Boston-based Dr Dhruv S. Kazi, who is Member of the Faculty of Medicine, Harvard Medical School, speaks to The Sunday Guardian.
The “global superpower” tag of the United States has taken a beating when it comes to handling of the deadly coronavirus pandemic spreading far and wide across the country. With nearly 20,000 cases and 200 deaths, health experts have expressed concerns about the handling of the epidemic, while others are bracing for what lies ahead.
The Sunday Guardian spoke to Boston-based Dr Dhruv S. Kazi, who is Member of the Faculty of Medicine, Harvard Medical School, Affiliated Faculty of the Harvard Global Health Institute, and the Associate Director of the Smith Center for Outcomes Research in Boston. Dr Kazi talked to ITV Network Editor Maneesh Pandeya on a range of issues linked to the pandemic. He told The Sunday Guardian that the vaccine is unlikely to be in production for a year or so, so we need to ramp up other public health strategies to protect ourselves from the coronavirus pandemic. Excerpts:
Q: The US status of a global superpower and a Mecca in healthcare has taken a sort of beating in handling the deadly coronavirus? Your frank take on this?
A: The US response has been suboptimal, particularly given the severe lack of testing kits. As a result, we do not yet have a full sense of the scale of the epidemic in the US, though hospitals are starting to see increased hospitalizations, including in intensive care units. The early shutdowns in some states of schools and non-essential businesses have, hopefully, helped slow community transmission. The shortage of protective equipment in US hospitals is also very problematic.
Q: What is this buzz about the US making a breakthrough in corona vaccine?
A: To the best of our knowledge, the availability of an effective and safe vaccine is at least a year away, and it’s not likely to help with this pandemic. On the other hand, initial results of studies testing the use of existing drugs for treating the novel coronavirus are promising, so I’m cautiously hopeful that we will have some treatment options for the viral infection soon.
Q: What are the striking gaps other than “late reaction” you see as a health expert in the US case?
A: The delayed availability of testing has been the primary challenge. The scale of the problem was appreciated early by Anthony Fauci and others at the NIH, as well as some of the state governors. Because healthcare delivery in the US is managed at state and local levels, the response has been patchy—with some states better prepared than others. At this point the biggest challenge appears to be the shortage of protective equipment like masks and gowns—without which it would be very hard for doctors and nurses to do their job and puts them at risk for infection themselves.
Q: Do you think India has managed it well within the given infrastructure limitations? India is banking heavily on information and prevention measures to cut community spread further by closing down to the world. Will that be useful?
A: Travel bans, social distancing, restriction of unnecessary movement within the country and outside the country, closing of schools, encouraging hand washing will all help slow the spread. Again, like in the US, we won’t know the full scale of the epidemic in India till testing ramps up. High risk groups—particularly older adults and those with chronic conditions—should take precautions and possibly self-isolating as much as possible. But even young adults are not immune to devastating consequences of the disease. The population density and the limited number of critical care beds in India (most recent estimate was 70,000 beds in the whole country) limit the ability of the health system to manage a widespread pandemic. So prevention is the best strategy for the country.
Q: America has not tested at desired levels, so is India. But we don’t have testing kits. What plagued America?
A: Testing is ramping up now (in the US)—will have a clearer picture of epidemic in the next week or two. But we still need millions of tests.
Q: Interestingly, even in Italy and the UK, the infected and death toll numbers “puncture” the “high quality health system” tags these countries enjoyed for long. What failed them in the first place?
A: We shouldn’t confuse high-quality healthcare with high-quality public health measures. Over the years, investments in public health have lagged behind investments in high-end healthcare, but even in this setting, the financial pressures have been to shorten lengths of stay and to reduce the number of beds in the hospital. This reduces the capacity of public health systems to respond to emergencies like this, and for the health system to absorb the excess demand for beds and healthcare workers at a time like this.
Q: A study by Johns Hopkins University says that the infected may be over 100,000. Do you think the numbers of infected and the death toll could be higher than reported, including in the United States? How is the coronavirus pandemic panning out to be?
A: At this stage, it is hard to predict the total number of global deaths from the novel coronavirus in the long term. It would help for us to stick to what we know so far—that almost all countries have cases and that there is community-level transmission in a large number of countries. The economic consequences of this shutdown are going to be real, but the cost of not doing anything would have been unbearable.
Q: What made President Trump accept the danger staring at America so late? Was there any political compulsion behind and will this affect the Presidential elections and his prospects as well?
A: Hard to comment on why the administration responded the way it did. It’s clear that our response has been delayed, and that, in the initial stages, the administration underestimated the threat of the coronavirus pandemic.
Q: The world is choking at China’s neck for what some say as “Dragon unleashing the biological warfare on the world to counter the Western world”. Do you agree?
A: I don’t want to support rumours by even trying to counter them. This is nonsense. If we look through the scientific literature, scientists have been warning about the potential of coronavirus pandemics for much of the past decade. These pandemics have always been possible, and will continue to remain so. What has changed is that we live in a very inter-connected world—where an epidemic that started in one city in China can cause 200,000 cases around the world in three months. We should wait on more information before we jump to judge the local response in China. It is likely that earlier, more strategic response would have saved lives.
Q: Last question: Do you think India and the US can share more on this to battle this menace in future as they have battled terrorism together?
A: There is definitely room for the countries to learn from each other. Effective communication—both from public health experts and local, state, and federal administrations—can help calm nerves at a time when people are generally anxious and afraid. The risk is real—so we shouldn’t underplay it. But the interventions we have brought to bear on this global public health crisis will bring it under control in the next several months. The hope is that we can win this battle without losing a lot of lives, and that we can learn from it for the future. This experience underscores for more effective coordination among countries for infectious and other disasters.