In an interview that will puncture the government’s claim that we are in control of the trajectory of COVID-19 and, additionally, is critical of the Director General of the ICMR, Balram Bhargava, India’s top virologist has said, “Obviously the situation is alarming”.
Dr. Shahid Jameel says there are two worrying aspects – first, the rate at which COVID-19 is growing and, second, the location where it’s growing. Two-thirds of the cases today are in rural India and in villages. He believes we could already have over 650 million undetected cases.
In a 42-minute interview to Karan Thapar for The Wire, Jameel drew attention to the dramatic increase in both cases and deaths over the last two months. He said the seven-day moving average of cases on September 16 was 93,200. The seven-day average for deaths was 1,160. Two months earlier the seven-day average for cases was 27,000 and for deaths 540. He pointed out that this means that in just two months the case load has increased by 230% whilst deaths have increased by 115%.
Jameel predicted to The Wire that India would move from 5 million to 6 million in under 10 days.
Asked by The Wire whether his figures meant that the spread of COVID-19 is accelerating in India, Dr. Jameel answered “absolutely”. He said this is “indeed worrisome” and we are seeing a significant escalation in both cases and deaths.
Asked if one can extrapolate from the ICMR’s serological survey done in May and June, which suggests that for every detected case there are likely to be something between 82 and 130 undetected cases, to conclude that on that basis today, when we have 5 million recorded cases, we are likely to have somewhere between 410 million and 650 million unreported cases, Jameel said “yes indeed”.
However, Jaleel pointed out that the real number is likely to be even higher because the outbreak of COVID-19 has expanded considerably since mid-July. He said logically speaking we are probably likely to have somewhere between 700 and 800 million cases (both reported and unreported) today.
Jameel pointed out that the interview given to The Wire on March 18 by Ramanan Laxminarayan, the director of the Washington-based Centre for Disease Dynamics, where, applying US estimates to India, he had forecast that in the worst case scenario India could end up with 60% of its population infected i.e. some 700 or 800 million people, was spot on.
He said Laxminarayan has been wrongly and foolishly criticised both by BJP spokespersons and some senior journalists. Today that forecast has been vindicated.
Jameel, who is the CEO of Wellcome Trust DBT India Alliance and a winner of the coveted Shanti Swarup Bhatnagar Prize in 2000, compared India’s present situation with that of the United States. He said India was growing at a 7-day average of 93,000 cases daily. For the US the figure is just 39,000 cases daily. He said India will overtake the United States in 3-4 weeks, if not earlier.
However, Jameel was critical of ICMR director general Balram Bhargava who on September 15 had said: “We distributed the curve in a way that … we didn’t have a huge peak at all”.
Jameel said: “How does one respond except to feel sorry for such people? He (Balram Bhargava) is an important man and his words should be chosen carefully. People in important positions should choose their words carefully.”
Asked by The Wire if he was disappointed by the ICMR and, in particular, Dr. Bhargava, Dr. Jameel said, “You are being very kind”. Asked to spell out more clearly how he viewed them, Jameel politely laughed but said no more.
Speaking about statistics made public by Health Secretary Rajesh Bhushan on Tuesday that only 3.6% of India’s COVID-19 patients need oxygen, only 2.1% are in ICU and just 0.3% on ventilator support, Jameel said that “percentages don’t tell the actual picture”. No doubt the percentages are small but, because the actual number of cases is large, in absolute terms the numbers needing oxygen, ICU treatment and ventilators will be very big. If you speak in percentages it might give you comfort but it hides or even disguises the reality of the actual numbers involved, he said.
Speaking to The Wire about the comfort the Indian government gets from India’s low mortality rate (60 per million as of September 17), Jameel pointed out that the mortality of all our neighbours is considerably lower. It’s 29 per million for Pakistan, 29 per million for Bangladesh, 13 per million for Nepal and 0.6 per million for Sri Lanka. He said we keep looking to the West and, therefore, assess our performance as better than that of Europe and America. If we look to the East what we will discover is that there are many countries whose performance is better than ours. What is also clear is that India’s low mortality is not unique. It does not put India into a special category.
Also read: Should India Join the COVAX Initiative To Secure COVID-19 Vaccine Doses for Indians?
However, Jameel does not believe there is a huge and worrisome under-estimation of COVID-19 deaths in India. First, he pointed out that deaths would be undercounted in a pandemic all over the world. Second, because most of the COVID-19 deaths so far have been in urban India and likely to have happened in hospitals, the undercounting will be less. However, this does leave open the possibility that as the virus moves into rural India, where hospitals are few and doctors lacking, under-estimation of COVID-19 deaths could considerably increase.
India’s top virologist said it’s not surprising that COVID-19 antibodies wear off in 4 or 5 months. He said thereafter T-cell immunity and memory response immunity will continue to protect. He pointed out that this may not protect against a second infection but it will definitely protect against disease. He added the infection is not what matters. What counts is the disease and T-cell immunity and memory response immunity will guard against the recurrence of the disease.
Speaking about Dr. Anthony Fauci’s claim that it’s unlikely a COVID-19 vaccine will be 100% effective, Jameel said that no vaccine in the world is ever 100% effective. Even the oral polio vaccine can cause the disease in one out of a million cases.
Speaking specifically about the Russian vaccine Sputnik, Jameel said he had read the report in the Lancet as well as the criticisms of the findings. He said he believes Sputnik is “under-powered”. He said “only 40 volunteers had been tested in the Phase 2 trials”. He added that the fact there are identical data points “does raise concerns”. He said this “needs clarification … it’s a matter of credibility”.
Finally, Jameel spoke about a recent article published by The New England Journal of Medicine which hypothesises that mask-wearing could become a form of variolation which could reduce the severity of the virus and ensure that a greater proportion of infections are asymptomatic. He said he believes mask-wearing will become common but doubts whether it can reduce the virulence of the virus.
Please see the full interview here.