Multiple peaks on road ahead: experts’ Covid insight in book

Dr Guleria, the AIIMS Director, is the country’s top pulmonologist and a member of the government’s Covid-19 task force. Dr Kang is a world renowned vaccine and infectious disease researcher, and Dr Lahariya is a leading public policy and health systems expert.

“This is a unique journey that all of us have gone through. None of us was fully prepared either at the individual level or as a country.

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We thought it was important to explain firsthand how we all sort of got together, pulled our socks up, and fought our way through the pandemic,” Guleria told The Indian Express.

The book focuses on three principal issues regarding the still evolving pandemic: why Covid-19 is not just another respiratory disease; the public health response and stories from the frontlines; and the future roadmap for the public, policymakers and physicians given the long road ahead to vaccines.

The book also deals with the after-effects of the infection, termed Long Covid, which could be the next crisis in the pandemic. “When we started, our main aim was to ensure cases were low and to prevent deaths. Now we have a situation where we are realising that unlike in the case of a viral infection, in a large number of people who have recovered, Covid-19 does lead to some degree of residual post-Covid sequela. In many this is very mild and they recover within a few weeks but in some, this can cause significant damage to organs like the lungs and heart, necessitating long-term rehabilitation and increased care. We need to move into the next phase of being able to provide long-term care,” Guleria said.

He said they also dealt with challenges on the vaccine front in the book. “There is a lot of hope that we will have vaccines early next year. However, a lot of changes will happen as we go along. We have many vaccine candidates and the first one may not be the best and we may have more immunogenic and safer vaccines subsequently… Therefore… how do we decide if we will have one vaccine or multiple vaccines or will different groups receive different vaccination, and how do we distribute them to the entire population. These issues are addressed to some extent.”

On when the country will hit the peak, the authors say they expect multiple peaks. “However, it cannot be said how many and when…Whether those were peak or not and how many peaks happened, that can be answered (only at) the end of the pandemic.” They also state that it’s not necessary that the places where cases and deaths have gone down are those which have already reached the peak.

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On pre-symptomatic patients, the book raises a red flag, saying evidence from India suggests they can be as infectious. “A small proportion, maybe around one in every 10 cases, would be pre-symptomatic or (have a) mild disease. The key point is people can infect others (when) pre-symptomatic, when they themselves do not show any sign of disease. This would be around two days before the first sign of disease appears… There is also evidence that a recovered person can shed the virus from the upper respiratory tract for up to three months after the illness.”

On re-infection, the authors say, “Till now it is being inferred that even if a person is infected a second time, he or she is unlikely to develop serious disease in (the) second infection.” The book says that in such cases they had seen that the immune system responded quickly, and this showed it won’t affect vaccine development and efficacy.

On why men and people with co-morbidities are at a higher risk, the experts state, “The reasons are not fully understood… Researchers have found that in Covid-19, the immune response of men is mostly through cytokines and chemokine. In women, the immune response against Covid-19 is considered to be driven by T-cells… The T-cell dependent response is more balanced and nuanced.” On comorbidities too, the book talks about T-cells, saying that in many patients with such conditions, these are not fully functional. “The people with comorbidities also produce a specific type of protein, which acts as a brake on the immune system and makes them prone to severe diseases,” the experts state.