‘If we become complacent in even
preventing it, then we are in for a disaster.
A volunteer holds a placard to create awareness about COVID-19 at the
Chhatrapati Shivaji Maharaj Terminus in Mumbai.
disease specialist at the Unison Medicare and Research Centre, south Mumbai.
She consults at the Prince Aly Khan hospital at south-central Mumbai.
KEM and Nair hospitals in Mumbai and spent three years doing her fellowship in
infectious disease at Harvard. Dr Gilada has won a global award for HIV
extremely well prepared for the epidemic. We are only saying that because we’re
still at (low fatality) numbers.
exactly is the community spread of a viral pandemic like COVID-19? Has India
reached that stage yet?
other goes through different stages.
country (that had the viral outbreak).
we find cases amongst contacts of these travelers.
when the disease has come into the community, which means that it’s not just in
the travelers or their contacts. It’s also now in the general community, which
means that now, if we were to screen only those who were travelers or contacts,
we would miss a lot of cases.
we (in India) are just between
(Stages) Two and Three, because
all the recent cases, that we have found, have only been in travelers or in
their contacts. But we also know that what we find is probably just part of the
me just backtrack to again understand the definition of community spread. If
there’s a traveler, and he has given it to his family, so when the family gives
it to their neighbors, that still is not community spread?
So once the neighbour
has acquired it, it is community spread.
I am told the community spread means when some case presents itself, where the
person doesn’t know where he’s got it from. So you’re saying it’s both?
you will be able to just go back and see that: ‘Oh so this person got it from
the neighbour’s house and the neighbour were in touch with this person’.
when three or four steps have gone (missing),
and there is no way to go and say where did that happen from?
happens, that is the point where — if you’ve seen the graph of any epidemic —
that is the time when the graph starts rising ie when it’s community spread.
they have always been able to track down the contacts and who these cases have
been in touch with.
not going to be like this for another one week. We know it is going to spill
out into the community a bit.
nobody’s talking about community spread yet?
social distancing is because we anticipate community spread.
anticipating community spread, there was no need of social distancing. Then
just screening travelers and quarantining them and asking them to get
self-isolated would have been enough.
that we are all really, really
urging on social distancing means that we anticipate that there is going to be
way the leadership of a country deals with an epidemic and how it communicates
a message to its people is critical at these times. One has been watching how
different national leaders are tackling the crisis across the world.
The prime minister addressed the nation
when demonetisation happened. But not for this. We haven’t heard anything from
the health minister.
Do you think the leadership is stepping
up to the task?
ways, we are slow.
think that we are doing everything up to the mark. And we are extremely well
prepared for the epidemic — which isn’t true.
well prepared for the epidemic. We are only saying that because we’re still at
(low fatality) numbers.
many government officials have been announcing that we are well prepared. And
because of that people feel it is not going be that bad.
to think that way and say it in the papers.
are not well prepared.
and or in Bombay, we know that they are really taking a lot of proactive steps
and are already planning for weeks ahead.
coming up with plans that if this epidemic really blows up, what will be the
other labs that will be open for testing, and what will be the other hospitals
that will be utilised.
it’s not just about getting the infrastructure ready. It’s also about
retraining a lot of manpower to handle this epidemic in the right way.
to accept that we are in for a disaster in the next two weeks if we really
don’t do what a lot of other countries did in a very, very regulated and a
strict manner. Like if you see what happened in Wuhan, they really, really had
a very bad peak with the epidemic.
rest of China they were beautiful in what they did. They did see huge numbers
and they did see a lot of deaths. But they were able to do that they were able
to curve that epidemic in a span of one-and-a-half to two months.
that if the epidemic comes to our country?
handle an epidemic of that strata, (causing
that kind) of excessive calamity, then we really have to prevent
it. Then if we become complacent in even preventing it, then we are actually in
for a disaster.
worship politicians in India. They really worship (Prime Minister) Narendra (Damodardas)
Modi and they worship some chief ministers.
the time, that if they really come out and say that Narendra Modi is going to
address the people of India at 8 pm tonight, it’s like a big thing.
people to: ‘Please stay at home and this is what we really want you to follow’,
we know it will make a big impact.
first time. We know that health and education really doesn’t receive that kind
of priority or attention or response from politicians the way it should. I hope
at this point, some good sense will prevail.
me ask a kind of bald question. I’m holding my cell phone and I feel for sure
that a few COVID-9 viruses are on it. How do I kill them? How do I know or am
absolutely sure they are dead?
corona-virus is on your cell phone?
say where coronavirus is at this point in time.
assume that corona-virus is on surfaces that are being touched by several
people, door handles, cabs and whatever.
sub-conscious mind, we just need to keep thinking that this virus is everywhere,
which will really make us
follow hand hygiene religiously.
difficult to kill the virus. Any disinfectant which is either alcohol- or
bleach-based is enough to disinfect surfaces.
like even like when you are washing things in the kitchen, vegetables, milk
bleach. Sterillium that we use. You can take some sterillium on a tissue or
cotton and clean your cellophane. Little things. That’s enough.
lot of educated people one talks to don’t believe that we are in a dangerous
situation. And this particular virus is a little bit more dangerous than other
viruses for various reasons.
Why does this pandemic seem to be worse
or maybe on par with previous pandemics?
Why has it gotten more out of hand with
this virus? Or is it just the nature of this virus, where people don’t actually
die and it quietly spreads. Is it
more lethal than some of these other viruses like SARS, swine flu, Ebola, bird
Is this pandemic worse than other ones?
What is your view?
qualities that decide how bad the disease is going to be.
spread. So any disease that spreads through respiratory secretions always tends
to spread faster. Because the virus is there in the cough and the sneeze, and
it’s extremely difficult to have 100 per cent hand hygiene or cough etiquette.
infectiousness of the virus. And that is like an innate quality or that’s like
a personality of each virus.
called R0 (basic reproductive rate)
which decides how infectious each virus is going to be. And that number
technically means that during the disease period, in any patient, how many
other people will this patient infect.
corona-virus 19, the SARC-CoV2, is around three.
lot of other viral diseases, like for HIV, for that matter, the R0 for HIV is
what’s so different?
positive person will infect three people in the course of the disease, which is
an entire lifetime.
someone with COVID-19 will infect three people, in the course of the disease,
which is only 10 days. That means it’s such
a short span of time, three people will keep getting infected.
people get infected, and each of these infects another three, that’s nine, and
then another three it’s 27. So it’s like exponential.
such a short span of time, within like a matter of months, we’ve really crossed huge numbers.
infectiousness of the virus. And that’s the reason why this entire concept of
social distancing, because, we believe, that if someone who’s infected with the
virus actually doesn’t come in contact with that many people, we are basically
trying to bring down the R0.
people getting infected, we really want zero or one person to get infected, so
that’s the aim (with regard to)
the infectiousness of the virus.
quality of the virus is the mortality rate or the case fatality rate. And the
case fatality rate is out of hundred people who get infected with COVID-19, how
many of them are going to succumb to COVID-19.
rate, if you see, this number has changed from country to country like South
Korea clearly has a very low case fatality rate.
between 2 to 4 per cent. The fatality rate in South Korea was 1 per cent.
actually seeing in Italy is around 6 per cent.
of the higher population older people?
fatality rate also depends on a lot of things. It depends on what the age
structure of the population is, how good your healthcare system is.
healthcare system will be great. But if it is over-challenged, so there are
just too many people reaching the healthcare system beyond what the hospital
can handle, then the entire system just collapses.
receive five people in the ICU, I can offer really good care to five. But
instead of five if I start receiving 15 on the same day, then I know that the
care will be compromised.
reason why they really want to flatten the curve (COVID-19 case curve). That’s the entire concept of flattening
the curve — you don’t want that peak to be really high.
peak, the more number of people who will reach the hospital and the more
over-burdend the health system will be.
infectiousness: So SARS was like an epidemic that spanned over six months. And
even over six months, the cases were not as much as what corona saw just in a
matter of one-and-a-half months.
time, it hasn’t killed, percentage-wise, that many people.
know that, at most, it has been 5 to 6 per cent.