Month-long Lockdown, Pop-up Hospitals, Vaccine: Dr Fauci on India's Covid Conundrum

·11-min read

Terming the current situation in India ‘very desperate’ and ‘urgent’, America’s top public health expert and one of the foremost authorities on SARS-CoV-2, Dr Anthony Fauci suggested that the government marshal all its resources, including the armed forces, to immediately build makeshift field hospitals, and urged other countries to help with not only materials but also personnel.

Dr Fauci spoke to CNN-News18‘s Zakka Jacob on the second wave of coronavirus pummelling India as he answered questions and put forth his views and advice on how to resurrect the stretched-to-a-thread medical resources and bring the country out of the throes of a deadlier, more virulent second wave.

Edited excerpts from the interview:

Zakka: India is currently going through the second wave of Covid-19, which I’m sure you’re also following with great interest. What do you make of it? Is there anything that stands out for you in this second wave?

Dr Fauci: Well, the thing that stands out, it has the dynamics, is really somewhat similar to the extraordinarily large wave that we had in the United States. At the end of the fall in the beginning of the winter where we were seeing 300,000 cases per day, and we were up at around 3,000 and sometimes as high and as close to 4,000 deaths per day. So there is a similarity there as I’ve mentioned when I was asked by several members of the Indian press, what my recommendation would be and what I thought would be going on.

I think it’s clear that you have to take the step of shutting down most of the country, particularly the involved areas and I don’t mean shutting down for six months, you don’t need to do that. You just need to break the chain of transmission, and one can do that by shutting down to the extent possible for two, three weeks, four weeks, and then as soon as the cases start coming down and you vaccinate more people, then you can get ahead of the trajectory of the outbreak because obviously, you’ve got to get as many people vaccinated as you possibly can. And when you do that, we’ve got to do public health measures.

The other thing that, at least from my viewpoint, looking at India from a distance, what we’re seeing on TV and in the printed press, is that there’s a dire need for hospital beds, people are not able to get a hospital bed. So the United States has responded, both with oxygen cylinders as well as oxygen generators, and PPE etc.

In so many respects, India has helped out other countries, when they’ve had difficulties, so I think as part of solidarity with India, we really need to show that we are really very concerned. One of the things that I thought that you might be able to do as you recall when the Chinese had their big surge over a year ago, they very rapidly put up hospitals, almost like field hospitals for the military. In the United States, our National Guard has been very helpful, for example, in the distribution of vaccines. If you can mobilise the Indian military to help out and maybe put up field hospitals, the way you would do for example, during armed conflict, that could temporarily alleviate the shortage of hospital beds.

The last time India went into a nationwide lockdown, we are still reeling under the economic repercussions.

I think it’s very clear from experiences that we’ve now had throughout the world, in these terrible 16 months that we’ve gone through that the economy is going to suffer badly if you don’t control the outbreak. So when you try and balance it, preserving the economy versus keeping the outbreak going, the best thing to do is to shut down the outbreak. When you close for a few weeks, the economy will recover. The economy is going to recover without a doubt. Look at what’s happened in the United States to the economy, it’s recovering very nicely. So I would think that if you’re talking about shutting down for a prolonged period of time, that’s a different story. But if you’re shutting down just long enough to break the chain of transmission, in the long run, it will be beneficial to the economy, as opposed to it being detrimental.

Two things are different this time around – a lot more younger people are getting affected, and a lot more people are asking for oxygen, having breathing issues. This is not something we noticed in the first wave.

Well, it appears that there are two types of variants now, in India, at least. One is the B117 which is the UK variant, which seems to be concentrating in New Delhi. And then there’s the 617, which seems to be more concentrating in Maharashtra. Now, that being the case, both of those have an increased capability of transmitting better and more efficiently than the original Wuhan strain from over a year ago that spread throughout the world. So, since it has a better capability of transmitting, you would expect to see all kinds of people young and old, getting infected more. The fact that people seem to be requiring oxygen more frequently, is entirely conceivable and there are data suggesting that this virus may be a bit more virulent, or a bit more dangerous, in the sense of making people more seriously ill, than the original virus. Both of those things could explain both younger people getting infected because the more efficient a virus spreads, the more people that can get infected, but also the requirement for oxygen very well may reflect the fact that it might be a bit more pathogenic.

What can India do to expedite the vaccination process and I’m looking for examples of things to learn from the US experience where I believe you’ve vaccinated more than 200 million people.

Well, there are two parts of the vaccination programme, and it may be that India right now is not in a position to have both of those going at the same time. One is to have an adequate supply of vaccine coming in at a rapid rate as you probably know, the United States contracted with multiple companies, particularly the two major mRNA companies as well as J&J. We contracted for a total of 600 million doses and each month there was a very good flow or cadence of vaccines coming in. That’s the first thing, the second thing was when President Joe Biden became president, he immediately instituted a very efficient way of implementing the delivery of vaccines into people’s arms. We did community vaccine centres, federally qualified health centres, pharmacies, mobile units. We got vaccinated as volunteers who are physicians and nurses who came out of retirement. We got our National Guard to help out. So it was a very, very aggressive – in a positive sense – effort to get the vaccine that we have into the arms of people. However, you can’t do that unless you have a steady supply. And so it seems that is what India has to do. Because remember, prior to this, India was the largest vaccine producing country in the world. So you’ve got to now take your own resources, make vaccine yourself. I know there’s a supply shortage, but try and get as many supplies as possible to rev up your own capability, and then try and get it from other countries.

Yesterday, the decision was taken by the US to waive off patent rights for many of the pharma companies manufacturing vaccines. What do you think of that decision? Will that help developing countries like India?

It will, but it won’t be an immediate fix because if companies transfer and don’t get any patent restrictions and are allowed to develop the technology to develop an mRNA vaccine, let’s say in New Delhi and Mumbai or wherever. The fact is, that’s going to take a while to get that up and running. So that’s a good solution intermediately and in the long range, but it doesn’t solve the problem that India has today and tomorrow or the next day. What you need now is for the vaccines to put directly into someone’s arm. You will need, in a year or in six months, the capability of manufacturing by technology transfer, but that’s going to take several months to a year to get running.

Have you or the CDC or any other institute had a chance to genome sequence or study the new variants in further detail?

Literally, as I’m speaking to you within the next few days to a week, we’ll be able to know what the capability of the currently-used vaccines is and to what degree they protect against the 617 variant.

So, you’re saying to deal with this current wave, more than vaccines, it is about having field hospitals, increasing bed capacity, making oxygen available. What would your prescription be to the Government of India if they were to ask for your advice?

I think you have to look at it as an immediate, an intermediate and a longer range. Right now, immediately, you have people dying, you have people needing hospitalisation. You’ve got to get them oxygen, drugs, personal protective equipment, a variety of things to save their lives. You’ve got to get hospital beds now, you can’t have people out in the street in taxi cabs getting oxygen, the way we see on the international TV, media, you have to correct that problem right now. Then there’s the intermediate, how do we get more vaccines so that we can prevent people from falling sick three weeks or a month from now. That means you got to get vaccines that are already produced. Then, in the longer range, you’ve got to be able to get the transfer of the right vaccine technology so that over the next six months to a year, you can prevent subsequent waves from coming in. So I look at it as three phases. Today, a few weeks to a month from now and many months to a year from now.

Is there a fear of a third wave and a fourth wave, because it seems like with each new wave, the intensity of the disease, its ability to spread and to cause long term damage is that much more.

We’re experiencing that when you get a good vaccine, like the ones we’re vaccinating with, you get a higher tide of neutralising antibodies that not only protect against the original virus but there is a spill-over effect – not 100 per cent – but enough to protect people from getting a serious disease from the variants. So what I believe will happen is that if India now gets as many people vaccinated as they possibly can with their large population of 1.4 billion people now, even when we get new variants, the vaccination that you do now will very likely cushion or buffer the effect of a new variant. It may come, but I don’t think you’re going to get a very serious disease if you get almost everybody vaccinated because even though the vaccine may not be specific against the variant, it will have some effect against the variant.

There seems to be a lot of emphasis on Remdesivir and also steroids like Dexamethasone. I know there isn’t a standard prescription for this but what would your advice be as to when to go in for these medicines?

Right now, you want specific drugs against the virus to begin very early on, when people get symptoms to prevent them from going to the hospital. Once they’re in the hospital and require mechanical ventilation or high flow oxygen, that’s a different type of pathogenesis, you’ve got to suppress the inflammation, and the aberrant immune response. That’s the reason why Dexamethasone works so well. And next semester will embarrass cinnamon and other things that suppress inflammation. So you have to have two poles of the treatment, one early on to prevent people from going to the hospital and then once they’re there, and they get seriously ill, you’ve got to suppress that apparent inflammation.

Dr Fauci, you’ve led an entire nation through a very turbulent time of Covid-19. You were a voice of reassurance in your daily briefings. What has been the biggest learning for you that you would like to share with readers in India?

I think you can learn from the difficulties that other countries have had. In the United States, when we went through a very difficult time and we’re still not out of it completely, one of the things you’ve got to do is pull together as a united nation. You can’t have divisiveness among you, the common enemy is the virus. So you’ve got to put aside all political disagreements, all ideological differences and focus on one thing, like a laser beam. The enemy is the virus. You’ve got to fight the virus together, particularly when you have a big, diverse country like the United States, and a big diverse country like India, you’ve got to put all of your resources and focus just on the virus, that’s the lesson that I’ve learned.

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