 Hello and welcome to New State. Today we have with us Professor Satyajit Rat and we are going to discuss COVID-19 and the few studies which have come out recently. Satyajit, one of the studies is about this mask unmasked disparities and it has been done with a very large sample sizes of both the control group and the target group. It is a study from Bangladesh researchers as well as the US combined together. Now one of the things of course is that we should actually require a double blind study to state the obvious but not apart and also that we now know much more accurately than we did earlier the impact of aerosols on infections. So both counts we really have much more knowledge than we had a couple of years back. So given this what is the importance of the mask unmasked study and how would you look at it in terms of long-term health strategies? So let me make four points. The first one that you made is quite obviously even for the what ought to be obvious it is good to have empirical evidence and this is really good empirical evidence about the fact that masks help. Secondly, it's about a real life situation while this is a randomized trial. It's a trial not under controlled conditions where people are made to wear masks and so on and so forth. This is Bangladesh villages where as part of planned COVID interventions outreach interventions where you simply promote the usage the difference between these two is the making available masks for wearing and promoting mask wearing versus not. So this is in the vaccine language you will remember we make a distinction between efficacy and effectiveness. Efficacy is in extremely controlled conditions, effectiveness is in real life and so on and so forth. So this is a study which veers towards the effectiveness end rather than the efficacy. Quickly to interrupt you Satyajit, quickly to interrupt you. It also is not simply mask wearing and not wearing but also the study of the intervention itself that how to promote masks. It's not simply the intervention about how to promote masks. It's an intervention of how to structure a whole range of communications about COVID appropriate choices. I won't say COVID appropriate behavior but COVID appropriate choices to be made including masks but I think it's critical that the study incorporates free easily available masks in communities which are economically disadvantaged enough for this to be a major factor and I'll come back to that in a minute. Finally the study also allows us to make a distinction between different levels of masks and what the study analyzes is cloth masks versus surgical masks and surgical masks are really a whole category of masks where there is nonwoven material between woven layers so that as you point out a whole range of droplets ranging from big droplets to very fine aerosol level droplets where things are stopped at what size level things are stopped begins to vary and the study shows that cloth masks do provide some modest amount of intervention but that the surgical category of masks provides much more of a reduction of infection and I think that all of these together provide a really dramatic real-life empirical evidence for masks and I think that this is important for us to consider in the larger scheme of how we begin to live with COVID-19 as an endemic infection. I think those are very important points but I also found the one part of the data a little difficult to understand that it seems to be more effective among 60 plus people and less so among 40 plus people this seems to be little difficult to understand unless we think that the 60 plus people behave better when the 40 minus people did not behave so well even while wearing masks. That's almost well let me not say almost certainly but that's very plausibly likely to be the case as indeed the lead researchers have pointed out in various media interactions all said and done one of the things that the whole world knows about COVID-19 is that old people die and therefore it's not surprising that even amongst relatively disempowered communities under informed communities this piece of information has reached and therefore that the elderly tend to adopt more stringent COVID appropriate choices than the non-independent and therefore the with and without mask difference will be a little more strikingly apparent than that. The other interesting data that I found from this also the fact that the surgical masks got cost less than the cloth masks and that was something which I think should be taken into consideration while talking about masks. Absolutely but let me make the far more practical point that we've been making in these discussions over these past months which is that while we've been planning and arguing about public health facilities for severely ill COVID-19 people while we've been arguing about vaccine accessibility and so on and so forth the one thing that none of us have argued about in any with any traction in public discourse is shouldn't the public health system in India begin be providing masks for use by financially underprivileged people in communities and shouldn't those masks have supply chains of their own setup which are sustainable which are biodegradable which are reusable all of these boxes can be checked it's not that technologies are not available for this it is that we've spent a year and a half with no traction about mask as a public health intervention from the state and I think that this study underlines the pressing need let me make an additional science-based point we all talk about variants we all keep pointing out discussions about whether vaccines of one generation are going to be useful and to what degree in protecting against variants of a next generation masks are independent of variants and yet we have not planned a durable public health policy intervention that incorporates mask distribution and of course we don't need to discuss this but the anti-mask fervor which is at least in the United States combined with the right to carry guns which is that we should have the right to carry guns but not wear masks this kind of madness of course also therefore is you know to be combatted with what is obvious but at least those who have been talking about there is no scientific proof here at least the scientific proof is there but let us be very clear this is not a science issue it's really a political social issue that we are confronting second question that I have for you Satyajit and it's really connected again to masks as a part of a strategy that it's very clear looking at what we have discussed earlier on the question of vaccines that the vaccine adoption is so disparate in the world today that Africa has less than two percent vaccinations the United States has 60 70 percent vaccination Israel has they claim very high rates of vaccination but they also have fairly large number of cases now appearing of course when Israel says it has got a very good coverage they don't count the Palestinian enclaves which they hold within their borders and which they now say they don't have any right to send determination they cannot be a Palestine state but when it comes to vaccines they count them as not Israel when it comes to territory land they count them as a part of Israel so the figures are actually quite fictitious so I'm not surprised that their numbers are still high because of course they have not vaccinated the Palestinian population that live with them but given that apart it's also true that it does appear that there is going to be lowering of vaccine efficacy or efficiency after a certain point of time I don't know what the correct word is but that it's obviously the antibody levels seem to go down and we do seem to see again the possibility of infections so we are seeing with the rise of possibly even more new variants like Liu as it is being talked about the possibility that masks as you said being an independent completely independent of vaccine should be a very much a part of a larger public and strategy. Absolutely and let me make two points about this entire issue of beginning to live with the COVID-19 virus rather than having silly pipe dreams about eradicating it. Number one we have said since last year across the world all scientific communities have said this vaccines are never going to provide 100% protection nothing is going to provide 100% protection all vaccines currently provide more than 90% protection quite surprisingly robust protection against seriousness and death even from the current variants current crop of variants there is no guarantee that this is going to continue into the future but suddenly new generation vaccines can be developed and are being developed and will be distributed but the reality is vaccinated communities do not completely stop transmission of the virus they slow it down they reduce it they do not halt it completely as the Bangladesh US study points out for masks masks again reduce transmission and are therefore a very useful low cost intervention but they do not eradicate it all of these COVID appropriate policies and individual choices that we are talking about all provide incremental control over this rate of spread the numbers hospitalized and the strain that the public health system is put under none of these eradicates or eliminates the disease and therefore all of these become matters for the long term become policy choices for the long term and therefore the durability of these policies and the sustainability of these choices such as with vaccine accessibility such as with mask accessibility become major issues for us to keep in mind again and again we've we've discussed this issue and I bring it up again we need to get out of dealing with COVID-19 policies in the immediate acute crisis mode and think about them over the long term. If you think over the long term that the key to it has got to be public health it is not private health it's not protecting my health or your health and here is the basic shall we say the basic disaster that the world is facing that the rich are trying to protect themselves both as nations and as individuals and the cost of the larger public health scenario and all this talk about WTO the United States accepting certain you know weakening of the trips protection given to pharmaceuticals companies in the because of the pandemic all that has turned out to be hogwash nothing has changed what we find is the rich countries are trying to protect themselves and they're willing to give a third booster dose to their people while the large sections of the people today have not even a single dose given even to the health workers forget about the older and more vulnerable people India is somewhere in between but at this rate we are also not going to see the entire population post 18 population being covered at least optimistically by middle of next year that's what we can hope for maybe even longer but given what Satish said public health demands are if they're not met if they're not promulgated if they're not practiced we are going to see a continuation of the pandemic and possibly waves again may not be as severe as the second wave we saw maybe more dispersed but again possibly weight Satyajit last few comments on this before we wind up what we're discussing today absolutely and in addition to pointing out that the global that the rich countries of the global north are behaving in this fashion that you just pointed out let us not forget that even within India we have this clear distinction between the haves and the have nots we have it in terms of access to healthcare facilities for seriously ill people we have it in terms of livelihood support and effects on livelihoods for the for the well off versus the poor we have it in vaccine coverage we talk about our current vaccine coverage only being you know some 12% odd of the country's population but that average hides major disparities and again those disparities end up between have been between the haves and the have nots and I end my point again with the with the issue that we began with we have not even planned for mask accessibility for the poor of this country in all of these ways we need a much more public facing policy in place well as we know and our viewers know that this has been a really a disaster for the poor those who are disadvantaged they have those sections for instance like women and children have been even more hard hit schools have closed women have lost employment they have to take care of the home that's unfortunately the way the system is devised today and therefore we have they have they're under double attacks on their livelihood as well as on their social existence so all of this has also been highlighted by the fact that our GDP still has not reached the level we had in 2018 employment opportunities have really gone down it's been a huge hit on for instance against the people have made in this country and this is not not changing even today so I think that how we tackle all of these issues will depend on what something is said how we bring a public health dimension to this issue how we talk about distributing masks and vaccines in a way that it reaches all sections and of course other activities that is required economic activities required to sustain the weakest of our people in the sense that the inequalities then do not sharpen further as they're doing now thank you very much Satish for being with us bringing not only the health dimension but also the social dimension of the pandemic this is all the time we have for news click today do keep watching news click and do visit our website