- COVID is a systemic disease rather than just a viral infection: Dr Guleria
- Dr Guleria says COVID vaccine possible by end of the year
- India’s coronavirus cases will rise as testing has increased: Dr Guleria
New Delhi: On Friday, the phase-I human clinical trial of India’s first indigenously-developed vaccine against novel coronavirus, Covaxin, began at Delhi’s AIIMS and the first dose of the injection was given to a man who is in his 30s. Covaxin, developed by Hyderabad-based Bharat Biotech in collaboration with ICMR and the National Institute of Virology (NIV), the hospital had recently got the approval for human clinical trials from the Drugs Controller General of India (DCGI). AIIMS-Delhi is among the 12 institutes selected by the Indian Council for Medical Research (ICMR) for conducting the first two phases of the randomised, double-blind, placebo-controlled clinical trials of Covaxin.
In phase I of the vaccine trial will be done on healthy people aged between 18 and 55, having no co-morbid conditions. Women with no pregnancy will also be selected to be a part of the trial in the first phase. Whereas, in the second phase, 750 people will be recruited between the ages of 12 and 65. According to the official statement from the hospital, around 1,800 volunteers have already registered themselves for the trial at AIIMS.
To know the timeline of India’s coronavirus vaccine and know more about the pandemic, NDTV spoke with the Director of AIIMS Dr Randeep Guleria. Here’s what he has to say:
NDTV: How soon can India find a COVID-19 vaccine?
Dr Randeep Guleria: Vaccine trials for any disease can normally take numbers of years as we go in a sequence manner – first we have phase 1 trials wherein few people are tested, depending on the results of phase 1, we have phase 2 trials, wherein some more people are tested and then finally we have phase 3 trials in which a large number of individuals the vaccine is tested to look at the efficacy. Because of the pandemic, all of this is compressed and rather than doing it in sequels, we are doing in parallel, meaning, we are simultaneously doing phase 1 and 2 trials and we are also looking at doing early phase 3 trials and at the same time the manufacturers are taking the risk of manufacturing these vaccines already, assuming that these vaccines will work and therefore investing in that production so that as soon as the data is there stating that the vaccines are effective to fight COVID-19, one will have it in the market immediately, rather than the production of that itself taking the few months. So, I think, we all are looking at a very compressed programme, and which I think, by the end of this year or early next year, we should complete and if everything is alright and if everything goes as per plan then we should be able to have a vaccine for COVID very soon.
NDTV: In terms of accessibility, in how much time we see the vaccine available or being given to each and every citizen of India?
Dr Randeep Guleria: The manufacturers have already started to manufacture the vaccine irrespective of the results, plus, we all should remember the point that 60 per cent of all the global vaccine that are made are actually made in our country, so, we do have a lot of manufacturing capacity. At the same time, I do believe, that it will not be possible to give the vaccine to each and every individual of the country on the very first day or for the first few weeks. I think India will need to prioritise patients, in terms of vaccination, the main focus should be on giving the vaccine to high-risk patients. We all know from the past few months experience that younger people have very mild disease and most of them get treated on their own or with a very mild treatment, so, once we have the vaccine in place, it will make sense to give it first to a high-risk group, for example, the elderly, those with Comorbidities, the healthcare workers who have the high chance of contracting the disease and then it can be prioritised to other groups. But, I am quite certain that the bulk of vaccine manufacturing will occur in India and it would be available easily to the large population of the country.
NDTV: Can we say it will take a year for everyone to get immunised to COVID once we have coronavirus vaccine available in the market?
Dr Randeep Guleria: That will totally depend on how rapidly we can produce the vaccine and on the other side we need to note that we do have a huge population so in absolute number it is huge and to get every individual immunised to fight coronavirus with COVID-19 vaccine will take some time.
NDTV: India’s rising cases. How worrying are the numbers?
Dr Randeep Guleria: The cases in India will continue to increase and that is related to two parts – one is that India has now increased its testing, we are doing 4 lakh tests per day, so the more we will test, more cases will get reported, which is a good sign because then the country is able to take measures such as contact tracing, isolation and treating its patients. At the same time, there is now a movement of the virus to the smaller cities and that is also accounting for the increasing number of cases in the country on a daily basis. What we have seen is that, initially, we do have a large number of cases of coronavirus occurring in the metros and now if you look data from these metros you will see they have somehow flattened their curve as cases are coming down. But in smaller cities, where the population is less, the cases are now increasing. I am hopeful that in the next few weeks, in the smaller cities as well there will be a flattening of the curve and they will also see a dip in a number of coronavirus cases. But, we know that the pandemic will evolve in different regions in different time.
NDTV: Are states like Bihar, Andhra Pradesh, Karnataka witnessing coronavirus peak at the moment as these states have witnessed a sudden surge in coronavirus cases?
Dr Randeep Guleria: Yes, they are showing a rising trend and we will need to see the states for the next few weeks to see how the cases behave in these regions. These are the states in India where the coronavirus cases have started to rise suddenly and there has been a focus on these states to aggressively manage COVID-19 so that large spike can be managed well. And once that is done, I am sure the cases will start to see a downward trend.
NDTV: Are weekend lockdowns effective in the fight against coronavirus?
Dr Randeep Guleria: I think, the government will have to have a strategy where they are aggressively able to contain the spread of coronavirus and for that, they need to do a lot of mapping of the area, see where clusters are being developed and then doing lockdowns in such areas rather than doing for the whole city. And the lockdown needs to be done in such areas for a number of days rather than just 2 days to actually break the chain of the infection. And within such zone, when a lockdown is implemented, there is a need for a house-to-house survey, we need to see who all have influenza-type symptoms and then the isolation strategy or system should come in the picture. Doing two days lockdown alone will not help fight coronavirus as such, it may give authorities time to build up facilities or ramp up their testing but alone it cannot kill the virus as it is a very short time period.
NDTV: How long does immunity to COVID last?
Dr Randeep Guleria: I don’t think, we understand the immunology or immunity from the virus in a complete manner till date. We are only talking about antibodies being present in patients but there is also something called T-Cell Immunity, which also plays a role as far as immunity is concerned and that sometimes be more important. There are some studies that suggest that while we are looking at the what are the antibodies in an individual, there may be the cell-based immunity or T-cell immunity which also may be protecting them and we have seen that in cities like London where the presence of antibodies in their population is still not high but the pandemic there has come down dramatically. So, there has to be some other mechanism, which is protecting the individuals who are getting infected more than just antibodies and I feel we need to do more research to fully answer this question.
NDTV: Is Herd Immunity a myth?
If you look at the study from Spain, which is a very large study done in the population, or you look at the serosurveillance done in Delhi, the numbers suggest that the immunity is not that high but still the pandemic has come down. To reach herd immunity, we will need at least 60 per cent of the population to get infected and recover from the virus so that they don’t get the infection and then they don’t transmit the same. In Delhi, as per the serosurveillance we have seen that the number is only 23 per cent, in Spain, it is much less. In areas like Italy, London, New York, there also we have seen that the immunity is not that high still the pandemic has actually come down there and the number of cases has actually declined. So, there has to be some other mechanism which works and to know that we will need to do more studies and research in the area.
NDTV: Skin rashes a new symptom of COVID-19? What should one watch for?
Dr Randeep Guleria: Skin rashes to itching and vascular rashes have been reported in the recent past in some COVID cases. However, they are not that common a symptom for coronavirus. But now a large number of what we call Extrapulmonary manifestations of COVID are being reported, these include neurological, cardiac, skin, gastrointestinal illness like nausea, vomiting and diarrhoea, skin rashes in the form of rythmol rash, which is sort of viral eczema and of course cardiac issues in form of a heart attack or myocarditis. So, we are realising that COVID-19 is a systemic disease rather than just a viral infection and that is why the diagnostic criteria and the index of suspicion have changed significantly over the last few months.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.