 Good evening. You're watching NGTV with Meera Shakabarwa. This is a show where we take your questions on the coronavirus. You can dial us in the number of flashing on your screens. We'll be joined by a panel of expert doctors who will answer those questions. But what are we focusing on this evening? A second wave of the coronavirus is inevitable. This is what has been said by US's leading epidemiologist Dr. Anthony Fauci. Now just how bad this second wave is, he says, depends on the progress we make in the coming months. He's of course said this in context with the United States, which is the worst affected country. But let's first listen in to what he's had to say and then we'll ask the doctors about it. If we are unsuccessful or prematurely try to open up and we have additional outbreaks that are out of control, it could be much more than that. It could be a rebound to get us right back in the same boat that we were in a few weeks ago. So that's why we've really got to be careful and very circumspect as we go from a lockdown to a gradual rolling reentry into some sort of normality. All right. So that is what Dr. Anthony Fauci has said. He's talked about the possibility of a second wave of infections. Is that something which is possible? Is that something that we need to guard ourselves against? And what does this second wave of infections essentially mean? Joining us on the broadcast, Dr. K. N. Manohar, he's a consultant physician with the Manipal Hospital in Bangalore. He's also a fitness enthusiast and has participated in many marathons. Appreciate you, doctor, for being with us this evening. Also joining us is Dr. T. K. Venkatesh. He is an interventional cardiologist from the Apollo Hospital in Bangalore as well. Appreciate you, doctors, for being with us on the broadcast. You know, I want to begin by asking you a little more about what we just heard Dr. Anthony Fauci say. He says that, you know, a second wave of the coronavirus is inevitable. Do you think this will happen, Dr. Manohar? Perhaps in the winters, can one expect a second wave? How can we guard against it? What would you like to tell our viewers? Yes, Dr. Shikha as Dr. Anthony Fauci has already told that we will have a second wave. So end of lockdown is not end of coronavirus infection. So this virus is here to stay. So what are the precautions to take for this? Are the five commandments. Clean, washing your hands, cover your coughs, contain yourself. Someone is sick. Please stay at home. Physical distancing, not so much of social distancing. We call it as physical distancing also. And avoid men touching off mouth, eyes and nose repeatedly. These are what we are talking from so long about all these things. But what we are trying to reiterate is end of lockdown or release somewhere we have to release it. And our experts believe that up to 60 to 70% of the population, possibly sometime or the later, will have this coronavirus infection. So why did we do the lockdown is just to avoid the week? All right, very interesting point that you make there. Let me also bring in Dr. Venkatesh. Dr. Venkatesh, would you like to comment on what Dr. Anthony Fauci has said he's also warned against the premature lifting of a lockdown saying it could lead to a resurgence in cases. But he seems pretty confident as an epidemiologist when he says that there will be a second wave. This is extremely worrying. Yeah, I completely agree with what he says. And the fears of a second escalation is always there. This would happen in such time as something called as herd immunity would happen. Now what is herd immunity herd immunity is at least when 30 to 60% of the population have the virus in them and they have become immune to it so that if the other person transmits the virus, they just bounce off these people who have become immune to the virus. And that way the population to a very great extent is protected. So until such time as herd immunity develops, this is going to be a problem where we have to live with. All right, our first caller Vasudevan is on the phone line from Bangalore. Let's go in and get a question and then we'll talk a little more about this. Go ahead, ask a question. Hello, ma'am. I am Vasudevan from Bangalore. It has been in US Ramdesvair is giving a positive treatment. If it is so, when will we get the drug? If it is successful in US because the treatment for 10 days, if you take the drug, it is showing some positive results. All right. I'm not I'm not entirely sure, Mr. Vasudevan, what drug you're talking about because there are several drugs that are being considered for treatment. But let me take that to Dr. Manohar. You know, the big question, of course, on everyone's mind is when will we get a vaccine? How far away do you think we are from it? Yeah, first to answer the caller's question, I think he was alluding to Ramdesvair, one of the antivirals, which we use it for HIV, as we all know from simple medications like vitamin C to anti malarial drugs to plasma therapy to Ramdesvair. A lot of drugs have been contemplated to be useful, but none of them have been consistently shown to have any benefit. So some weeks back itself, we had some reports from CNN itself to say that Ramdesvair may not be as useful. So we need to wait for that. Secondly, to the vaccine, what you alluded generally takes 12 to 18 months to get a vaccine in place. But yesterday, I think in our show, we saw that ICMR is speeding up the process. CRM Institute is hopefully closer by and by the end of this year, if things go well, right, we may have a vaccine. But to add to that, this COVID-19, I call it as an elusing moving target. What we know about it today is not the final thing. So what vaccine problem is, we all know that there is mutations in this viruses. So that could also pose a challenge for any form of therapy, including vaccination. All right, Dr. Venkatesh, is there anything you'd like to add? Yeah, I think as far as vaccines are concerned, it'll take a long time for the vaccine to come. And if a vaccine is found against coronavirus, then this is going to be probably the quickest vaccine which we are going to see in our lifetime. Right. There are so many genetic mutations, which probably would happen with the virus. And so that makes the production of a vaccine a little tricky. And it is now undergoing some human trials. A couple of countries have jumped into it. And once we get the vaccine, well, I think it is an add on to probably the herd immunity that we are going to develop over a period of time. All right. Our next caller, Amar, is on the phone line from Bangalore. Go ahead. Very good evening. My question to the doctors is actually in two parts. I would like to know if this virus is evolving. Does it have characteristics of evolving over a period of time? And second part is I would like to know if the people who are infected and who have recovered, do they have the chance of getting infected again? Okay, let me break it down into into two parts. Dr. Manohar, would you like to, you know, talk about whether the virus is evolving? Yes, coronavirus is a very well known virus being there here for so many decades. So once it got evolved, it became Mars. Later, it got evolved, it became SARS-CoV. Then again, it is a world SARS-CoV 2 has come in. So survival of the fittest, even organisms will try their best to survive. When they evolve, they change their genetic component. In this case, we call it as a zoonosis. They pick up component from, let's say, bad as it is postulated here. And when they develop the beta types of the coronavirus can infect the humans also. So when they infect us, we don't recognize this because our most cannot, our defense cannot recognize this. It's a new virus. Okay. And the problem is this, this type of virus can spread from one person to one person easily. So that's why this havoc is happening. Definitely it is evolving. All right. Dr. Lekates, would you like to answer the second part of that question on whether a person who's been infected once can get the infection again? Yeah, it's too early to actually jump to that kind of a conclusion, because COVID-19 testing is still not very widely available. Secondly, we have to prove the antibody titers of that person who has been infected and shown that it has reached a good value. And in spite of that, he's got infected. So they're still in the preliminary stages of trying to conceptualize this kind of a situation where probably we hypothesize that there is a reinfection occurring. Yes, there are some anecdotal reports in the literature where people have gone and reported a few cases that this patient was considered to be cured. And now they've got a reinfection. All right. Our next caller, MML Verma is calling from Mumbai. Go ahead. Yeah, my question is today, the data of total deaths during March 2020 has come up in USA. Okay. Yes. Yeah, now there is a reduction over the average of last four years, total number of deaths. So what would be your comment on this? All right. Dr. Manohar, would you like to answer that? I'm not clear whether he's referring to what deaths and total mortality is a whole? Yes, with the mortality rate is a whole. Yeah, there are lots of interesting things which are coming up. It's too early to sum this up and say that corona has protected lives. There are a lot of people who the lives have saved by less number of accidents, less people are stressed, hopefully, so that incidents of myocardial infarctions are also much lesser. Right. But I can't be too early to analyze that data perhaps. Mr. Venkata Subbaru is calling us from Guntur. Go ahead. Good evening, madam. Good evening, sir. Good evening, sir. Go ahead. Good evening, madam. Sir, my question is asthma patients are prone to coronavirus. Okay. My question is asthma patients are prone to coronavirus, COVID-19. Asthma patients, please answer that. All right. Yes. Is your question... Okay, Dr. Venkata, should I take that on? Yeah, I'll take it on. There are a subgroup of people who are probably more prone to coronavirus and they are usually people who are more than 65 years, patients with type 1 diabetes, those who are on immunosuppressive therapy, patients with heart and lung diseases, chronic kidney disease, and patients who are suffering from cancer. In them, the immunocompromised state exists and so they are more prone for catching an infection. Asthma is also a respiratory illness and to a certain extent, having a coronavirus infection in an asthmatic, can we be a little more mortality probably compared to patients who don't have asthma and who develop a coronavirus infection? All right. Very interesting. As far as patients who are predisposed to a particular condition, Ramana Rao from Hyderabad, our next caller, go ahead. Good evening to all of you. Good evening. Go ahead. My question is regarding everybody is saying, including ITMR, RT-PCR is the only reliable test to confirm the disease. But my question is, how many districts are available? RT-PCR killed a person among the infected districts. How close are they to the test? All right. It's difficult, of course, to quantify it. The ICMR website, I can tell you, has a list of accredited labs. You know, Mr. Ramana Rao, if you want to go and access that list to figure out if there's a lab in your neighborhood, you can do that. The ICMR website has a list. But let me take this question to Dr. Manohar because it's interesting. On the reliability of the test, that's the other point that has been raised. You know, are the other tests like the antibody test, for instance, as reliable as the RT-PCR? Definitely not. The gold standard test is RT-PCR. Even that sensitivity is about 70 odd percent. The antibody test, I think we all know that a lot of news are coming in that what is the reliability? You have to go on to roughly about five percent. Some people are questioning the way it is done and also the kits from where it has come from. So the gold standard test is RT-PCR. All right. Our next caller, Srikanth, is on the phone line from Bengaluru. Go ahead. Hello. Hello. Good evening, Dr. Venkatesh. Good evening, Dr. Manohar. Good evening, sir. Hi, Dr. Manohar. I am Dr. Manohar's patient, actually. So one of the doctors, I know, he's been treating me for diabetes. All right. Could you please ask your question? Yeah, I will be coming to the question. See, basically, this coronavirus has hit us for a very long time. And according to some school of thought, this particular virus can be cured by taking some hot water every day. That's what I believe. So there's some, I've heard about this, that drinking hot water for at least 15 minutes. Is there any evidence to suggest that? Yeah, I don't know the doctor's name. The question is for the doctor. Dr. Manohar, since this is your patient, would you like to answer his question? No issues. Yeah, there are a lot of preventive measures, as we say. General thinking is code, anything code can stimulate the virus. Right. Anything hot is good. That's why even data today's article, if you look at it, Mumbai and Bangalore, they evaluated and say 85% correlation with temperature. So any warm fluids are better than consuming cold fluids. Possibly because the virus can have receptors around the world of firings. It's very interesting that you talk about a temperature correlation because Dr. Venkatesh, very briefly, could I then ask you, you know, the talk of the possible resurgence of the virus in winter, in lower temperatures? Is that perhaps something which is possible? Can we consider? Oh, yes. There has been some kind of a correlation attributed to temperature and humidity as far as the behavior of the virus is concerned at its virulence. They say that any temperature which is more than 25 degrees centigrade or some say 24, whatever, 24 to 25 degrees centigrade makes the virus a little more less penetrative and less virulent. And if you keep up the humidity, it's good for you basically not for the virus. People say that if you decrease the humidity in your room, then your mucosal will dry up and the mucosal barrier, that is the first resistance against this virus is kind of eliminated and therefore people tend to catch an infection much faster. So there are certain papers which say that you have to dehumidify rather than humidify. So this is a little controversial as far as the humidity part of it is concerned, but temperature, yes, definitely. All right, our next column, Vikram Sarkar is calling from Mumbai, go ahead. So my question is on the set-free WAC that is there. And which I understand is working not on the virus, but on our immune system. And basically it is already an approved medicine which is already used. So and I think some of the trials have already successfully done on that. So can't we use it? So what is restricting? I mean, why are we not able to use it? Dr. Manohar, would you like to take that on? I didn't get what medicine was referring to. The drug by the name of Cepcivac. It's a Cepcivac. It's a... Dr. Venkatesh. Dr. Manohar. You want me to take that? Yes. Cepcivac is supposed to be a drug which is mycobacterium W and it's usually used in gram-negative Cepsis. And it's used basically to overcome the cytokine storm. So it's generally restricted to be used in critically ill patients and that has been approved by the DCGI. But we still are just doing clinical trials. We do not have large outcome data as far as Cepcivac is concerned. So we got to wait and watch. Is it true that the drug doesn't actually attack the virus but helps to build the immunity? Dr. Venkatesh? Well, it prevents a cytokine storm. When the virus gets into the body, you know, it kind of initiates a lot of inflammation and a lot of cytokines get liberated. And this cytokine storm is supposed to be subdued by the Cepcivac. That's how it works. All right. Our next scholar, G.T. Suresh is on the phone line from Bangalore. Go ahead. Hi, Reshika. This is Suresh here. I have a couple of questions. No, I have come back from UK. Okay, it's been over a month and I have not had any symptoms or any such problems. But then, you know, the way that they're saying that first wave, second wave, and then in addition to that, you know, that in the initial stages, it was said that the vulnerable people, a lot are basically the older people are the young kids. And then, you know, but in India, it's been, you know, very different. With many people, young, you know... So what's your question, sir? Everybody getting affected. But, and also being a fitness, you know, one of the doctors here, Dr. Madhavar. I'd like to ask him if, in any way, the fitness would help us to keep, you know, away this virus. Right. Dr. Manohar, you know, a lot of worries about the possibility of a second wave and of course, you know, what can one do in order to sort of guard yourself? See, how any organism can affect us based on three things. Agent, host, and environment. Agent and environment, we spoke. Host, it all depends on your immunity, which is not actually directly measurable as general people think about it. And Mr. Suresh, as he was rightly said, we are expecting a second wave and it is true. Why are more younger people affected? Because younger people are the one who are mobile and they go and catch it. If it happens in the elderly population, the risk and the outcomes are much poorer in the elderly population. So as we started the program, if you're thinking of lifting the lockdown, my message is if wealth is lost, nothing is lost. If character is lost, something is lost, if health is lost, everything is lost. Please think over it again. And we expect a second wave because as we discussed again. But Dr. Manohar, then advise viewers because you know, we've had a lot of callers call in and ask what kind of exercises, et cetera, they can do given the fact that, you know, that walks are not allowed. We've had cardiology patients as well, Dr. Venkatesh, who've dialed in and said that, you know, walks are mandatory if you are a cardiac patient but they can't go down for a walk or go out for a walk in these circumstances. So what do you advise, Dr. Manohar? There are a lot of exercises available. Now it is, everyone is tech saving, you get it. Many of these YouTube channels, you get it. Yoga is the best. It comes you down also, improves flexibility. You can do it at home. You can include everyone in the family to join you. There are a lot of exercises which we can do. You can squat and I can go on and on. I think 30 minutes you can do it. A lot of exercise and 30 minutes of good exercise at home. Dr. Venkatesh, do you advise that to your cardiac patients as well? Because it's recommended for cardiac patients that they must engage in some kind of, you know, walking, exercising, et cetera. Very true, yes. It's very individualized, like, you know, it's basically a cardiac rehabilitation program. It would depend on a lot of factors as to whether you are doing it as a preventive strategy or as a rehabilitation strategy. If you're doing it as a prevention against coronary artery disease, yes, a regular physical activity, at least try to catch up of 35 minutes of walk every day and good activity, that's a good one. So important to keep the exercise going, even if you can't get out of your homes, do it within. I think every doctor on every show has emphasized on that. Our next caller, Shobha Srinivasan, is on the phone line from Mumbai. Go ahead. Yeah, hi, doctor, good evening to you. Just wanted to ask you one question. We constantly talk about the sneeze or the water which comes from the mouth as a carrier of the virus. Any other kind of discharge from our body could be the carrier of the virus which is wanted to check on? Dr. Venkatesh, would you like to answer that? Yeah, basically I think it's all about the respiratory hygiene that we have been talking about. The coronavirus is a virus which basically initially affects the bucus membranes, that is, the mouth, the nose, and the eyes, and that's exactly the reason why you should avoid frequent touching of these places. And these are the places from where transmission can occur and let us say there's a person with infected coronavirus who speaks somewhere. Yes, if it is on a fomite surface, depending upon the smoothness of the surface, well, this coronavirus can still latch on to it, maybe for up to 72 hours in case of stainless tea. But Dr. Pannur, very briefly, what about tears or sweat? For instance, that's also bodily fluid. Yeah, see, as I said, every day we are learning something. Again, fecal oral transmission also is the question. Some people are having diarrhea. The confirmed are the respiratory secretions. Right. From the cold and cough, sweat, we don't know. That's all that we know for sure. We are definitely knowing about it. Time will tell if we are knowing everything or not. All right, I appreciate you doctors for being with us on the broadcast, for sparing the time to answer the questions that our viewers have had. That's all we have time for on the show this evening on the other side. It's the 8 o'clock news with Sonia Singh. Stay tuned. Knowledge partner, USB, your reliable health care partner.