In a forthcoming book titled ‘Till We Win: India's Fight Against Covid-19 Pandemic’, three of the country’s healthcare experts Dr Randeep Guleria, Dr Gagandeep Kang and Dr Chandrakant Lahariya have answered some pertinent questions surrounding the novel coronavirus, what we know so far, and what the coming months could hold.
According to a report by The Indian Express, the book will touch upon issues like how COVID-19 is not just another respiratory illness, the public health response and frontline experiences, the future roadmap for the public, doctors and policymakers.
Dr Guleria, the AIIMS Director, and a member of the government’s Covid-19 task force told The Indian Express.
“This is a unique journey that all of us have gone through. None of us was fully prepared either at the individual level or as a country. We thought it was important to explain firsthand how we all sort of got together, pulled our socks up, and fought our way through the pandemic.”Dr Guleria
Dr Kang is a prominent vaccine and infectious disease researcher, and Dr Lahariya is a leading public policy and health systems expert. The book is published by Penguin Random House India.
Speaking of long COVID, or the long-term effects of the infection which show up for months after testing positive, Dr Guleria said, “When we started, our main aim was to ensure cases were low and to prevent deaths. Now we have a situation where we are realising that unlike in the case of a viral infection, in a large number of people who have recovered, Covid-19 does lead to some degree of residual post-Covid sequela. In many this is very mild and they recover within a few weeks but in some, this can cause significant damage to organs like the lungs and heart, necessitating long-term rehabilitation and increased care. We need to move into the next phase of being able to provide long-term care.
More importantly, the authors note in the book that they expect ‘multiple peaks’, but whether certain periods were peaks or not can only be answered at the end of the pandemic.
“However, it cannot be said how many and when…Whether those were peak or not and how many peaks happened, that can be answered (only at) the end of the pandemic.” They also state that it’s not necessary that the places where cases and deaths have gone down are those which have already reached the peak.”Dr Guleria
The book also discusses the challenges we face on the vaccine front. “There is a lot of hope that we will have vaccines early next year. However, a lot of changes will happen as we go along. We have many vaccine candidates and the first one may not be the best and we may have more immunogenic and safer vaccines subsequently… Therefore… how do we decide if we will have one vaccine or multiple vaccines or will different groups receive different vaccination, and how do we distribute them to the entire population. These issues are addressed to some extent,” said Dr Guleria.
A more concerning observation pointed out by the authors is that pre-symptomatic patients could be as infections as a person with all symptoms. Dr Guleria told the Indian Express, “A small proportion, maybe around one in every 10 cases, would be pre-symptomatic or (have a) mild disease.”
“The key point is people can infect others (when) pre-symptomatic, when they themselves do not show any sign of disease. This would be around two days before the first sign of disease appears… There is also evidence that a recovered person can shed the virus from the upper respiratory tract for up to three months after the illness.”Dr Guleria
Would the possibility of reinfection prove to be a hindrance to vaccine development? The authors say, “Till now it is being inferred that even if a person is infected a second time, he or she is unlikely to develop serious disease in (the) second infection.” The immune system in these rare reinfection cases has been observed to respond quickly, and this could mean it won’t affect vaccine development and efficacy.
(With inputs from The Indian Express)
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