Dr Arvinder Singh Soin says that thankfully, India is seeing a flatter curve than many other countries.
New Delhi:India ranks one of the lowest in “Test Positivity” rate (the rate of confirmed Covid-19 cases vis-a-vis the number of persons tested for the virus) compared to western countries and this, many doctors and epidemiologists say, is because of the innate immunity level of Indians. Some have particularly focused on the BCG (tuberculosis) vaccination that every Indian receives early in their age.
Dr Arvinder Singh Soin, researcher and chairman of the Institute of Liver Transplantation and Regenerative Medicine, Medanta-Medicity, was one of the first doctors to have highlighted this. The Sunday Guardian spoke to Dr Soin on the issue of the BCG vaccination and many other issues related to the Covid-19 pandemic. Excerpts:
Q: You have been one of the first doctors to point out that the “test positivity” rate in India is possibly lower than many of the countries around the world because of the BCG vaccination. Could you throw some light on this?
A: There has been a talk about testing more in India, that should be done, but what we need to look at here is the “test positivity” rate and India has had a “test positivity” rate of about 3.5% to 4% over the last few weeks and that is very interesting. I think the real reason for this is because of the natural immunity in us. There is a concept of cross immunity, as we have a lot of pathogens in our body which incite an immune reaction in our body similar to Covid and, therefore, the immune reaction that we have in fighting those is protecting us against Covid.
The BCG story is also circumstantial; a host of countries which have BCG vaccination programmes is showing lower incidents of Covid reaction. But I must underline here that it is all conjectural and there is still no hard scientific evidence to prove that the BCG story is concrete.
I must also add that timely travel restrictions and an early lockdown are also reasons we are seeing less number of Covid-19 positive cases in India.
Q: Is India in phase 3 of the Covid-19 pandemic, which is the community transmission phase, or has India been able to avoid that stage? Or is it inevitable as many epidemiologists suggest?
A: I think we have not avoided this phase, and community transmission is definitely happening in India, but thankfully with a flatter curve than many other countries. And the reason I say community transmission is happening is because the recent ICMR report is a proof of that. The report says that 1.8% of the randomly tested SARI (sick) patients had Covid-19 and out of those tested, about 40 of them had no travel history or any contact with affected persons.
Q: So, when do you think India is going to reach the peak? Or are we already at the peak?
A: This is a trillion-dollar question. Though the rate of rise in positive cases is far less than other affected countries, when we start testing more, unfortunately, we are definitely going to see a rise in the number of positive cases. Currently, we are doubling at a rate of four days, but then with increasing tests, the rate of doubling will also increase. Whether that could be called the peak, I am not sure.
Q: Whether the lockdown would be extended or not is in everybody’s mind. As a medical practitioner and researcher, what is your opinion?
A: I think we need to continue with the lockdown in almost the manner we have gone through in the last three weeks, at least till the end of this month. That will help in two ways—ramping up our testing and treating facilities completely so that if and when things go bad, we are better prepared. Secondly, maybe we are then entering the hot temperature zone of 40-45 degrees and the curve may never rise again.
Having said this, I would also like to add that in the next phase, in the beginning of May, things will have to open up partially and impose the containment to hotspots. India cannot afford a lockdown lasting that long; a locked down economy will wear out the bottom strata of the society, they will not have the money to live. But we still cannot have more than five people congregating, we still have to have social distancing and cleaning of hands and PPEs in the hospitals and so on, as I don’t see this virus going anywhere, anytime soon.
Q: So you believe that with rising temperature, there could be a possibility of the virus weakening?
A: I think there is a strong possibility. However, there is no clear evidence as of now, but there are studies which researchers are aware of in which increasing temperature in the laboratory was seen to be destroying the virus. At 45 degrees, 90% of the virus was gone and at 70 degrees, 99.9% of the virus was gone.
Q: Will the virus eventually die a natural death or when is this likely to end?
A: Unfortunately, Covid is not going anywhere. It is going to be around and it is going to become probably a yearly affair. Covid-19 vaccines are also in the stage of development and are likely to take about 6-18 months. A new drug would also take about 6-12 months. Effective or repurposed drug is our best bet in the short term. We are also starting a multi-centre trail in India.
Q: How effective is the much-talked-about hydroxychloroquine in treating Covid-19 patients? Is it advisable to take over the counter as precaution?
A: Hydroxychloroquine is being found to be effective in some cases and not in every case. I personally know cases where there has been response and some have not. So, this means we need more scientific evidence before we can universally recommend it. I have taken hydroxychloroquine because I go to the hospital everyday as I am on the frontline. I take it once a week for 12 weeks under current recommendation. But one has to be cautious and understand about its side effects. Heart disease is one of the most serious side effects of this medicine if not taken under strict medical advice. So definitely it should not be over the counter (OTC) medicine and no self-medication is recommended.
Dr Arvinder Singh Soin, researcher and chairman of the Institute of Liver Transplantation and Regenerative Medicine, Medanta-Medicity, was one of the first doctors to have highlighted this. The Sunday Guardian spoke to Dr Soin on the issue of the BCG vaccination and many other issues related to the Covid-19 pandemic. Excerpts:
Q: You have been one of the first doctors to point out that the “test positivity” rate in India is possibly lower than many of the countries around the world because of the BCG vaccination. Could you throw some light on this?
A: There has been a talk about testing more in India, that should be done, but what we need to look at here is the “test positivity” rate and India has had a “test positivity” rate of about 3.5% to 4% over the last few weeks and that is very interesting. I think the real reason for this is because of the natural immunity in us. There is a concept of cross immunity, as we have a lot of pathogens in our body which incite an immune reaction in our body similar to Covid and, therefore, the immune reaction that we have in fighting those is protecting us against Covid.
The BCG story is also circumstantial; a host of countries which have BCG vaccination programmes is showing lower incidents of Covid reaction. But I must underline here that it is all conjectural and there is still no hard scientific evidence to prove that the BCG story is concrete.
I must also add that timely travel restrictions and an early lockdown are also reasons we are seeing less number of Covid-19 positive cases in India.
Q: Is India in phase 3 of the Covid-19 pandemic, which is the community transmission phase, or has India been able to avoid that stage? Or is it inevitable as many epidemiologists suggest?
A: I think we have not avoided this phase, and community transmission is definitely happening in India, but thankfully with a flatter curve than many other countries. And the reason I say community transmission is happening is because the recent ICMR report is a proof of that. The report says that 1.8% of the randomly tested SARI (sick) patients had Covid-19 and out of those tested, about 40 of them had no travel history or any contact with affected persons.
Q: So, when do you think India is going to reach the peak? Or are we already at the peak?
A: This is a trillion-dollar question. Though the rate of rise in positive cases is far less than other affected countries, when we start testing more, unfortunately, we are definitely going to see a rise in the number of positive cases. Currently, we are doubling at a rate of four days, but then with increasing tests, the rate of doubling will also increase. Whether that could be called the peak, I am not sure.
Q: Whether the lockdown would be extended or not is in everybody’s mind. As a medical practitioner and researcher, what is your opinion?
A: I think we need to continue with the lockdown in almost the manner we have gone through in the last three weeks, at least till the end of this month. That will help in two ways—ramping up our testing and treating facilities completely so that if and when things go bad, we are better prepared. Secondly, maybe we are then entering the hot temperature zone of 40-45 degrees and the curve may never rise again.
Having said this, I would also like to add that in the next phase, in the beginning of May, things will have to open up partially and impose the containment to hotspots. India cannot afford a lockdown lasting that long; a locked down economy will wear out the bottom strata of the society, they will not have the money to live. But we still cannot have more than five people congregating, we still have to have social distancing and cleaning of hands and PPEs in the hospitals and so on, as I don’t see this virus going anywhere, anytime soon.
Q: So you believe that with rising temperature, there could be a possibility of the virus weakening?
A: I think there is a strong possibility. However, there is no clear evidence as of now, but there are studies which researchers are aware of in which increasing temperature in the laboratory was seen to be destroying the virus. At 45 degrees, 90% of the virus was gone and at 70 degrees, 99.9% of the virus was gone.
Q: Will the virus eventually die a natural death or when is this likely to end?
A: Unfortunately, Covid is not going anywhere. It is going to be around and it is going to become probably a yearly affair. Covid-19 vaccines are also in the stage of development and are likely to take about 6-18 months. A new drug would also take about 6-12 months. Effective or repurposed drug is our best bet in the short term. We are also starting a multi-centre trail in India.
Q: How effective is the much-talked-about hydroxychloroquine in treating Covid-19 patients? Is it advisable to take over the counter as precaution?
A: Hydroxychloroquine is being found to be effective in some cases and not in every case. I personally know cases where there has been response and some have not. So, this means we need more scientific evidence before we can universally recommend it. I have taken hydroxychloroquine because I go to the hospital everyday as I am on the frontline. I take it once a week for 12 weeks under current recommendation. But one has to be cautious and understand about its side effects. Heart disease is one of the most serious side effects of this medicine if not taken under strict medical advice. So definitely it should not be over the counter (OTC) medicine and no self-medication is recommended.
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