Mumbai: As the city continues to report a surge in cases amid low vaccination coverage among children, Somita Pal speaks to Dr Gagandeep Kang, professor of microbiology at Christian Medical College, Vellore. Kang, who is an expert on vaccines, Covid-19 variants and waves, was in Mumbai at the event organised at the Tata Institute of Fundamental Research, Colaba, on Monday.
Mumbai has reported an uptick in Covid-19 cases in June with the single-day spike ranging from 300 to 2,479. Would you describe this situation as one of concern or is it just a blip as some doctors describe it?
It is probably caused by the BA. 4 and BA. 5 variants of Omicron. It depends on what we want to call it — a surge or a wave. But, in a vaccinated population, counting cases is pretty much useless if you are not going to back it up with clinical data and sequencing. I want to know how many people are in the hospital. In South Africa, we saw cases go up. They were able to do sequencing rapidly and showed that it was because of BA.4 and BA.5 and cases came down without their hospitals feeling the consequences. We will very likely be in a similar situation.
Is there a mechanism to predict the pandemic waves?
There is no mechanism to predict the waves. Even the best infectious disease modellers will give you very general predictions on a large population and if you want specific predictions, they will give them for a short duration of time. So, if I know what is happening today, I can tell you what the situation will be two weeks to three from now. But I will not try and predict the situation after three months because a lot of things can happen in that time frame. In general, if you have a trajectory that persists today, it is not going to change very much tomorrow or next week. However, if you see a sustained change in the same direction for longer than two weeks then that is going to lead to some kind of a pattern. So long-term situations are difficult to predict.
Doesn’t the absence of a mask mandate and unreported Covid cases (owing to low tests, self-tests and no tests) make the current situation a fertile ground for the emergence of a new variant?
We need to remember the purpose of the mask. Is it to protect people or to prevent transmission? If it is to protect an individual, then that individual should be masked. If the goal is to decrease transmission in the community, everyone needs to wear a good-quality mask. The ideal situation is everyone wearing a mask every day at all times but that is not going to happen. Like other things in public health, we need to strike a balance between what people will accept doing with the benefit that you derive. The situation today is very different from when we had 1,00,000 and 4,00,000 cases. I don’t think the risk is so high that we need to insist on masking everyone but if you are vulnerable, you should wear an N95 mask and protect yourself.
It has been seen that many doctors have been prescribing monoclonal antibodies and the antiviral drug molnupiravir to high-risk patients with mild symptoms. Your take?
Unless the symptoms look like a delta variant, they shouldn’t be prescribed. Omicron variant infection symptoms don’t need these drugs.
Covid-19 is known to induce coagulation disorders. While the present variant/subvariants are milder, should people be worried about the post-Covid phase and what health parameters need to be checked?
It looks like there is an association between Covid-19 and vascular events that are persisting beyond acute illness. We are not seeing as many coagulation events with Omicron variants as we saw in the original variants. You should always watch out for symptoms though and get investigated. Patterns of long Covid are variable and it is not one condition. We have known about tuberculosis for 100 years and we still don’t know everything about it. We have known Covid-19 for three years. So, there is still a lot to know about the virus.
Mumbai has seen low vaccination among the eligible children population. Your thoughts on the same?
It is not the end of the world. While I am a vaccine enthusiast, I will wait and understand which vaccine is best for my child before giving it. No drug, no vaccine is 100% safe. You need to choose between benefits and risks. If your risk is low of getting the disease then the amount of benefit that you will get from the vaccine is also low. There is a risk of getting side effects, which is very low too. It is a balancing act. I think we do not know what is the best vaccine for children. Whether you should give a whole inactivated virus-based vaccine or a protein-based vaccine to your child, you have choices. You do not want to hurry up with the vaccine for your child and instead wait for the best product because the risk is low. There is nothing wrong with vaccinating children but we have choices. There will be an incremental benefit to children with any product. But is it the best product, is the question? This is my personal opinion.
In some people, the virus tends to stay for three to six months too. Is it transmissible? Is it a cause of worry for the person? How important is it to understand and track viral evolution to be able to anticipate a new variant and find better ways to treat infections?
+ It is a small fraction of people that stay infected beyond a month. They are unlikely to be a threat to public health unless they are immunocompromised. In such cases, the viruses may change enough to be the next variant that infects people as the immune system is unable to shut down the viral replication. If we are talking about the chances that one of those modifications will allow that virus to spread to people vaccinated or infected before, the level is 1 in many thousands. However, it is difficult to find and track such people all the time. This exercise cannot be used to prevent new variants. Most people, who are immunocompetent, won’t be infectious even if they are shedding the virus for a long time.
Since Covid-19 is here to stay, what should be the future management for it?
We have been in an endemic stage for the last one year. Endemic doesn’t mean that there will be no waves, patterns or an outbreak. It means it is a disease in the population which is going to stay. We are dealing with it pretty well. We need to follow vaccinated people to make sure we understand when they need a booster dose. We need to follow the virus but no longer follow case counting.