COVID Webinar on 30th June-2020

A Webinar on COVID-19 was conducted on 30 June, 2020, from 10 am to 12.18 pm. The following panel of experts discussed the pandemic in India and world.

  1. Dr. V. Surya Prakasa Rao, Dean, Professor & Head of Community Medicine,Narayana Medical College, Nellore.
  2. Dr. K. Nagaraju, Professor & Head of Community Medicine,Sri Padmavathy Women’s Medical College, Tirupati.
  3. Dr. G. Ravi Prabhu, Professor & Head of Community Medicine,S.V Medical College, Tirupati.
  4. Dr. Sushant Kumar Mishra, Professor & Head of Community Medicine,G.S.L Institute of Medical Sciences &

Dr. Rao moderated the panel discussion. He introduced the invited speakers and gave a brief overview of the COVID-19 problem. Some of the important points of his observation were as follows. The situation is gradually increasing in the world as well as India. Countries like USA and Brazil seem to be facing a very difficult situation currently. Unless the information is freely available it will be very difficult to understand the situation. Correct information and transparency of data are essential pre-requisites for accurate analysis of the problem. He looked at factors like the emerging evidence of epidemiology, bottom-up consensus of trust and faith, role of medical colleges and epidemiologists, unexpected events that could occur etc., before concluding his opening remarks.

Dr. Nagaraju discussed the situation in the world with a focus on the success stories. He started with the overall world situation currently, in terms of deaths and cases and also during the last 3 months. He discussed the pandemic with a special focus in the countries of New Zealand, South Korea, Vietnam, Germany, Australia, Taiwan, Tanzania, China, Singapore and Canada. He analysed the data of these countries with reference to the number of cases and deaths, for three months since March, 2020. Total cumulative numbers and daily numbers were shown in graphs to emphasize the points. These countries probably succeeded because of the following factors. Measures like, strict adherence to the rules and regulations, closing of international borders, rigorous screening of the population, public cooperation, high tech way of tracing and isolation, in addition to the measures like, lockdown, quarantine, isolation, treatment, support by other sectors of govt, testing facilities, self-reliance in testing facilities, cooperation by the people, minimizing the economic burden by the govts etc.,helped great deal in containing the pandemic in these countries.

Dr. Mishra presented the problem in India.Some of the facts and figures presented by him were as follows.Total cumulative cases are 5.67 lakh and deaths, 16,904, while in AP, they were about 14,000 cases and 180 deaths (appx). In Italy the cases reached 2.5 lakh in only 75 days, while in our country it happened in 130 days, showing a slower progression of pandemic. Some factors that operated could be, genetic variation of the virus, humidity and temperatures, exposures to many corona viruses like in African countries, exposure to MERS, more young population, 21-day average of deaths etc., were discussed. State-wise testing activity was discussed. Test positivity rate (TPR) among the different states varied between 1% and 17%, with a mean TPR below 10%. With reference to treatment, there are no specific medicines so far, but remdesivir, hydroxychloroquine, dexamethasone, favipiraviretc are being used. Basing on severity protocols are given. Recovery rate is good. Mortality rate is low. Capacity building of personnel and facilities is important. Infection control measures like triage are very important. Bharat Biotech has developed a vaccine and human trials are about to start.Other measures like the MMR vaccine, plasma therapy are being considered.Although there are some lacunae here and there, overall picture shows that we are doing a reasonably good job in India.

Dr. Prabhu discussed the future projections for the country and also some of the states.He analysed the data ofthe cases, deaths, recovery rates, CFR to make his points.The problem was approachedfrom two angles, namely, R(t) or R(0)and the herd immunity. He calculated R(0) to decide the probable progression. He looked at the herd immunity concept to give some projections. The five day moving average R(t) currently is about 1.31, based on 14-days period of communicability. Accordingly, in India the cases by the end of July could be between 15 to 17 lakhs. In AP, at an R(t) of 1.5, the cases could vary between, 80,000 and 120,000by the end of July. For Telangana it could be between 90000 and131000. Next the probable end of epidemic is considered based on herd immunity. At 50% level of natural infection rate, the cases have to become about 70 crores. As per the recent ICMR survey, the rate of infection is 0.73% and the CFR is 0.08%.This means, 1.05 crores are already infected, which translates to 1 crore reported infections to herald the end of epidemic. With a CFR of 0.08% the cases could be 2.6 crores. Which means, about 1 to 2 crores are infected by now. Similarly 5.6 lakh total deaths are likely to occur. Herd immunity is likely to develop faster in urban areas, and hot spots, as the infection spreads faster in these areas. Analysis of the current data, says that the rate of infection has to reach at least 500/one lakh population. This means the cases will increase to 1.4 crores before the pandemic ends. As of now measures like lock down seem to have succeeded to flatten the curve of the epidemic. In conclusion, when the cases become about 1crore, the epidemic may start to decline.This may happen by the middle of Sept or at least by Oct, 2020.

Dr. Rao discussed the way forward. He opined that since the predictions are based on several assumptions and presumptions, we need to consider them carefully. The way forward will be very difficult. We need to use Artificial Intelligence in all of our activities like contact tracing. Some of the important factors like global collaboration to develop a vaccine, enhancing the testing capacity, strengthening of the health system, empathic communication, mental health problems etc, will influence the outcome, significantly. Professional organizations like, IPHA & IAPSM recommended measures like, cluster containment in place of lockdown, resumption of all health care services, universalizing preventive measures, sentinel surveillance (fever clinics) etc. The neglect of general health care services is bound have a very bad effect on the health of the people in future.

Some of the questions asked by participants and the answers by the panelists are as follows. What proportion of the infected are asymptomatic and are we justified in hospitalisingthe asymptomatics? Dr. Mishra said that about 90% are likely to be asymptomatic and hospitalization may not be required and where ever possible home quarantine may be preferred.

Are separate room and bath room mandatory for home quarantine and since the family members are already expected to be infected, is this advisable? Dr. Prabhu agreed that home isolation may be considered where ever possible and in addition to this precautions like mask, sanitation etc, also will also help.

Why the CFR in Gujarath quite high?Dr. Prabhu felt that the reason could be the age distribution and co-morbidities. Why COVID-19 is feared so much as there are other diseases with more CFR are already around us? Dr. Prabhu opined that since it is a new disease with lot of media coverage, people are paying great attention.

What are the lessons for India from the success abroad?We need to focus on IEC, educate more and more people to voluntarily use masks, maintain social distance and follow the basic principles of hygiene like frequent hand washing, etc.

Dr. Prabhu was asked when the pandemic will end. He reiterated that as per the predictions based on scientific calculations, it may end when the number of reported infected people reaches 70 lakh to 1 crore. This is likely to occur by Sept 15 or at least by October 2020 and then it will slow down. How ever in the mean while all precautions need to be followed meticulously. Will there be a second wave? Dr. Prabhu says it may follow after about 1 to 2 years, and that by then vaccine will definitely become available, which will further control the situation even more rapidly and efficiently.

Dr. Rao, added that the second wave of H1N1 epidemic did not occur, even though it was predicted by him and other experts of Maharashtra in the recent past.

Dr. Rao thanked the panelists for their excellent discussion and the Webinar came to an end at 12.18 pm.