One Of The Puzzle Of COVID-19 Is The Large Proportion Of People Who Are Asymptomatic: Dr Vincent Rajkumar of Blood Cancer JournalIt's important to test asymptomatic people who have been exposed to COVID-19 because they could act as a carrier: Dr Vincent Rajkumar
Highlights
  • 80 per cent of COVID-19 patients in India are asymptomatic: Study
  • Severity of COVID-19 could depend upon viral load: Dr Rajkumar
  • Exposure to coronaviruses in past may trigger immune response: Dr Rajkumar

New Delhi: India has crossed the 55 lakh mark in terms of the confirmed COVID-19 cases. As per an internal analysis by the Integrated Disease Surveillance Programme (IDSP), about 80 per cent of COVID-19 patients in India are asymptomatic. The large chunk of those infected being asymptomatic has not only made controlling this pandemic a challenge globally, it is also something that sets the SARS-CoV-2 apart from the other coronavirus outbreaks like Severe Acute Respiratory Disease (SARS) in 2002 and Middle East Respiratory Syndrome (MERS) in 2012.

Both these outbreaks were contained as only the people showing symptoms were at risk of transmitting the disease, which made isolating the infected cases easier.

NDTV speaks to Dr Vincent Rajkumar, editor-in-chief of Blood Cancer Journal and a cancer expert, to help us understand why are some people asymptomatic while others suffer from a serious bout of infection.

Also Read: Coronavirus Explainer: What Is COVAX Initiative?

NDTV: One of the biggest mystery in understanding the novel coronavirus remains – why do some patients get critically ill while most remain asymptomatic?

Dr Vincent Rajkumar: Yes, we do know that while some people suffering from COVID-19 are severely symptomatic – they need oxygen support, ICU, ventilators; while others are completely asymptomatic and then there’s a spectrum in between. One of the puzzles of COVID-19 is the large proportion of people who are asymptomatic.

I think there are four easy ways to look at it and these might be the main reasons for this. Firstly, some of us have innate ability to quickly clear the virus, so we hardly have any symptoms, it’s about immunity.

Another possibility is the viral load; if the exposure to the virus is a small amount of virus or a small dose that gives the system enough ability to clear the virus quickly before it becomes symptomatic. It gives a head-start to the immune system.

The third factor might be genetics – there are some studies that suggest that certain blood group types, certain polymorphisms, may explain why some people get much sicker than others.

And lastly, there is the issue of cross-reactive immunity. SARS-CoV-2 is a coronavirus and coronaviruses cause the common cold, so it is possible that a huge proportion of the population might be exposed to the various coronaviruses in the past not the same SARS-CoV-2 but others. And whatever immunity they have against that could play a cross-reactive role, could affect or target the new coronavirus as well, this is called cross-reactive immunity. it can be in the form of B cells or T cells. That might be protecting them from COVID-19.

These four reasons probably can help explain why some people are asymptomatic while some much more symptomatic.

Also Read: Nine Months Into The COVID-19 Pandemic, Which Vaccine Candidates Are In The Final Stages Of Trial? 

NDTV: Can you tell us more about T cells, they have been talked about a lot since the COVID-19 pandemic and there’s a lot of ongoing research on these.

Dr Vincent Rajkumar: Again the background is that when we get an infection, we usually amount both antibody responses, which is called a B cell response as well as T cell response. Both responses work together to help us fight most infections. And when you measure antibody levels, you’re only getting part of the picture, you’re finding out all of the people who have been exposed to SARS-CoV-2, who have developed antibodies. But what we are finding from many studies is that there’s an extra subset of people whom we’re not able to detect antibodies, maybe they already have T cells that are reactive to the SARS-CoV-2 virus.

Therefore, these T cells could also offer some protection that we are not recognising. The second factor is that they have looked at samples collected before COVID-19 came and you can detect these T cells that are reactive to SARS-CoV-2 virus even the samples that were collected way before the start of the pandemic. That means there must be some T cells that are cross reactive again, that was generated in response to some other virus but somehow, they seem to cross-react with the new virus.

And so we don’t understand how much protection the T cells will offer, I don’t think they’ll be enough to prevent you from getting the infection. But from what we have seen with young kids who have been vaccinated at six months with measles, that T cell response may be, by itself, enough to prevent at least severe disease.

Also Read: AstraZeneca Vaccine Trial Pause A ‘Wake-Up Call’, Says WHO

NDTV: India is now at a stage where it is adding nearly 1 lakh cases every day. What do you think about how India has dealt with the coronavirus?

Dr Vincent Rajkumar: I have been following India very closely. My parents are living in India, I have a lot of friends and family there. It’s a country that I’m hugely concerned about and from what I’ve seen there are many optimistic signs.

One is that there must be some level of cross-reactive immunity in India that is protecting the population because in terms of deaths per million, India has about 50 deaths per million and that’s ten times lower than the United States. So, to the extent that you have zero positivity in Mumbai, Pune and Delhi; you are not seeing the overflowing ICUs, and the huge number of deaths that we saw in New York or Lombardy. So something is protecting India which I’m very grateful for.

I think the government has done a really good job of trying to impose restrictions, trying to emphasise the need for masks. As long as the public is aware of taking just simple precautions – wear a mask, don’t join people in crowds, be very careful indoors particularly and keeping hands clean, as that alone will reduce the viral dose, if not prevent from getting an infection.

Also Read: Coronavirus Explained: What Are The Phases In The Clinical Trials Of The COVID-19 Vaccine?

NDTV: WHO has been emphasising about testing, tracking, to fight COVID-19. But in US recently, Centre For Disease Control (CDC) said that it’s not necessary for everyone to get tested, specially if you’re asymptomatic. What is your take on this?

Dr Vincent Rajkumar: I disagree with that statement by CDC. I think it’s clearly important to test asymptomatic people who have been exposed because they could act as a carrier. They themselves might be asymptomatic but the risk is that they could spread it to others just as efficiently, and cause very severe symptomatic diseases. It’s very easy to identify who these people are if they’ve been exposed to someone and take the necessary precautionary measures. I think we have to operate on the precautionary principle that asymptomatic people are there and if you can identify them, you should identify them and protect other people from getting infected.

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 (WaterSanitation 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 pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

4,29,71,161Cases
1,28,60,263Active
2,89,57,428Recovered
11,53,470Deaths
Coronavirus has spread to 189 countries. The total confirmed cases worldwide are 4,29,71,161 and 11,53,470 have died; 1,28,60,263 are active cases and 2,89,57,428 have recovered as on October 26, 2020 at 3:48 am.

India

79,09,959 45148Cases
6,53,717 -14437Active
71,37,228 59105Recovered
1,19,014 480Deaths
In India, there are 79,09,959 confirmed cases including 1,19,014 deaths. The number of active cases is 6,53,717 and 71,37,228 have recovered as on October 26, 2020 at 2:30 am.

State & District Details

State Cases Active Recovered Deaths
DistrictCases
Mumbai45,478
Thane13,660
Pune9,920
Mumbai Suburban5,363
Aurangabad1,974
Nashik1,575
Raigad1,462
Palghar1,421
Solapur1,291
Jalgaon1,039
Akola757
Nagpur692
Kolhapur646
Satara629
Ratnagiri350
Amravati291
Dhule228
Hingoli208
Jalna201
Ahmednagar190
Nanded176
Yavatmal150
Sangli145
Latur139
Osmanabad125
Sindhudurg114
Buldhana88
Parbhani78
gondia69
Beed54
Nandurbar42
Gadchiroli42
Bhandara41
Chandrapur32
Washim13
Wardha11

16,45,020 6,059

1,41,001 299

14,60,755 5,648

43,264 112

DistrictCases
Kurnool795
Krishna557
Guntur511
Anantapur428
East Godavari356
Chittoor319
Sri Potti Sriramulu Nell*296
Y.S.R.205
West Godavari199
Srikakulam183
Prakasam104
Visakhapatnam103
Vizianagaram23

8,07,023 2,997

30,860 609

7,69,576 3,585

6,587 21

DistrictCases
Udupi1,176
Kalaburagi669
Yadgir538
Bengaluru Urban529
Raichur369
Mandya346
Belagavi337
Bidar219
Hassan205
Davangere204
Vijayapura201
Dakshina Kannada179
Chikkaballapura149
Mysuru107
Bagalkote103
Uttara Kannada95
Shivamogga67
Dharwad61
Ballari60
Gadag45
Bengaluru Rural40
Tumakuru36
Kolar29
Haveri24
Chikkamagaluru19
Chitradurga14
Koppal5
Kodagu4
Ramanagara3
Chamarajanagara0

8,02,817 4,439

81,069 5,699

7,10,843 10,106

10,905 32

DistrictCases
Chennai23,324
Chengalpattu1,314
Thiruvallur774
Villupuram509
Kanchipuram503
Tiruvannamalai496
Cuddalore477
Ariyalur444
Tirunelveli433
Tuticorin333
Kallakurichi324
Madurai322
Salem258
Coimbatore188
Virudhunagar185
Dindigul175
Perambalur133
Ranipet133
Thanjavur130
Theni129
Tiruchirappalli119
Ramanathapuram119
Tiruppur116
Kanniyakumari110
Tenkasi103
Nagapattinam99
Karur88
Namakkal83
Erode75
Vellore71
Thiruvarur67
Pudukkottai53
Sivaganga46
Tirupathur45
Krishnagiri43
The Nilgiris17
Dharmapuri15

7,09,005 2,869

30,606 1,181

6,67,475 4,019

10,924 31

DistrictCases
Gautam Buddha Nagar1,119
Agra933
Ghaziabad794
Meerut504
Lucknow386
Saharanpur298
Kanpur Nagar286
Moradabad252
Varanasi243
Hapur225
Aligarh215
Basti214
Amethi206
Rampur203
Jaunpur194
Firozabad190
Barabanki168
Gorakhpur166
Bulandshahr166
Siddharth Nagar159
Ghazipur159
Bijnor157
Deoria143
Azamgarh138
Sant Kabeer Nagar132
Mathura129
Ayodhya120
Muzaffarnagar117
Sambhal116
Sultanpur97
Ambedkar Nagar92
Maharajganj85
Amroha80
Rae Bareli78
Bahraich73
Kheri72
Kannauj69
Baghpat68
Kushi Nagar67
Bhadohi60
Ballia60
Gonda59
Etah52
Hardoi49
Balrampur49
Mau48
Mainpuri46
Etawah46
Hathras43
Unnao42
Jalaun41
Jhansi41
Shamli40
Chandauli38
Auraiya37
Farrukhabad36
Sitapur32
Prayagraj30
Banda27
Shahjahanpur25
Shravasti23
Budaun23
Mirzapur22
Bareilly17
Kasganj16
Pratapgarh15
Pilibhit15
Sonbhadra10
Kaushambi6
Kanpur Dehat4
Chitrakoot4
Lalitpur3
Hamirpur3
Mahoba3
Fatehpur3

4,70,270 2,032

27,317 364

4,36,071 2,368

6,882 28

DistrictCases
Kannur357
Kasaragod333
Palakkad224
Malappuram119
Kollam118
Thrissur106
Thiruvananthapuram104
Pathanamthitta98
Kozhikode90
Alappuzha76
Kottayam73
Ernakulam60
Idukki40
Wayanad36

3,92,930 6,843

96,688 832

2,94,910 7,649

1,332 26

DistrictCases
North West5,463
Central4,817
West4,768
New Delhi3,405
North3,059
East2,472
South East2,446
South West2,391
South2,329
North East1,914
Shahdara1,580

3,56,656 4,136

26,744 277

3,23,654 3,826

6,258 33

DistrictCases
Kolkata2,777
Howrah1,435
24 Paraganas North1,031
Hooghly604
24 Paraganas South281
Maldah235
Dinajpur Uttar216
Coochbehar210
Birbhum206
Medinipur West159
Medinipur East153
Nadia139
Purba Bardhaman130
Murshidabad125
Bankura116
Darjeeling97
Jalpaiguri88
Paschim Bardhaman70
Purulia66
Dinajpur Dakshin50
Alipurduar39
Kalimpong18
Jhargram9

3,49,701 4,127

37,017 210

3,06,197 3,857

6,487 60

DistrictCases
Ganjam581
Jajapur322
Khordha238
Baleshwar190
Kendrapara164
Cuttack155
Bhadrak137
Balangir129
Puri103
Sundargarh102
Jagatsinghapur91
Nayagarh86
Mayurbhanj73
Nuapada69
Gajapati61
Dhenkanal36
Boudh34
Kendujhar34
Deogarh33
Kalahandi33
Sonepur29
Kandhamal28
Anugul26
Malkangiri20
Bargarh16
Koraput16
Sambalpur16
Jharsuguda8
Nabarangpur2
Rayagada2

2,81,215 1,633

15,868 454

2,64,102 2,071

1,245 16

DistrictCases
Hyderabad2,475
Ranga Reddy183
Suryapet87
Jagitial77
Nizamabad76
MedchalMalkajgiri75
Mancherial43
YadadriBhuvanagiri40
Jogulamba Gadwal40
Vikarabad40
Nalgonda33
Warangal Urban32
Mahabubnagar30
Sangareddy26
Khammam26
Adilabad22
Nirmal21
Karimnagar17
RajannaSircilla16
Medak11
Kamareddy11
Mahabubabad10
Jayashankar Bhupalapally9
Nagarkurnool8
Kumuram Bheem Asifabad8
Jangoan8
Siddipet7
Peddapalli5
Bhadradri Kothagudem5
Warangal Rural4
Mulugu3
Narayanpet3
Wanaparthy1

2,31,834 582

18,611 854

2,11,912 1,432

1,311 4

DistrictCases
Patna279
Bhagalpur266
Rohtas256
Khagaria253
Begusarai243
Madhubani199
Munger188
Jehanabad178
Katihar175
Darbhanga143
Samastipur139
Siwan139
PurbiChamparan138
Purnia135
Banka134
Buxar134
Nalanda123
Gopalganj123
Nawada122
Sheikhpura118
Gaya115
Kaimur (bhabua)105
Bhojpur103
Saran101
Muzaffarpur96
Saharsa88
Supaul87
Vaishali87
Madhepura82
Kishanganj75
Aurangabad75
Sitamarhi73
Lakhisarai72
Araria68
Pashchim Champaran57
Arwal52
Jamui47
Sheohar20

2,11,689 431

9,722 737

2,00,918 1,161

1,049 7

DistrictCases
Kamrup Metro276
Golaghat203
Nagaon143
Hojai89
Dima Hasao86
Karimganj85
Tinsukia84
Cachar80
Dibrugarh61
Hailakandi57
Lakhimpur57
Marigaon50
Dhemaji47
Kamrup42
Kokrajhar37
Dhubri30
Charaideo29
Barpeta28
Udalguri28
Sonitpur27
Jorhat24
Nalbari23
Darrang20
Sivasagar20
Goalpara19
Biswanath16
Baksa14
KarbiAnglong13
Bongaigaon12
Chirang6
West KarbiAnglong5
South SalmaraMancachar4
Majuli2

2,04,171 204

17,510 2,761

1,85,755 2,961

906 4

DistrictCases
Jaipur2,177
Jodhpur1,748
Udaipur724
Bharatpur563
Kota503
Nagaur500
Ajmer379
Dungarpur374
Pali352
Jhalawar329
Bhilwara250
Sikar231
Chittorgarh188
Tonk171
Jalore164
Rajsamand140
Sirohi130
Bikaner112
Banswara91
Alwar90
Churu81
Jhunjhunu64
Dausa61
Dholpur60
Baran59
Jaisalmer53
Barmer34
Hanumangarh31
SawaiMadhopur26
Karauli17
Pratapgarh14
Ganganagar8
Bundi5

1,86,243 1,821

16,668 432

1,67,736 2,240

1,839 13

DistrictCases
Bilaspur100
Korba100
Mungeli87
Baloda Bazar85
Jashpur77
Janjgir-Champa56
Mahasamund54
Rajnandgaon52
Kabirdham52
Raigarh47
Raipur46
Balod41
Korea39
Durg31
Bemetara21
Kanker19
Balrampur17
Surguja14
Gariyaband10
Surajpur9
Dhamtari6
Bijapur2
Bastar2
Dantewada0
Kondagaon0
Narayanpur0
Sukma0

1,75,959 1,368

23,743 156

1,50,398 1,499

1,818 25

DistrictCases
Indore3,839
Bhopal1,880
Ujjain799
Burhanpur351
Neemuch319
Jabalpur276
East Nimar266
Sagar228
Gwalior211
Khargone196
Dewas140
Dhar132
Mandsaur112
Morena109
Bhind87
Raisen71
Barwani60
Ratlam51
Rewa39
Shajapur39
Hoshangabad37
Vidisha37
Chhatarpur35
Betul35
Rajgarh31
Dindori29
Sheopur26
Damoh26
Satna24
Anuppur22
Panna20
Tikamgarh18
Sidhi17
Narsinghpur17
Chhindwara16
Agar Malwa15
Mandla15
Shivpuri15
Jhabua14
Shandol14
Singrauli13
Ashoknagar13
Datia12
Sehore12
Umaria10
Balaghat9
Guna8
Harda4
Alirajpur3
Katni3
Seoni2
Niwari0

1,67,249 951

11,237 240

1,53,127 1,181

2,885 10

DistrictCases
Ahmadabad17,125
Surat2,311
Vadodara1,555
Gandhinagar410
Mahesana159
Banas Kantha147
Bhavnagar146
Rajkot135
Arvalli134
Mahisagar125
Anand107
PanchMahals107
Patan105
SabarKantha101
Kachchh99
Kheda98
Jamnagar63
Bharuch56
Botad55
Surendranagar55
Valsad47
GirSomnath45
Dohad43
Chhotaudepur37
Naysari35
Junagadh31
Narmada25
DevbhumiDwarka22
Amreli16
Porbandar11
Tapi6
Dang5
Morbi4

1,67,011 919

13,914 51

1,49,411 963

3,686 7

DistrictCases
Gurugram2,950
Faridabad867
Sonipat404
Rohtak145
Palwal120
Jhajjar114
Karnal104
Hisar98
Ambala93
Panipat78
Nuh68
Bhiwani60
Rewari56
Kurukshetra55
Sirsa50
Kaithal48
Mahendragarh47
CharkiDadri43
Panchkula39
Fatehabad38
Jind38
Yamunanagar19

1,58,304 1,240

10,295 147

1,46,282 1,086

1,727 7

DistrictCases
Amritsar485
Jalandhar297
Ludhiana293
Tarn Taran163
Gurdaspur154
Hoshiarpur140
S.A.S Nagar137
Patiala132
Sangrur107
Shahid Bhagat Singh Nagar (Nawanshahr)99
Pathankot86
Rupnagar (Ropar)74
Faridkot74
Sri Muktsar Sahib71
Moga65
Bathinda60
Fatehgarh Sahib57
Fazilka53
Firozepur50
Kapurthala44
Mansa31
Barnala25

1,31,055 415

4,217 60

1,22,721 465

4,117 10

DistrictCases
East Singhbum170
Ranchi148
Hazaribagh110
Garhwa80
Ramgarh75
Koderma58
Simdega48
Dhanbad32
Gumla28
Palamu27
West Singhbhum21
SaraikelaKharsawan20
Giridih19
Bokaro16
Latehar14
Khunti10
Lohardaga8
Deoghar5
Dumka5
Pakur4
Jamtara2
Godda2
Chatra1
Sahebganj0

99,686 258

5,844 122

92,976 378

866 2

DistrictCases
Anantnag395
Srinagar300
Kulgam295
Baramulla271
Shopian255
Kupwara231
Bandipora175
Udhampur155
Ramban151
Jammu138
Budgam110
Pulwama108
Kathua53
Rajouri39
Ganderbal37
Poonch35
Doda27
Reasi26
Samba25
Kishtwar10
Mirpur0
Muzaffarabad0

91,861 532

7,565 115

82,858 639

1,438 8

DistrictCases
Dehradun370
Nainital323
Tehri Garhwal110
Haridwar94
Udam Singh Nagar83
Almora71
Champawat45
Pithoragarh43
Chamoli36
PauriGarhwal36
Bageshwar31
Rudraprayag30
Uttar Kashi24

60,376 221

4,425 117

54,958 329

993 9

DistrictCases
South Goa69
North Goa57

42,242 211

2,576 116

39,090 321

576 6

DistrictCases
Pondicherry111
Mahe4
Karaikal2
Yanam0

34,193 81

3,804 108

29,801 187

588 2

DistrictCases
Dhalai196
Sepahijala174
Gomati74
South Tripura53
Unakoti49
West Tripura45
Khowai24
North Tripura14

30,257 36

1,845 147

28,069 183

343

DistrictCases
Hamirpur117
Kangra105
Una41
Solan32
Chamba29
Bilaspur21
Mandi21
Sirmaur11
Shimla10
Kullu4
Kinnaur2
Lahaul And Spiti0

20,370 157

2,489 116

17,590 272

291 1

DistrictCases
Churachandpur32
Kangpokpi26
Imphal West21
Thoubal18
Imphal East10
Tengnoupal9
Bishnupur7
Senapati6
Chandel5
Kamjong5
Ukhrul4
Jiribam3
Pherzawl3
Kakching2
Tamenglong2
Noney1

17,162 140

4,166 1

12,857 138

139 1

DistrictCases
Changlang31
Papum Pare8
Lohit3
Namsai2
West Siang1
East Siang1
Upper Siang1
Tawang1
PakkeKessang1
West Kameng0
Upper Subansiri0
Tirap0
Siang0
Shi Yomi0
Anjaw0
Lower Subansiri0
Lower Dibang Valley0
Longding0
Leparada0
KurungKumey0
KraDaadi0
Kamle0
East Kameng0
Dibang Valley0
Lower Siang0

14,244 33

2,260 137

11,951 170

33

DistrictCases
Chandigarh313

14,038 61

653 21

13,167 80

218 2

DistrictCases
East Khasi Hills22
West Garo Hills5
South West Garo Hills4
North Garo Hills1
West Jaintia Hills1
West Khasi Hills1
East Garo Hills0
East Jaintia Hills0
Ribhoi0
South Garo Hills0
South West Khasi Hills0

9,018 136

1,605 31

7,332 104

81 1

DistrictCases
Dimapur20
Mon8
Kohima7
Kiphire3
Tuensang3
Peren2
Phek1
Longleng0
Mokokchung0
Wokha0
Zunheboto0

8,626 111

1,871 54

6,724 56

31 1

DistrictCases
Kargil77
LehLadakh43

5,933 20

736 54

5,126 74

71

DistrictCases
South Andamans33
Nicobars1
North And Middle Andaman1

4,245 20

204 5

3,983 15

58

DistrictCases
East District3
South District3
North District0
West District0

3,835 16

246 20

3,525 35

64 1

DistrictCases
Dadra And Nagar Haveli20

3,228 3

51 1

3,175 2

2

DistrictCases
Kolasib11
Aizawl10
Mamit8
Lawngtlai2
Lunglei2
Saitual1
Champhai0
Hnahthial0
Khawzawl0
Saiha0
Serchhip0

2,493 46

290 41

2,203 5

0

DistrictCases
Lakshadweep District0

0

0 0

0

0

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