Virus researcher Gagandeep Kang breaks down India's corona challenge

Gagandeep Kang is one of India's primary clinician scientists and among other things is the first Indian woman to be elected as Fellow of the Royal Society, London. As professor of The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, she has been a leading researcher in viral infections in children. Here she answers some questions on coronavirus from Kaveree Bamzai for SheThePeople.TV.

What is your view on the Government response? Can we not look at a new model of government-public healthcare-private healthcare-citizen model in battling coronavirus? What role can private hospitals and private diagnostic labs play?

The response is now obvious, travel restrictions internationally and domestically, promotion of social distancing and I hope, building hospital preparedness for the proportion of patients who will need admission and ICU care. I think strengthening primary health care is the backbone of effective healthcare, get care to people as early as possible. If we build strong primary healthcare we can then build a system that people access to keep them well, not one where need for hospitalisation is what brings them in. Private health care in India is the bulk of inpatient care provision at the moment, and we will need a partnership to be able to handle COVID-19 cases.

For both diagnosis and provision of care, private facilities must contribute their services, because while we may not need them today, we are likely to need them soon. The preparation time is now and a lot is needed.

Till now it has infected more than three lakh people in over 100 countries and claimed the lives of more than 16,100 so far. But as you have said, 770,000 people still die every year from AIDS and related illnesses, and around 15,00,000 of tuberculosis. So why is there so much panic?

Infectious diseases that we should have been able to limit are sadly still with us and are huge public health problems. In the case of COVID-19, it is more severe than influenza, but the bulk of infected people will recover. The problem is that it is a new virus that no one in the world has seen before, unlike TB where most Indians have been exposed and infected at various times and have learnt how to deal with TB bacilli. With SARS-CoV2, there is no protection and it spreads fast, so the worry is more about what the rapid spread means for the ability of the healthcare system to cope with sick patients in a short span of time.

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What are the strengths and weaknesses of India in fighting the virus?

The strengths- we have started earlier than many countries. The weaknesses- the uneven and patchy quality of our public and private healthcare systems and the density of our populations which makes respiratory spread even more likely.

What are the lessons from global responses for India so far? Why can't we do drive-through testing like South Korea?

We should test more. Drive-through testing like South Korea requires a car which most Indians do not have. That's facetious, but we need to and will ramp up testing now that the government has allowed private and research labs to test.

Given that the virus involves case identification and contact identification, where India is somewhat weak, what is the way out? Do we have enough testing kits and diagnostic labs?

Given our population, no numbers are ever enough, but as we expand testing, we have Indian companies producing new diagnostics which I hope will be available soon so that we do not fall short.

What is the larger lesson for the world when it comes to investment in healthcare- whether it is the US or India, both have cut spends in healthcare?

Invest in primary care, invest in surveillance, prepare for outbreaks--they will happen. And invest in basic and applied research--new problems will need new solutions.

How long do you see this epidemic lasting?

Not less than 12-18 months for the acute phase, after that we may be able to control it, but I am not sure elimination or eradication is feasible.

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What are the contours of a new way of living that this will lead to? Social distancing, home cooking, better hygiene?

All of these are good ideas where infectious diseases are concerned.

All people have immunity to what they have been infected by before. In this case, no people in the world have encountered this new virus until now, so there is unlikely to be a difference.

Does the epidemic have anything to do with being vegetarian or non-vegetarian?

Not at all, the epidemic that we are seeing now is driven by human to human transmission.

How do we stop the flow of rumours and disseminate credible information?

Ask for evidence, spread credible information. Counter misinformation--it is a public service.

As a scientist, did you ever expect an outbreak such as this?

Absolutely, and there will be more outbreaks, perhaps not the same scale and spread, but they will happen.

How close are we to a vaccine of this? And what will the cost of such a vaccine be? As vice-chairperson of CEPI can you share this information with us?

Not less than a year. Now there are over 40 vaccine projects, so if we get one-two successful vaccines that would be great. The sooner the better but developing and testing vaccines takes time and many projects will fail.

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Do Indians have better immunity than most other nations in your experience? Some experts have suggested that 60 percent of Indians will be affected.

All people have immunity to what they have been infected by before. In this case, no people in the world have encountered this new virus until now, so there is unlikely to be a difference. Sixty percent seems a reasonable estimate--others have suggested 25 percent to 80 percent, depending on whether or not measures for control are implemented, but remember that infected means a spectrum from mild to deadly with most towards the milder end.

How has the government involved you and your expertise in fighting the virus?

The Department of Biotechnology is undertaking multiple research efforts in which my colleagues and I are participating.