Dr Soumya Swaminathan, Chief Scientist at the World Health Organisation (WHO), speaks to Abantika Ghosh on the coronavirus outbreak.
Why is the coronavirus situation worsening this fast? Were countries unprepared?
The outbreak is getting into a new phase; it does look shocking. The very aggressive action China took in Wuhan bought us some time and delayed the spread of the virus. It would eventually have spread to many countries, and that is what is happening now. Now we are seeing localised outbursts, even community transmission in some countries.
It was a new virus so WHO started issuing regular updates about what countries should do. It is not as if countries were not prepared — India, for example, started airport screening, picked up cases, isolated them, prepared testing facilities; now they are being sent to NIV (National Institute of Virology), Pune. In some ways you can say this spread was inevitable.
The Prime Minister has tweeted that he will not attend Holi Milan events. Is it safe to send children to school, and use public transport?
You have to understand that this is an infection that spreads by droplets — and not, say, through the breath of the person who is carrying it, like TB. You cannot just stand next to someone and get infected unless you are close enough for the droplets to reach you.
The most common method of transmission right now seems in fact, to be through infected surfaces. So it is important to avoid touching, to wash hands repeatedly, and to avoid touching your own face with unwashed hands. The elderly should avoid crowds as far as possible. But unless there is a specific advisory asking people to refrain from sending children to school or using public transport, or unless there is a cluster of cases reported from one particular school or college, in which case the institution will have to be closed down and students followed up for 14 days, such precautions are not necessary. Read more on how to handle the coronavirus outbreak
Experts across the world have advised to reduce mass gatherings to avoid the spread of COVID-19 Novel Coronavirus. Hence, this year I have decided not to participate in any Holi Milan programme.
— Narendra Modi (@narendramodi) March 4, 2020
Based on the available data, there is no reason to panic — 28 cases in a country the size of India are not worrying. As for whether schools, public transport etc. are safe, the (Health) Ministry should make recommendations based on the situation. It would be different from state to state or city to city. Even in China, the graded approach worked. The kind of containment measures put in place in Hubei were not replicated everywhere.
So should people not celebrate Holi?
People cannot put their lives on hold, nor is it necessary. Celebrate Holi, but maybe you should not celebrate it with thousands of people. Celebrate with close family and friends, avoid big gatherings as far as possible.
Is it true that children are at a lower risk of contracting the infection?
So far, what we know of corona, all of the evidence is from China. The evidence that we have from the largest sample so far suggests that less than 2% of the infections are among people of age less than 20 years; 1% cases are in people ages less than 10 years, and another 1% in people between ages 11 and 20 years.
What we do not know is whether children were carrying the virus but were asymptomatic. This is a very important epidemiological question impinging on the decisions about closure of schools, etc.
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The Ministry of AYUSH issued an advisory on alternative medicine remedies to “prevent” coronavirus infections. There have been prescriptions of yoga and gaumutra for preventing coronavirus. How should people take these suggestions?
There is absolutely no evidence whatsoever on the efficacy of any medicines in preventing coronavirus infection. Yoga is good for you in a general way. But it is not effective in preventing corona. I would urge all these people to work with scientists and hospitals to implement clinical trials to find out whether these are indeed effective. The WHO has put out on its website the protocol for clinical trials. WHO busts 12 myths about the infection
How close are we to a vaccine against COVID-19?
There are about 20 vaccine candidates in early stages of development. There is one that can go into phase-I trial perhaps as early as next month. This is an mRNA vaccine being developed by Moderna Biotech, and the phase-I trials will be carried out by the National Institutes of Health in the US. So if everything goes really well, we would probably have a vaccine in the next 12-18 months — but even after that, there would be the question of availability of sufficient doses. We are probably looking at an 18-24 -month window for that.
What about therapeutics?
There is work taking place on that using monoclonal antibodies from people who have recovered from the disease. Several trials are taking place in China, Japan, Korea, and the US. The most promising one is of remdesivir. Some trials are on for the second-line HIV drugs lopinavir and ritonavir, but some small trials in China have already reported negatives. (The Indian Council of Medical Research has obtained approval for use of the lopinavir and ritonavir combination in coronavirus patients in case of a public health emergency. They have not been used in any patient so far.)
India has put curbs on the export of some pharmaceutical ingredients given the China lockdown. Would this affect the availability of medicines globally?
If China’s manufacturing problems continue, the world could start facing drug shortages. However, for the time being, companies have assured us that they have adequate stocks of active pharmaceutical ingredients to last a few months.
Why do so many emerging infections come from China?
It is the practice of animal markets, the way they are set up; there are many different animals, some of them live, capable of transmitting infections. China has now started looking at regulating these markets and to put in place biosafety rules.
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