If current COVID-19 positive numbers continue, then peak can be expected in August: Virologist Dr Jacob John

India had 7,94,864 registered COVID-19 cases as of July 10. We are expected to cross 10 lakh cases soon. There are no signs of abatement, yet people have begun to complain of COVID-19 fatigue. Maharashtra tops the list with 2,30,599 cases, followed by Tamil Nadu with 1,26,581 cases and then Delhi with 1,07,051 cases. A total of 1,07,40,832 tests were conducted countrywide as of July 8.

According to the Institute of Mathematical Sciences in Chennai, the virus reproduction rate increased in July to 1.19 from 1.1 in late June. And we are nowhere close to the peak of the virus. According to virologist and former professor at the Vellore-based Christian Medical College, Dr T Jacob John, the peak can be expected in the second week of August or a few days later, depending on the testing.

If the government reduces the testing numbers or increases the rapid antigen testing numbers, then it will take a few more weeks to peak as then the government is manipulating the data.

“The peak can be expected in the second week of August. The rate at which the cases are growing shows that we are headed that way. As long as there are people have not been infected or are immune, the virus will spread and that is the majority now. If one person is infected, then the virus can spread to only 2-3 people. If the virus is in 2,000 people, it can spread to 4,000, 6,000 and even 8,000 people. So, it depends on the base. If the base population is large, then the growth will also be rapid. This means that it will become 15 lakh cases in one week,” he said.

In India there is an average of 23,000 cases new cases being registered for the last 10 days. “If this trend were to continue, then the cases will continue to grow until August. By the time the cases peak, the virus should have infected about 10% of the population. We have about 138 crore population and 10% of that is 13.8 crore and we are likely to reach there by mid-August. After that the virus will not go away, it will only reduce in numbers till about January-February. These are all predictions based on intelligent guesses based on the current numbers and not mathematical modelling,” explained John.

Several state governments have responded to the virus better than the Central government, which still has not released enough guidelines and procedures to follow. But John believes that people should be taught to control the spread and not the state.

“People should know facts about the epidemic, its spread, wearing of masks etc. They can do it even now. We are still in the midst of an epidemic and it is not too late to educate the public with the correct information. All sorts of misinformation are being spread. The government must have a set of data that is reliable and authentic. It must be taught to people and the best person to teach Indians is the Prime Minister. That means he has to learn it first,” underscored John.

Each infected person is a link in the chain of transmission. So, if one person doesn’t infect four people, they won’t infect 16 people.“This will eliminate one line of infection and that is what the country must be aiming at. It is not too late to educate the public why their behaviour is in national interest, family interest and community interest. People must take precautions themselves, willingly and knowingly. The old and the vulnerable must be kept at home. My wearing of the mask is a national contribution. Do people know that? No,” asserted John.

What is COVID-19? In several villages in the country there are no testing facilities, so then will nobody ever get COVID-19? These are questions that many epidemiologists have been attempting to teach the government. The insistence on tests to prove COVID-19 is also worrying.

“Are tests the only way to find COVID-19 cases? What is the clinical diagnosis? We have strict clinical criteria for COVID-19, so if you fulfil it, you don’t even need a test. If a person has fever and loses sense of smell, it is COVID-19. No more proof is required. Similarly, there are about eleven criteria and if a few of them are fulfilled, it is COVID-19. So, even if we do not test, we know that the person has COVID-19. And even if they test negative, they have COVID-19. Tests can be falsely negative in half of the tests,” highlighted John.

Though RT-PCR COVID-19 tests are considered the gold standard, the sensitivity of PCR is about 50%, so for each detected case, we are missing one case. Sensitivity is the ability of a test to detect a positive case correctly. So, with 50% sensitivity, it means another 50% of those tested get false negatives.

PCR testing was primarily done to trace contracts, not to determine infection. Many states, including Delhi have given up on tracing and isolation. Instead, Dr John advocates teaching doctors about mild, moderate and severer cases. “Doctors should know what should be done when. It is very easy to say doctors are gods, and when they make a mistake, gods are making a mistake. Science doesn’t work like this. It works on evidence-based action.These things should have been done in February, if not in March, but now we are in July. The epidemic has been raging since April,” observed John.

Even if cases increase, reducing mortality should be of importance. “Doctors must be given the right lessons because medical colleges never taught anyone about COVID-19. If Kerala can teach its doctors, then any state can teach its doctors. What should be taught must be decided by the Medical Council of India, Union Health Ministry and Indian Council of Medical Research,” noted the virologist.

Teaching the doctors is important to reduce deaths in the country. India has had 21,623 registered deaths due to Covid-19. Many more have gone under-reported or even unnoticed. Training helps doctors to understand how each medicine works and at what stage they must be given to a patient. It cannot be trial and error, insists John. Error here means death.

Citing studies, John says there are three proven drugs to reduce mortality – hydroxychloroquine, Dexamethasone and convalescent plasma. “Even though the World Health Organisation does not like hydroxychloroquine (HCQ), this medicine must be given on Day 1 of hospitalisation. It has to be a short course as there are side-effects. If we give it as per protocol, mortality will decrease by a significant chunk. If HCQ does not work, then a short course of dexamethasone. If this also does not reduce severity of the COVID-19 virus load, then convalescent plasma,” explained John.

United Kingdom had done a trial for dexamethasone and it had largely benefitted patients. It is a corticosteroid, which is used for its anti-inflammatory and immunosuppressive effects in COVID-19 treatment. Moreover, dexamethasone is readily available as there are several generics in the country.

Though HCQ raises so many questions, its testing has been a comedy of errors. “There were two trials – in the US and UK. In both of them, HCQ was tried on cases when they were severely ill. The French had showed how HCQ works; it reduces the viral load in the respiratory tract. If it is given late, it wreaks havoc, but those who have it early found it successful. In the Detroit study, when they gave HCQ with strict dosage, mortality came down by half,” said John.

On July 10, India recorded 26,500 new cases, the highest single-day total. Yet the Union Health Minister Harsh Vardhan continues to maintain that there is no community spread. The minister prefers to call it localised transmission. The current transmission rate of 1.19 means that each infected person on average infects 1.19 people. At this rate, the increase in the number of active cases will overwhelm the healthcare infrastructure in the country.