In his first interview after retiring as Head of Epidemiology at the Indian Council of Medical Research on June 30, where he discusses India’s COVID-19 crisis in depth, Raman Gangakhedkar has refuted the health minister Harsh Vardhan’s claim that the virus is “not that virulent” in India.
Dr. Gangakhedkar said there is “no biological reason to say less virulent”. He said that there was “no robust evidence” anywhere in the world suggesting different strains of the virus.
In a 60-minute interview to Karan Thapar for The Wire, Dr. Gangakhedkar spoke about two issues Prime Minister Narendra Modi has frequently mentioned to claim India is doing better than other countries. On the mortality rate, he agreed with points earlier made to The Wire by Prof. Ashish Jha of Harvard – that you cannot compare inter-country mortality rates because they do not take into account the different age demographics of each country.
However, Dr. Gangakhedkar, while accepting that India’s mortality rate calculation may not be perfect because of “missing pieces of information”, insisted that it’s not unreliable.
On the issue of recovery rate, another point frequently mentioned by the prime minister, Dr. Gangakhedkar agreed with Prof. Jha that eventually “all countries will have a recovery rate close to 99%”.
Speaking about the recent controversy created by the ICMR Director General’s letter stating that India would “launch a vaccine for public health use by August 15 after completion of all clinical trials”, Dr. Gangakhedkar said that this would not “have a long lasting impact” on the ICMR’s image. He said “it won’t affect credibility completely”.
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Elaborating on this point Dr. Gangakhedkar said, “It’s easy to talk like this, but ICMR’s credibility is not so fickle… ICMR won’t go down as a bad organisation because of one small issue… its long term credibility will not be affected.”
In the interview to The Wire, Dr. Gangakhedkar also explained why he retired in the middle of a pandemic which is steadily getting worse. He said the ICMR “wanted to keep me”. However, he explained he wanted to go back to his family after living alone for two years.
He said the ICMR had given him a professorial chair, which means that he is now Professor Gangakhedkar. He said he remains connected to the ICMR, even though he is formally retired.
In the 60-minute interview, did not refute projections made by Harvard professor Ashish Jha that India probably already has a total of 50,000 cases a day (both reported as well as undetected) and could increase to 200,000 a day by August. Nor did he dispute a projection made by Raman Laxminarayan, the Director of the Washington-based Center for Disease Dynamics, that India could have 200 million cases by September.
As he put it: “All these numbers are good for the moment when you are speaking”. He said projections such as these depend on disease dynamics but they are also impacted by the assumptions that go into them as well as by the impact of various lockdowns on the spread of the disease and by the proportion of people who follow non-pharmacological interventions such as social-distancing and mask wearing. “All possibilities exist”, he said. “I won’t say no to any possibility, but these are highly speculative”.
Questioned about Dr. Balram Bhargava’s categorical assertion on June 11 that “India is not in community transmission”, Dr. Gangakhedkar said there were pockets in Delhi and Mumbai where you could have community transmission, but that he would prefer to call it localised transmission. However, he insisted that India as a whole does not have community transmission though there may be a number of areas where localised transmission has occurred. He also pointed out that whether you call it community transmission or localised transmission the strategy for handling the problem will not change.
Questioned about categorical statements made to The Wire by leading epidemiologists, like Jayaprakash Muliyil and T. Jacob John in India, and Sunetra Gupta and Ashish Jha in the UK and the US respectively, that community transmission is undeniable, Dr. Gangakhedkar said “differences of opinion is common in science”. He added, “In science, we never say I alone am right.”
Dr. Gangakhedkar said “everyone would be worried” by the possibility that the millions of migrant workers who have returned to their villages could carry the infection and create surges in rural hinterlands. However, he tellingly added that lockdowns in rural areas were much more effective than in urban areas. He pointed out that villagers had made “make-shift isolation huts” to protect themselves from returning migrants. He said there had been many more violations of the various lockdowns in urban areas.
Speaking about the total number of cases, which is just short of 700,000 and increasing at 25,000 a day, making India third largest both in terms of daily increases and total cases, Dr. Gangakhedkar said “when you lift the lockdown the numbers will go up”. He explained that this was likely to be particularly so in metropolitan cities where “keeping social-distancing is difficult”. He added “where the population density is high the virus will spread rapidly”.
Asked by The Wire when he expected the pandemic to peak, Dr. Gangakhedkar said its “very difficult to say”. He said that different cities at different times will have different peaks depending upon their population. He explained that India is a sub-continent which means it’s like a combination of many countries and, therefore, a uniform national peak was very unlikely. Furthermore, he added, to predict a peak you need uniform testing, and that that is not the case in India.
Speaking to The Wire about the steps India must now take as it hits 700,000 cases and grows at around 25,000 a day, Dr. Gangakhedkar identified three “additional components”. First, he said we must make an effort to quarantine the entire family of every person in a high population density area who becomes infected. The family must be taken somewhere where they can be quarantined. He admitted that this would be an onerous task in metropolitan cities because the numbers involved would be high.
Second, he said we must improve hospital infection control so that non-Covid patients visiting hospitals do not get infected. Third, he said, we must devise strategies to reduce stigma. He referred both to the stigma of getting tested, which arises out of fear of the disease, as well as the stigma of being admitted to hospital where, additionally, patients can lose contact with their families. All of this puts people off getting tested. As a result symptomatic people often choose to not get tested and that only spreads the infection.
Finally, Dr. Gangakhedkar revealed that the serological survey of containment zones and hotspots announced by the ICMR on June 11, which has so far not been made public, shows that there are small areas – he did not define whether he meant entire containment zones or parts thereof – where the percentage of people found to be exposed to the virus is “close to 30%”. He added “there is no doubt about that”. He explained that the delay in announcing the result of this containment zones serological survey is due to “operational reasons in one or two areas” and it would be made public shortly.
This is the first time anyone connected with the ICMR has confirmed – although only in part – press leaks that the containment zone serological surveys reveal that up to 30% of people could have been exposed to the virus in certain areas. In fact, Dr. Gangakhedkar is the first official connected with the ICMR who has spoken at such length and willingly addressed all the issues and concerns about India’s handling of COVID-19.
The above is a paraphrased precis of Dr. Gangakhedkar’s interview to Karan Thapar for The Wire. Please see the full interview for further details.
