic estimates of how quickly they would be able to upscale their production. For a variety of reasons, this has not happened and this has resulted in the shortage.

Third, for vaccine manufacturers, knowing that they have an assured market and how they are required to provide within the country and what they can export is essential for their planning (and these needs to ensure that companies have enough cash flow to function). If there is no predictability, and the government orders vaccine piecemeal with short timelines at very low prices, it makes it very difficult for the industry to function optimally.

ETV Bharat:After this one-year intense research in virology, are we in a position to predict the future behaviour of the virus? or get stronger?

Gagandeep Kang:In this past year, we have learnt a great deal about the behaviour of this virus and have a reasonable ability to predict what will happen next. As with all viruses, this virus would like to be able to spread more easily so that it can keep multiplying. That means that it will try to become more infectious and if vaccines are used widely, it will try to escape the immune response of the host. Fortunately, because the spike protein of the virus is essential for infection and there is a limit to how much the spike protein can change, it is possible that all the variation that we are likely to see in the virus might be seen in the next two years. While random mutations may make some strains capable of severe disease, these mutations will also need to be with viruses that spread well, and since viruses that kill their hosts cannot easily multiply, I do not expect to see increasingly severe disease become the norm in the future.

ETV Bharat:How do you assess the consequences of the imposition of a countrywide lockdown in this 2nd wave? Can economic and political reasons be allowed to influence scientific decisions? Do you think governments address the issues properly to control virus?

Gagandeep Kang:I think that we need to move beyond lockdowns as interventions. Which are the activities that are most likely to result in a spread in the state? Can we categorise? Is it markets or colleges or schools or cinema theatres or festivals or election rallies? Which ones are most likely to result in spread? Those are the ones that we should target for interruption/ Governments need to be informed by evidence. The lockdown is a blunt instrument and we can do better without disrupting all of society and economic activity.

ETV Bharat:Through some light on virus variants in India? What is the severity of the new variants?

Gagandeep Kang:The virus variants in India have been insufficiently studied but it appears likely that there is an ability to cause more infections. Whether these are more serious infections remains to be seen. It is clear that we need to link the epidemiology with more laboratory studies to understand the behaviour of the virus and though we have been trying to expand the sequencing, we have been slow to do the establishment of methods that allow us to understand its ability to infect and escape vaccine response.

ETV Bharat:What the state governments should do in this situation? What are the responsibilities of people and their leaders now? What are the crucial steps and strategies needed to be taken to control virus spread?

Gagandeep Kang:State governments need to think about the maintenance of essential functions and essential economic activities without compromise on public health. Some activities like entertainment, political rallies and religious functions as we have seen in the recent past attract crowds, and crowding is essential for spread. State governments need to consider whether the risk of such activities is worth taking, given the consequences.

ETV Bharat:Our vaccination is still below 10 per cent. What can be done to increase vaccine uptake?

Gagandeep Kang:We need to communicate better regarding the value of vaccination and how much of a difference it can make. We need only look at the example of Israel to understand that once a significant proportion of the population is vaccinated, we can be released from many of the restrictions that are currently placed on us.

ETV Bharat:How effective would the vaccine be in controlling the spread of infection?

Gagandeep Kang:At the moment, our vaccination strategy is not focused on controlling the spread of infection but on controlling severe disease and mortality in the highest risk populations. Once we are able to immunise over 30% of the people in our country we will begin to see an effect on the spread of infection. This will depend on how long protection lasts and how quickly we can vaccinate our population. There is still a lot to learn.

ETV Bharat:How long would this wave last?

Gagandeep Kang:Overall the pattern of the ways from start to decline is somewhere between three and four months. We are already at the end of the second month, so we don’t have much longer to go for the peak and the decline, particularly if we avoid activities that allow spread as we have finally started to do.