Hyderabad: In an exclusive ETV Bharat interview, renowned virologist Dr. T Jacob John, formerly with the Christian Medical College, Vellore, told us about the virulence factors of COVID-19, traditional dietary advice and the expected timeline of the disease to die down.
Here are excerpts from the interview with the expert:
Q1. The country is on a phased relaxation of the lockdown. At this stage, can we avoid the spread of COVID-19? What will be the effective measures to prevent the infection despite allowing people to start their economic activities?
Dr. T Jacob John: We must look at this in two ways. One, the epidemic grew fairly rapidly even under lockdown (March 25 to April 14). In about 20 days, we saw a 20-fold increase. We knew that economy was getting quite bad under lockdown but the epidemic was not slowing down as expected. That was the appropriate time to improve our national strategy to slow down the epidemic. By then we knew the importance of wearing face masks. If that was enforced more aggressively, we could have achieved better results without hurting our economy any further.
In the next stage, we could have had relaxed the physical distancing norm from 6-8 feet down to 2-3 feet between people. Economic, social, educational, transport, etc could have been restarted from April 15. In another major precaution-- all elderly and those with chronic non-communicable diseases should have been cocooned (reverse quarantine).
I have strongly disagreed with the extension of the lockdown the second time and highly disappointed the third time.
Q2. Several restrictions of social distancing have been planned when people travelling in city buses and suburban trains. Will it be possible to follow the norms of social distancing when public transport is allowed given that people travel in large numbers?
Dr. T Jacob John: The simple and efficient alternative to strict "social distancing" is to reduce the social distancing gap from 6-8 feet to 2-3 feet by the universal use of simple cloth masks. All usual activities can be re-started given that everyone wears masks. Another important precaution would be to avoid social gatherings at all costs until the epidemic is over.
Q3. Is there any relationship between temperature and the spread of COVID-19? Tamil Nadu is experiencing extreme summers now. Will the hot tropical climate act as a deterrent for spreading the virus? Will the multiplicity of the virus be affected at high temperatures?
Dr. T Jacob John: Whatever the outside temperature be, our body temperature is always at 37 degrees. The virus will grow, spread via droplets, and infect others by inhalation. "Fomite transmission" -- via contaminated surfaces and objects, will be reduced as the atmosphere is hot. We cannot expect very hot weather to contain the epidemic -- it might be slightly reduced only to regain speed after rains start and climate cools a bit thereafter.
Q4. It is predicted that COVID-19 will spread rapidly after the beginning of the south-west monsoons? Does that also mean that the virus will not spread in parts of the country that do not receive rains during that time?
Dr. T Jacob John: Let us wait and see what happens during this monsoon season.
Q5. The mortality rate of COVID-19 in India, especially in Tamil Nadu is very low. Do Indians have more immunity than the Europeans and Americans?
Dr. T Jacob John: Mortality rates are influenced by the population of the elderly and those with chronic diseases which are far lower in India than in the USA. Naturally more will die there and less here. All the more reason why we should not have taken drastic steps including extension of lockdown after the promised 3 weeks. PM's office reassured Indians that there will no extension beyond April 15. The government's credibility was tarnished and economic hardships continued, all for a less severe problem than in countries with greater risk to life among grandparents and those in old age homes.
Q6. Will the Indian diet comprising of garlic, ginger, pepper and similar items help in fighting this virus? Is there any relationship between diet and immunity?
Dr. T Jacob John: Maintaining health with a good diet and exercise will keep our immune system strong. Artificial methods are not useful. Obesity should be controlled to keep the immune system healthy. Diabetes and other chronic conditions must be under control.
Q7. When and how this deadly virus will end? Can we expect to get any vaccines in a few months? Will people develop immunity to the virus?
Dr. T Jacob John: We cannot expect it to "end" unless we have vaccines. Infection is most likely to behave like flu -- endemic and seasonal. Immunity will develop only after infection. About 80% of infections show no symptoms -- not even the infected will know he is infected. That is why all should wear masks until this epidemic is over. We expect to reach the peak of the epidemic during July-August. This may transition to endemic by end-2020 or early 2021. Medicines are likely to be available soon. One anti-HIV drug Remdesivir is probably the best so far. We hope one or more vaccines to be available by early 2021.
About Dr. T Jacob John
T Jacob John is the former president of Indian Academy of Pediatrics and has retired from the Christian Medical College, Vellore. He is now Chairman of Rotary Club of Vellore TB Control Society.
He established India's first diagnostic virology laboratory and conducted pioneering research on infectious diseases, clinical virology, vaccinology and epidemiology. He detected a high risk of post-transfusion hepatitis B (HB) in 1972 and established donor screening for recipient-safety.
He documented the world's first 'vaccine-failure' polio cases despite 3 doses of live vaccine, and showed several ways to improve vaccine efficacy, including 'pulse vaccination'. His model of polio control in Vellore and North Arcot district became the forerunner of global polio eradication. He showed superior efficacy of the Salk polio vaccine during the 1970s and 80s.
He established a retrovirus laboratory and field unit and, in 1986, detected HIV infection among sex workers, first in India. He guided the opening of HIV sentinel surveillance in all states by ICMR Task Force and instituting donor blood screening for HIV.
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