 Hello and welcome to NewsClick. Today we are going to discuss with Dr. Satyajit Rath, who is one of the people who has been following this issue and also is technically competent to talk about immune system, reaction of the immune system to COVID-19 and various other issues. Satyajit, recently one issue that has come up is that a lot of the COVID-19 infections are airborne, not just through what are called big particles, which are easier to stop and so on, but through what is called aerosol, small droplets, which stay in the air, can float for a much longer time, do not drop to the ground very rapidly and also operates through what's called the air conditioning and ventilation system, which can therefore affect large buildings, where a lot of this actually are sort of shared through the air conditioning system. So the virus can spread to the air conditioning system if a number of people are in a closed hall, even if the hall is large, which is large gatherings, this seems to have an effect. So do you think the aerosol issue is really something which we should take much more seriously now? Okay, so this is obviously exploded into the media and public discourse over these past three days or so, ever since a couple of Australian authors I think led a 200 plus researcher letter to clinical infectious disease, suggesting that we, suggesting more accurately rather than we, that the WHO should be much more focused on the aerosol issue than the WHO has been so far. WHO has been more or less denying that aerosol is a major cause of concern and is really focusing on droplets and surface contamination through droplets. So to be fair to the WHO, the WHO has not actually denied that aerosol issue. The WHO has simply said that the evidence with regard to aerosol as far as the WHO's own technical committee is concerned is somewhat equivocal at the moment and therefore they are not taking a position on it in formal recommendation terms. But let me get both ourselves and our listeners to step back a little. You see, the fact of the matter is that the virus spreads from one airway to another airway. The way it will spread is that the airway will put out virus in droplets of a whole variety of dimensions. When you say airways, you mean the human being? Oh, airways of the human beings, presumably airways of the bats as well, but that's a couple of years ago, so let's not worry too much about that anymore. But the reality is that you're going to have all manner of spread to be statistically possible, whether it is through large droplets, small droplets, whether it is through droplets directly inhaled or droplets falling on some surface and then transferred by my touching the surface and then my touching my nose. These are all just variations on the theme. So the first thing we must remember is that this is not some completely different method of transmission. These are all just variations on the theme. The second point is none of this has a breakpoint. Everybody talks about dogas duly, the two meter distancing, but the two meter distancing is not because transmission remains exactly the same, whether you are two inches away or dogas away and then when you are two inches beyond two meters away, transmission falls to zero. That's not the case, although when we speak about this in public discourse and we say, keep two meter distances, we begin to make it sound inadvertently as though that is the case. And I think this is a good time to remind ourselves that as you go further and further away from each other, there is a gradual decay in the likelihood that infection will reach. That's because actually much larger volume will take place. You draw a sort of hemisphere around you, so the volume reduces for you in terms of your ingestion, the further away you go. That's one point. The other side of that is that when I sneeze, there are very large droplets which don't even travel six inches. Then there are smaller ones and smaller ones and smaller ones. There is a whole distribution also. So you're always going to have some likelihood. The real question about recommendations of a cutoff kind is, at what point do you recommend the cutoff? And that point needs to exclude a lot of possibility and yet be practicable. That's always going to be a shifting zone. So we need to keep the reality of this continuum in mind rather than getting head up about, are you three inches on my side of the two meters or four centimeters on your side? Exactly similarly, think about the aerosol problem now in context because what we now have is, do aerosols matter? Now, if you are in the marketplace in India where you're buying vegetables from outdoor vendors and somebody sneezes, there is an aerosol but the aerosol dissipates in the open air and in all likelihood never achieves enough concentration to manage very strong transmission. Does this mean that nobody will get infected? Not at all. Let me interrupt it for a second. So the issue is one is of course that the transmission itself takes place. The second is what is the concentration which you ingest so to say through your air base and so therefore the degree of dilution in open and closed spaces could be very different. Number one, add to that the basic energy saving pattern in air conditioning where air is a substantial proportion of the air is recycled, which then exposes you over and over again. Now keep something else in mind, it's true that large droplets don't travel very far but because the droplet is large, there will be many more virus particles in the droplet. It's true that a small aerosol droplet will travel far but individual aerosol droplets will inevitably have fewer viruses. So there are these trade-off continuums all around in a variety of ways. So the question here is not is aerosol transmission possible? Of course it's possible. The question here is not should we worry or not worry about aerosol transmission? Of course we should consider aerosol transmission just as much as we should consider surface mediated indirect transmission. The question here is what are the practical situations and strategies to function as advice with specific reference to aerosols? That's really the issue and that context closed door crowded recirculating air conditioning is always going to be an issue. The restaurant example of major outbreak that is commonly used is in fact a classic example where under an air conditioner outlet there were three tables and people at all three tables got infected but remember that nobody else in the large room got infected. So it's essentially a matter of people getting exposed to aerosol over and over again. Is this an impossibility? No not at all. Should we be concerned about this? Absolutely yes. Should we be aware of the specific situation in which aerosol transmission becomes a likelihood a high likelihood hazard that we should do something about? That's the point that we should. Satyat I had two supplementary questions to what you were saying. One is that it also means that closed spaces with or without air conditioning both are could be dangerous and therefore large public gatherings where this church and the religious places theater all of these in fact in fact choir practices you know that was one of the cases of a very large number of infections taking place one event. So what I call super spreaders but more accurately super super spreading events. So these are one one set of issues and therefore we have to take that into account when we talk about say reopening or lifting the lockdowns making it easier. What do you do with schools so colleges so those are all those all become therefore issues if we take the air aerosol also into account not because it was not known but because its importance is being stressed over and over again. The second issue is of course the care homes for hospitals particularly those who do not separate their air conditioning from the COVID-19 and non-COVID-19 sections for example Delhi now they're talking of small hospitals reserving 20% of their beds for COVID patients. Now is anybody ensuring that they have independent air conditioning system so that one side will not impact the other otherwise it's a recipe for disaster and right now we have 10% of the people who are healthcare workers both in India and abroad who seem to be falling sick with COVID-19 so this is a very very important segment. Absolutely so let me make two or three points to supplement what you said rather than debate it. The first is in biology research institutions for decades there has been a quiet concern about trade-offs. What trade-offs trade-offs between laboratories acquiring independent what we in India call window air conditioners versus institutions whole floors or even whole wings of buildings acquiring central air condition and one of those trade-offs that have been discussed is because biology laboratories are far less consequential infectious organisms going to spread so biology laboratories when they shift to centralized air conditioning tend to worry a great deal about not having too much of recirculation having filtration having sterilization and so on and so forth so that's something of an issue that we should bring into the larger framework that's one point. A second point is you make an excellent instance of closed door crowding versus open air crowding. Essentially the point that you made is a distinction between closed door crowding versus open air crowding and in closed door crowding because you're going to have ambient air not be able to dilute out the aerosol is likely to cause prolonged exposure and therefore increase the dose of exposure that's that's really the straightforward argument if you think about it in those terms for the current situation of the United States here is a salutary point to consider that when they opened bars and churches and I'm deliberately coupling bars and churches they opened closed door crowding yes of course when Americans of my persuasion went out on the streets to protest the murder of George Floyd and all the accumulated murders of African Americans they did so in open air crowding that's an interesting point that did not lead to an immediate rise the pattern seems to be indicating so far that the greater growth of cases is coming from closed door crowding than from open door crowding so that's my that's my second point it's a very interesting point because yes this has been discussed because when the George Floyd protest started there was a lot of criticism coming from the people who were anyway against the George Floyd protests that you are ensuring or endangering everybody this will spread the virus will spread they had a far greater concern for the virus before or after that and in fact they are also the sections who are not very comfortable with face masks have been opposing it as well so it's a very interesting mix of opinions we saw over there about the concern for the protests or shall we say the so-called concern for the protests and we have also been the forefront of asking everything to be opened exactly so so so it's because of that last point that I'm I'm offering this juxtaposition for us to think about in terms of routes of transmission and the air solace and my third and last point about this is to do with reopening of educational institutions and as you pointed out it's an obvious difficulty that you have closed rooms with students crowded and are you inviting spread so one of the things that again public spirited progressive faculty members in state universities across the United States are considering is something that I think we ought to be considering as well which is open air class make sense and for the United States their great concern is you can do open air classrooms weather wise for only a very short period of the year for us it might be more feasible although our general crowding and space constraining will have other constraints of the of a practical kind to think about but these are really issues of practical policy and strategy that this particular current peripheral throws up so I think that's and it's been very useful that's very interesting because yes except in May and June perhaps we could do with it and it's all very drains you can have tarpaulins and so on and yes there is an expenditure but much less than anything else and the 10th house is in any case a lying idol so it might be easy to set tents also so that there is some protection from rain at least in this particular period but it's an interesting issue that the government actually will is not thinking about this but is quite keen to promote digital learning distance learning which of course as we know is neither a complete learning and it also privileges a certain section who can receive home support as well as of course the technology by virtue of internet and other equipment so on that point let me make a couple of let me offer a couple of observations the first is that I think that this lacuna on the part of government to think about a far broader spectrum of strategies is related to the general difficulty that the government has in dealing with a public health problem rather than a law and order problem and in that transition where government administration is most comfortable with the smallest number of options in with which to work because because it's much less trouble and I have a certain amount of sympathy for that but it still doesn't make sense in any any realistic way connected to that is my second point which is that the anxiety of government particularly this government to maintain control is linked to its intense affinity for cyber strategies and it's it's liking for online teaching has a connection with its general liking for what I'm calling cyber control administration that's interesting but you know there is the other part of it for instance Kerala government has been able to provide for instance midday meals to children by getting it cooked and delivered to their homes and you see Bihar at the moment and rest of the lot of the other states are now waking up to the fact after various outrages have been expressed about how it was so important and the consequences for the children now to talk about sending raw materials basically foods in terms of cereals and dal to their homes and what about the cooking we'll forget about that for the time being but only now and that we have not in the government who have been as you said talked about it is a law and order problem have actually responded to it I also wanted to make one comment like you are making some offhand comments laterally that we make one lateral comment here but you look at the coronavirus problem is a law and order problem the putikodi tragic example of this two father and son duo being beaten to death for keeping their shops more than 15 minutes past the deadline open now this is also the consequence of treating the coronavirus infection as if it's a law and order issue which has to be handled with sticks not in the case of Hyderabad where they were taking temperatures or testing for coronavirus mistake but in this particular case with very tragic consequences absolutely I couldn't agree with you more on that one and that's precisely the kind of approach I meant when I keep referring to the government's lamentable conversion of a public health problem you know Satyajit there have been a lot of comments both in nationally and internationally that India has one of the most draconian lockdowns in theory in practice it never understood what the lockdown meant it never understood how you cannot have lockdown of this kind and expect results if there are six eight to a room and there are 30 42 a building so would you say that we don't seem to have understood what a lockdown should or shouldn't do in a country like ours and one of the reasons the lockdown failed and let's face it it failed because the numbers have risen consistently unlike any other major lockdown we have seen in the world that this is essentially a failure of what you call it the administrative shall we say the police danda approach or the cyber approach yes so let me let me simply elaborate on that for just a moment I said this when we discussed this in April post the first phase of the lockdown and we have been treating our response to SARS-CoV-2 and COVID-19 as a war which is an utterly erroneous simile to use and we have been treating the lockdown as an effective instrument of war that would stop the virus in its tracks which was once again not simply as a simile but as an actual strategy completely erroneous what we should have used the lockdown for what the that's what the only reason to have a lockdown for would be is to get a little breathing space for the apparatus of government to put together a plan and a portfolio of strategies for sustainable responses to controlling the spread of infection to maintain the spread at manageable levels that's what the purpose of the lockdown was the lockdown was always going to be useful only if and when it was used as a breathing space to develop the resources and the plans for the lockdown instead we have been using the lockdown from its national manifestation we have now come to its micro incarnations but essentially our only real response to outbreaks of infections has been locked out unlike the Kerala example and to some extent your native state of Orissa seems to also be doing something a little more well that will that will take much longer to discuss than we have today I suspect but Kerala has actually been much more you know has involved the people in the struggle relatively more and in the in the sense that involving various sections of the people including the Kutumbushri for example for cooking food for both people who are outstation workers not exactly migrant workers but outstation workers and as well as the children who are out of and let me underline this we're not using the example of Kerala to claim that success of COVID-19 related state strategies will lead to no infections because that's not the point and purpose that's not realistic just as much as the end goal of herd immunity is not realistic complete stoppage of infection is not realistic management and mitigation is really what is realistic so the question is not whether Kerala or has Kerala stopped all infections no but that's not the point the point is has the response been a sustainable and being managed to keep case numbers at reasonable levels so far the answer to both is yes and the answer to both is yes in large part because as you point out the state seems to have made a steady practice of involving the community Satyajit thank you very much for being with us and we hope that in this COVID times we are going to get you regularly to both explain to us and also sketch out for us the larger dimensions of the problem we are facing not only medically scientifically but also socially thank you very much this is all the time we have reduced click today do keep watching this click and also look at our website