Six months ago, on March 11, the SARS-CoV2 or novel coronavirus that causes Covid-19 was declared a pandemic by the World Health Organization (WHO). Days later, India imposed the world’s strictest nationwide lockdown on March 25. However, the country is now a global hotspot with over 50 lakh infections.
India is currently in number two position after the United States, having overtaken Brazil. India has been adding roughly one lakh infections and reporting over a thousand deaths every day. The uptick, which started from mid-August, continues unabated.
So, what do we know after six months of the pandemic?
Initially, doctors were using many therapies without knowing if they worked. In March, hospitals launched in-patient clinical trials and antiviral drug remdesivir, tociluzamab (an anti-inflammatory) and hydroxychloroquine (HCQ) were given to in-patients. Now, we have two medications that have been found to improve clinical outcomes. While Remdesivir hastens clinical recovery by more than one third (from 15 days to 11 days), Dexamethasone (steroid), an anti-inflammatory, reduces likelihood of death, especially in critically ill, but does not work in earlier stages or for outpatients.
Meanwhile, HCQ, which was initially touted as the medicine for Covid-19 treatment, has turned out to have no benefit at all. These early trials have changed national and international treatment guidelines. No other therapeutic intervention has so far been found effective. The hype over plasma therapy has also died down.
Dr Rajesh Gandhi of Massachusetts General Hospital, an infectious diseases expert who also prepares Covid-19 treatment guidelines, told CNN-News18, “Most studies done so far have been in hospitalised patients. But Covid-19 is mild in most patients and hospitalisation is not required. If we could develop an effective outpatient treatment, it might prevent progression, hospitalisation, complications and transmission to others.”
Dr Randeep Guleria, Director of the All India Institute of Medical Sciences (AIIMS), told CNN-News18 in an interview, “We have already learnt a lot about treatment. There is a huge change in our treatment strategy in last six months which has led to a decrease in the mortality rate. It’s important to know what drugs work and what drugs don’t and when to give which drug. Giving a drug early before it is required can actually cause more harm than good. Effectively, 80 to 90 per cent of people with mild symptoms do not need much treatment. They get well with symptomatic treatment.”
Human behaviour – wearing masks, hand washing and social distancing – has been proven to be very effective in containing the spread of coronavirus. Airborne or not, coronavirus certainly remains afloat in the air for longer hours in closed air-conditioned rooms. Doctors stress on wearing masks all the time while in closed indoor areas. On the other hand, ventilated rooms and the outdoors are much safer.
Dr Faheem Younus, chief of infectious diseases at University of Maryland, who regularly busts myths on Twitter, says coronavirus spreads from humans and not as much from surface. He told CNN-News18, “There is no need to waste time in cleaning phones, groceries and things ordered online; washing hands after handling the box will do.”
In the absence of a vaccine, the test-trace-isolate formula works best, something South Korea and Taiwan put to use with great success in the summer. While rapid antigen tests don’t detect low level infections, they are useful in limiting the virus spread. And the laboratory technology-driven RT-PCR test continues to be the gold standard, even though it gives delayed results. After the new Indian Council of Medical Research (ICMR) guidelines, now anyone can take a PCR test ranging from Rs 1200 to Rs 3000 in a private lab and free in government hospitals, without a prescription and get the result the next day.
We still don’t know if herd immunity through natural infection is achievable. Top epidemiologists have written in Nature last week, “There is little evidence to suggest that the spread of SARS-CoV2 might stop naturally before at least 50 per cent population has become immune. Another question is what it would take to achieve 50% population immunity, given that we currently do not know how long naturally acquired immunity to SARS-CoV2 lasts (immunity to seasonal coronaviruses is usually relatively short-lived), particularly among those who had mild forms of disease, and whether it would take several rounds of re-infection before robust immunity is attained.” Sweden learnt this the hard way.
This clearly means we badly need a vaccine to acquire immunity. Even if a vaccine won’t be available to all in the beginning, even with a 50 per cent success rate, it will limit the virus spread significantly. Doctors believe we could have a vaccine by early 2021, or as early as December.
Though scientists continue to be circumspect over Russia’s Sputnik V vaccine, many countries including India have warmed up to it and are planning collaboration for mass production. Scientists are betting on three front-runner candidates being developed by Oxford-AstraZeneca, Moderna and Pfizer, which are in phase 3 human trials. The Pune-based Serum Institute of India (SII) is collaborating with AstraZeneca for trial and mass production.
But many doctors believe a vaccine won’t be the only way to defeat the virus completely. Speaking to CNN-News18, New York doctor and writer Dhruv Khullar said, “Many believe a vaccine will end the pandemic. But all vaccines are not as powerful as the one that was developed for polio. The immunity from vaccine can wane with time. Therefore we need other therapies to go with a vaccine.” Dr Khullar added, “In the absence of a single-shot cure, antiviral drugs, antibodies, immunomodulators currently under development, may finally help bring a decisive end to the pandemic. Alone or in combination with a vaccine.”
India eased restrictions from the first week of September. Everything, except schools, colleges and cinemas, is open. Market places are already bustling and traffic jams are back to pre-pandemic days, with people desperate to reclaim their normal lives. Metro trains have resumed operations in all major cities with Delhi metro running to its full capacity from September 12. Restaurants and bars are already open. Migrant workers have started returning to their work places in other states in thousands. Though offices, both government and private, are operating with reduced staff strength, we are back in business.
Schools, colleges in India may not fully reopen till infections drop significantly. Schools abroad that had reopened in the US, Germany and elsewhere were forced to close again after fresh outbreaks were reported. AIIMS Director Dr Guleria told CNN-News18, “Children do get coronavirus infections but the good thing is they get a mild infection and they recover. Still we will have to be careful in reopening schools as children may get the virus, can take it to their homes and could transmit to the elderly and with co-morbidities leading to an outbreak. Children themselves may not have that much of a problem but they can spread it to others. ”
While school children in cities are carrying on with their online education, in rural India children deprived of laptops and smartphones are either dependent on local private tuitions or simply sitting at home. College admissions are yet to start. Delhi University may come up with its first cut-off list by mid-October. Outlining the limitations of remote learning, the United Nations said 1.5 billion children were affected by school closures worldwide.
In other news, India’s growth shrank by 23.9 per cent in the April-June quarter. The Indian army is still engaged with the Chinese People’s Liberation Army (PLA) in an intense border stand-off. Dhoni quit international cricket. Sushant Singh Rajput’s untimely death has been the dominating theme of TV news coverage. The Indian Premier League (IPL) is set to be played in three empty stadiums in the UAE from September 19. Amitabh Bachchan after recovering from Covid-19 has started shooting for the 12th season of Kaun Banega Crorepati (KBC).
China has almost beaten the virus and ground zero Wuhan has also fully reopened. Meanwhile, China’s economy has recovered. Europe is reeling under a second wave with France planning more restrictions.
While President Trump has admitted to downplaying the severity of Covid-19, Shinzo Abe has stepped down as Japan’s longest-serving prime minister.
Chistopher Nolan’s much-awaited movie Tenet is has crossed the $200 million mark and Malayalam lockdown thriller C U Soon is making waves on OTT platform. Video conferencing service provider Zoom has reported a profit of 3,300 per cent and Messi has reluctantly decided to stay back at Barcelona. Pranab Mukherjee and Pandit Jasraj both died in August. And yes, Tik Tok and PUBG are now banned in India.
Quite an eventful six months, indeed, and the road ahead still full of uncertainties.