With 2.69 crore cases and 3.09 lakh deaths and counting, India has been battered and bruised by the second wave of Covid19 in the last month and a half. The country struggles to battle against covid-19. In an exclusive interview with Dr. Faheem Younus , the VP and Chief of Infectious Diseases at University of Maryland , Upper Chesapeake Health discussed methods and measures that can help in contain the raging pandemic. Speaking to Contributing Editor Smita Sharma from Maryland, Dr. Younus warns that unless country like India vaccinates 40 to 50 percent of its population, such outbreaks can not be ruled out in the future. He interestingly suggests that overall environmental contamination and not over use of steroids or high cases of diabetes may be the critical factor triggering Mucormycosis in India, as it has not been a similar experience for USA, South America or Europe despite the burning Covid numbers. The globally acclaimed doctor whose twitter timeline has been closely observed by public health experts, doctors and journalists in India for the past year also shared practical advice on how to Mask Up and why you need breathing spaces to sustain.
Q: How do you view India’s current Covid situation?
Answer: It’s a precarious situation that needs to be immediately controlled with our own behaviour. Whether you call them lockdown or whether you call them restricting. Some of the activities are social distancing but then focusing on the long term of mass vaccination because unless you get into 40-50 percent of vaccination of the country such waves are likely to happen or there is no predictability or sort of its living up to chance. So, I think vaccination will be the right way to continue it in the long run.
Q: Is Extending the gaps between two doses of Covishield to minimum 12 weeks advisable?
A: I think stretching the second dose is almost always supply related; otherwise, these trials were done within three and four weeks and I don’t think anyone should try to hide it or there is no issue. I don’t hold it against the government. Countries like India or even Canada have stretched it to 12 weeks and in some cases 16 weeks. If you have taken just one vaccine dose don’t consider yourself immune. Continue to use exact same precautions as if you are not vaccinated even after first dose. But I Wouldn’t worry that the immune boost would be not as strong if the second dose is delayed.
Q: Your thoughts on India’s vaccination drive speed and efficacy of vaccines against mutant variants?
A: Yes, even while you’re working on getting more vaccines we should be working on vaccine hesitancy and making sure people are comfortable with it and they are educated about the side effects. You’ve to somehow get to somehow 7 to 9 million vaccinations a day for India to be in a sustainable situation 3 months from now.
There is Enough data out there to believe that mRNA vaccines are more superior in terms of their protection against their variants which include Astra Zeneca, Sputnik, JJ (Johnson & Johnson). Some are conventional vaccines. But really no way to say one is better than the other. Whatever vaccine is available, take it, that is my best shot.
Q: India is faced with Epidemic within Pandemic-Are the Mucormycosis cases alarming?
A: We have seen tonnes of Covid cases in Europe, Brazil, South America and right here in US. We have used tonnes of steroids. There is lots of obesity and diabetes in these parts of the world
But we have not seen explosion of Mucormycosis in Europe, South America or US. Question is what is different in India? Leaves me with some environmental factors- level of hygiene in our societies, overall soil contamination and the milieu in which people exist . Because fungus lives in the soil there could be some risk factors. People need to understand that no matter what happens, Mucormycosis will remain a small number . NO matter what happens, I have treated this disease many times. This is not a viral infection. There is no chance of this becoming a pandemic. It doesn’t go from one person to second.
It ultimately has to do with host factors . We don’t know the exact numbers. But when you compare it with the millions of cases that India has had -precise treatment is always the right treatment. When you over treat there is always a risk. So there may have been overtreatment with steroids or contamination with oxygen supplies.
Science does not allow for either extreme. One extreme is this is all a hoax, a hyper reaction and denial. The other extreme is panic .We are now in that panic mode in multiple countries. I am seeing a little bit of that in India My advice will be always resist that temptation, you will be in error .Any time you are going on those two extremes, you are likely making an error .I am sensing Mucormycosis, Black Fungus creating an extreme narrative- that is wrong. It is a very small number of people that will be impacted. It does not go from person to person. You will be able to control it
Q: There is a lot of fear about the fatal impact of a possible third wave for children in large numbers. It is being debated here. How do you weigh in?
A: In a situation like this, we should not make careless, irresponsible statements unless they are backed up by the data. As far as I’m concerned, I have not seen compelling data to that effect (that third wave will affect children more adversely). Yes, Children and young people will get more infections as you open up a society.
There can be 100s of other reasons for it. So, we can’t label it a conclusive argument. This is a very bold statement to say that in India because of this variant more children will get infected and die. That’s a very bold statement. I cannot make that, cannot substantiate. We always need to be very careful.
Q:A common question is when and how to mask up. Is double masking the best solution for India given slow rate of vaccinations ?
A: Double masks are a good idea for high risk situations, if you are a bus driver or a frontline worker, if you’re around crowds all the time, yes you would want a double mask. In most other situations, a single mask worn properly is adequate enough. People can wear a surgical or a KN95 mask that should be more than enough. As long as you can reuse the K95 mask as they can be expensive and supply can be limited. If you are in your own house you don’t need a mask. If you are around your own family members and none of them are sick, you don’t need a mask. I don’t find the wisdom in someone driving in their own car alone and masking it. None of that makes sense. Mask is the same issue- we cannot go to extremes because we have to sustain it for weeks and months. Extreme situations will not be sustainable on either side . I do not think walking or jogging outside needs a mask. Science will say 90 percent of transmission is indoors. If you don’t allow people scientifically safe breathing space, it will increase depression. People have been making an insane amount of sacrifice for over a year now. There is a lot of emotional and physical exhaustion . You have to allow the middle path to people wherever science allows us.
Q: Should we be worried that Covishield and Covaxin are not accepted as vaccine passport for some US and EU cities and institutes?
A: Don’t take things personally from a religious or nationalistic perspective. Confidence is built by published studies. Any vaccine if it does not have enough data, which is peer reviewed, published in leading journals, you are likely to run into regulatory issues. There is a reason that Astrazeneca is still not approved in the US even though this is a vaccine by UK not by the developing world. Because it could not pass the robust screening of peer review in journals. These are not biased views, these are purely based on science. J&J case in point-great vaccine, single shot, no refrigeration needed but a handful of blood clots and it created an uproar. That’s the degree of safety we expect from these products. So unless it is published rigorously and analysed by independent authorities, it will be hard and some governments may not accept it as a vaccine passport .It will evolve very soon though
Q: Can vaccines be mixed and matched if there are delays between doses? Or can one vaccine be topped up by another in a few months as better protection against variants?
A: The scientific answer is we don’t know. As of today those studies have not been done. It will be hard to recommend that. The practical answer is that anyone who has access I think they are going to get it. They are not going to ask for anyone’s permission. But I have not seen that level of safety data. I have not seen that level of rigorous scientific research on it.
Q: ICMR dropped plasma therapy from Covid treatment recently. What is the lesson from the past year on what protocol really works?
A: The list of what doesn’t work is longer because a lot of people who indulge in pseudo sciences are allowed unfettered access to media . People who have no expertise will come out and throw their opinion around and nobody challenges them.
I also tried plasma on many of my patients. I also tried HCQ, azithromycin. I have given Ivermectin to a few patients. But this is what science does to you. You keep an open mind . When the data says you can use it, you use it. When there is enough data, that it doesn’t work then you change yourself and render your opinion to the evidence. We have a moral obligation to call out the pseudo science pedalling.