Once every month or so, I do a quick update on the Covid situation: discoveries, treatments, screw-ups, new research, and so on. This is the May 2021 edition. I’ve done it in question-answer form to make it easier to understand.
Q. Is the second wave ending?
A. It depends on who you speak to. According to the government it is, and the figures it releases seem to bear that out. The rate of increase in cases is going down. And the proportion of people who test positive after each round of testing is also down.
Two doubts. First, how accurate are the figures? There are constant complaints that not all states are reporting accurate figures for infections and that many are concealing the number of deaths. Over the last two days there have been shocking estimates in The New York Times. These suggest that while the official figure for the number of cases is 26.9 million, a more likely scenario is 539 million cases.
This is just modelling and The New York Times could well be wrong but it does make us think about how credible the information we are getting is.
A second doubt is the one regularly expressed by AIIMS’s Dr Randeep Guleria. He says that it may be a mistake to look only at the national picture; India is too large for that.
His view is that while the wave is winding down in Delhi, Mumbai and other places, it is too early to say anything definitive about the South and the East.
Q. Is there an upsurge in rural cases?
A. Once again, we don’t know. Anecdotal evidence suggests that Covid is cutting a swathe through rural Uttar Pradesh but the state government says that the surge is now over.
Because these claims are not always credible, we will have to wait till more information comes in.
Q. Is black fungus a normal post-Covid phenomenon?
A. No it isn’t. Our experience with black fungus in the second wave runs counter not only to the rest of the world’s experience but also to our own experience during the first wave.
Q. So why is it so common now?
A. Many people have theories but honestly, nobody has the answer.
One theory is that we repurposed industrial oxygen cylinders for medical use and that this led to black fungus. Another is that we used tapwater in our oxygen concentrators and its impurities led to the development of fungus inside the body.
A third theory is that an overdose of steroids leads to conditions that promote the growth of black fungus. And a fourth is that something about the mutated virus affects our nasal cavities in ways we still don’t fully understand.
Q. Is the point about too many steroids valid?
A. Probably. Indians self-medicate too often. And doctors sometimes over-medicate. But the basic problem is that there are confusing guidelines from the top of the medical establishment. Steroids are part of the AIIMS guidelines. So was the ivermectin which we are also told is unnecessary and ineffective.
Q. Is it now clear that the coronavirus escaped from a Chinese lab?
A. No it’s not. But nobody is ruling it out either.
Earlier, the idea of a rogue virus escaping from a Chinese lab had been roundly rejected as the stuff of conspiracy theories. The Chinese government cooperated with a World Health Organization (WHO) investigation that exonerated China.
But now reports suggest that even before the first Covid cases were reported, people who worked at a lab in Wuhan had been taken to hospital with a mystery illness.
The evidence is compelling enough for United States (US) President Joe Biden to ask his country’s intelligence agencies to inquire into the origin of the virus and report back in 90 days. The Chinese have attacked the decision (obviously) but WHO seems willing to go along with it.
Q. Do we know more about how Covid spreads?
A. Yes. We do.
We know now that much of what passes for Covid hygiene is Covid theatre. It does not help to put plates in paper bags at restaurants or to spray sanitisers on everything.
Covid does not spread by contact as much as it does through the air. We always knew that Covid was spread by droplets but WHO and the US Centre for Disease Control and Prevention (CDC) took the line that these droplets were heavy and soon dropped to the ground. If you stayed six feet away from someone, you were safe. This is why, in the first phase, we focussed on social distancing and not on masks till it was too late.
We know now that the virus spreads in a spray of micro-droplets that can travel much further than six feet and can remain in the air for longer than was previously thought. This means that six feet social distancing may not be enough. And that masks are the best protection.
Q. Should we change our behaviour because of this?
A. Yes. We should. We are at most risk when we are indoors in an enclosed space where other people are also present. Older forms of air- conditioning which just redistribute the air in the room may make the situation worse.
This makes going back to work in an enclosed office space more dangerous. We need to keep masks on at all times. We should check how the air-conditioning functions. And we should allow for ventilation by keeping some windows open.
Q. What about outdoors?
A. Well, there is outdoors and there is outdoors. If you go to a crowded outdoor event (a concert, a rally, a protest, a fair) where you are in close proximity to other people, you are still at risk.
But scientists are increasingly coming around to the view that if you are in a park or a garden in uncrowded surroundings, you are much safer than indoors. The US CDC says you have only a 10% chance of being infected outdoors. That is still high but the latest research suggests that the odds of getting it in a park are actually much less than one per cent.
This has still not been accepted by the CDC or WHO, so tread cautiously. But it is beginning to look as though one reason why so many people in India’s villages were not badly affected by the first wave was because they spent quite long outdoors in their fields and relatively little time (compared to city dwellers) indoors.
Q. Do vaccines work?
A. All research says they do. But they may work less well against the new variants. One report suggests that the first dose of the AstraZeneca/Oxford vaccine (made in India as Covishield by SII) only offers 35% protection against the variants spreading through India. On the other hand, the second dose will take you above 60 to 70%.
Q. Will we get more vaccines in India?
A. Absolutely. Our problem was that the government did not correctly estimate our needs, over-estimated the capacity of domestic producers and sent foreign manufactures away saying that their conditions were unacceptable and, even, that an Atmanirbhar Bharat did not need them.
But of course, we did. And the government is now eating humble pie and reversing all its old positions. On April 27, Dr VK Paul, the government’s vaccine czar, announced that vaccines approved globally “will not need to undergo prior bridging trials. The provision has now been further amended to waive off the trial requirement altogether.”
That leaves one other issue. Companies like Pfizer want to be indemnified against claims from disgruntled users. Six months ago, the government said a point-blank ‘no’. By next week it will probably say yes.
Q. Does that mean an end to vaccine shortages?
A. Only eventually. We will get imported vaccines in dribs and drabs but we will only reach a reasonable level of supply by December. This means that people will be safer by early next year (around February-March) when immunities kick in. This is better than nothing. But yes, till then, people will get ill and die.
It also helps that by next year, so many new vaccines will be available that the world will be awash in them. There should not be another global shortage from then on.
Q. What about immunity? Are people who have got Covid protected against a second infection?
A. The problem with all yes and no answers to Covid questions is that there are always exceptions. All of us know people who have died despite being vaccinated (which we are told is almost impossible) and we know of people who have been infected twice.
But here is the medical position: You should be immune for several months after an infection. And, according to the latest research, your immunity could last even longer.
Two recent studies, one published in Nature and another posted on a biology research site say that your body will continue to churn out antibodies for at least a year.
Q. So should we be hopeful now?
A. One should always be hopeful. Perhaps the worst really is over! (But then we said that when the first wave petered out!)