Dr Marc-Alain Widdowson is an infectious disease epidemiologist who worked for 18 years with the US Centers for Disease Control and Prevention (CDC). Since 2019, he has been Director of the Institute of Tropical Medicine in Antwerp, Belgium. He speaks to The Indian Express on the coronavirus pandemic.
Around a fifth of humanity is under lockdown, including all of India. How long can this work?
This approach will work to different degrees in different places. In temperate regions, there is intense transmission for a few months; in tropical regions, transmission is throughout the year. In Europe, lockdown is aimed at reducing transmission until summer starts, when we hope conditions will improve. In India with more year-round disease, it will indeed be difficult to lock down for very long periods.
Will this virus stick around and become endemic?
This is not yet clear, but I believe it will, indeed, become endemic. We should expect that the majority of the people globally will get exposed in the next year or two. A vaccine is the best hope for now — say, in 18 months. And importantly, Indian vaccine companies can get to manufacture it — decentralise the manufacture to avoid global bottlenecks. Even then, the virus is likely to be around.
Studies show the illness is mild in most people and severe in those above 60, with underlying conditions. What is the most effective treatment?
Yes, most cases are mild and do not reach the lungs, but just the throat airway. But when the virus does infect deeper tissues, you get a strong inflammation of the lungs that makes it difficult to breathe. Supportive treatment with oxygen and ventilators is key for severe cases. Several drugs are in trial stages and many have efficacy, but it’s too early to say which ones and when.
Can India’s hot summer slow the spread of the virus?
The virus can stay on surfaces for several days in the laboratory. It depends on the type of surface and environment. But the level does drop off quite quickly (in the heat). We are not sure what the clinical significance is of finding small amounts of the virus on surfaces. Certainly, surfaces like door handles that are used by many should be avoided or cleaned regularly.
There is a view that if 50% of the population is exposed to the virus there is a stronger chance of building immunity against it.
This is the concept of herd immunity — that if enough people get it then transmission will slow down, and non-immune people will be protected. The problem with the current lockdown is that it means in Europe there will be more susceptibles when it (the virus) comes back next winter.
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There is this big debate on testing in India currently.
There is a good chance that there will be some areas in India that can be overwhelmed with COVID-19. Testing helps to understand the scale of the problem and yes, it will protect the contacts of the positive persons. At the same time, transmission may be from asymptomatic persons, so it is unclear if the test-and-isolate strategy will prevent transmission effectively. Preparing innovative ways of delivering oxygen and conducting research on the best methods of clinical care in low-resource settings is key.
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