 Hello and welcome to Newsweek. Today we are going to discuss with Professor Satyit Rath, a slightly long view of COVID-19 as we have encountered it and as we are likely to see going forward. Satyit, quick question. COVID-19 is not going to go away. It has made changes to us and our lifestyles in a way. Some of it is which is going to stay? Absolutely. And it's interesting that from day one, all our empirical and conceptual science has been saying this, that a virus infection that enters a new host species will go through something like a pandemic and is not going to suddenly disappear or be eradicated but is going to settle into a mild and easy relationship. And that's what everybody has been talking about now in the shift from epidemic to endemic. And all that that means is that it's not going to go away just as influenza has never gone away. So effectively it will come to what you call an unsteady equilibrium with of course medicines, vaccines and so on. So the effect may not be as severe as it has been in the last few years. So when you say it's going to be endemic, of course it's going to be endemic with vaccines, slow emergence of maybe viruses or virus infections which will be milder and of course also medicine. So all a combination of that is you're going to see what would be an endemic, what you call an uneasy relationship, which is what we have with a number of other viruses in the world. Of course COVID-19 has also shown that it doesn't change as quickly as influenza virus perhaps but it still changes. And with a large number of infections, of course you will see new species, new variants if you will arise. Satyajit, looking at this history of COVID-19, it's almost as if it's an experiment on a very large scale. It is indeed. Given that, shall we also see that in this accelerated phase of laboratory experiment if you will on a global scale. We've also discovered things that we should have perhaps known earlier we did. And one of them is the discovery that aerosols are actually very important in viral infections. COVID being only one of them. But also flu viruses therefore the need to really redo our air conditioning ventilation systems across the world. And also when and what seasons, how we should behave. Flu is only one of them but also asthmatic infections. Absolutely. And as a matter of fact, we will all remember that early mid-last year there was a great deal of controversy about whether transmission was efficient via droplets versus aerosols. And while at one level this was a rather semantic debate over a continuum of droplet size. As you point out, the practical implications have been immense. In fact, I would like to interject for a second over here because really aerosol is defined but the air conditioning ventilation people was different than what was considered as droplet infections by the medical community. Yes. And it was a semantic confusion which the other side in this case I'll put the blame squarely on the medical community had that they didn't understand that droplets of smaller or bigger sizes could still be airborne under certain conditions. But the fact remained in a certain sense that there are... So the experiment that you point out led us to some really interesting outcomes. Just as what seemed to be astonishing close to miraculous rapidity, we identified the virus. We sequenced the virus. We designed vaccine candidates and began testing them only with a somewhat slower trajectory. We made this transition in understanding what the range of droplet sizes could do both in terms of how long they could stay suspended, how they would travel through air supply systems and how much and what kind of infections they would be able to generate. And therefore begin to talk about both air handling systems at the community level in terms of how to rethink them and masks exactly in terms of individual protection about what thickness, what properties, what characteristics would provide optimal protection. And as you point out, since these are the so-called non-pharmacological interventions, they would inevitably have a much broader footprint and impact than one infection. They've had an impact on other respiratory infections which is apparently quite substantial, although the data are initiated by the existence of the pandemic and consequent disruptions. And also non-infectious triggers such as allergens that trigger asthmatic attacks. So we've learned a great deal of nuance with practical implications in this accelerated experiment that we didn't know. Two quick responses, though you are giving the responses not me, is the fact that there's a lot of confusion about why masks should be worn. And initially it was believed that it is only for protecting yourself. And it took some time to get it into even what I will say as not only the practitioners, but the policymakers that this was for two-way purposes for also limiting your own droplets and not just simply protecting yourself. Because initially the response of even the CDC was they won't protect you. And the question that will they arrest the infections by stopping the droplets seemed to be something that was not addressed initially. The second is when you talk about the somewhat initiated experiment if you will. The asthma trigger and asthma because I am an asthmatic. So I have a special vested interest in this question. Strangely enough that the viruses could actually also trigger asthma attacks by creating small infections and that seems to have also come to the fore. Yeah, although I must confess that I think we did, we have had indications that this was the case. We have had a fair amount of work done on the so-called clinical crosstalk between allergic and infectious triggers causing inflammation and difficulties in breathing and so on and so forth. But certainly the pandemic has provided an unprecedented data set that can now be mined very robustly for far more definitive conclusions. So to that extent, absolutely yes. In fact, initially it was felt that the asthmatic population, particularly the children who have been kept at home would be major problems during having asthma attacks which didn't happen. In fact, that's how a lot of this discussion did arise. Coming to the other one which is the unfortunate part which again people are not talking about which is the number of diseases had a very adverse impact because of COVID-19. Normal routine surgeries did not happen. People didn't go to the hospital so the hospitals couldn't handle it. Tuberculosis for instance, the programs have taken a big hit because this is the kind of intervention that was required, follow-up that was required. All that didn't happen because the medical system was primarily, the public health system was primarily engaged with what was really an epidemic and a lot of the places systems were collapsing. Therefore, these are also the huge hits that we have taken. We have taken a number of hits of this sort. At one level, what I said earlier was about the fact that data collection about all these matters has been itself disrupted so that while we have large amounts of information, we're not quite sure how much of that information has been modified in terms of the reliability of it's being gathered as a consequence of lockdowns of people being disrupted in their professional lives and so on and so forth. But over and beyond that, here are a couple of issues. In the first place, we discovered that non-communicable diseases had major consequences for communicable disease outcomes. We discovered that hypertension and diabetes are comorbid factors for causing severe COVID-19. That in and of itself is an issue. On the other hand, we discovered that local ongoing inflamations such as with asthmatics and related issues may or may not be a massive trigger. Everybody had been expecting that because asthmatics have a compromised situation in their lungs, COVID-19 was going to be a major issue killing asthmatics left, right and center. And that has not turned out to be the case. It's quite remarkable how we have begun to understand the notions of what local inflammation and body-wide inflammation and the balances between those lead to as consequences of severe illness. So there are a number of issues of this sort. But the fact that we have been unable to treat a large number of chronic illnesses, tuberculosis, cancers, but not simply these, hypertension and diabetes have been poorly dealt with. Going beyond that, think about the other major category of illnesses for which sustained therapeutic interventions, measurements, analyses and interventions are needed. And that is to do with mental health. Yes, I was going to ask you that. The mental health in fact has been made much worse by isolation. It has been made worse by isolation. But in addition to that, I'm connecting it to the point that you raise that our inability to provide a public health care system that is robust to these disruptions has meant just as we have been unable in brief terms to provide the anti-tuberculosis therapy medication to people, we have been unable to provide updates, testing and medication for chronic mental health conditions. Consider what that does. Just as it leads to resistant tuberculosis and prolonged tuberculosis morbidity, mental health conditions will have significantly worsened. Have we even measured this? Have we thought about this? These are the sheer proliferation of issues that have gotten thrown up as a result of the health care system being put under this severe strain is going to be with us for a very, very long time to come. So, a number of issues, of course, primarily what is the long-term consequences of COVID-19? Yes, science has delivered that as we have discussed earlier. Science delivering is not enough. The public health system has also taken to the people. That, of course, is a question that Sanjit and I have been discussing quite some time. But beyond that, there has been certain things which we can welcome, not COVID-19, but the scientific initiatives on that and also some of the big hits we have taken. This is apart from the other hits we have taken which is on, for instance, education in terms of economy which all also have effects on the health. So, it's not just health and medicines that these are isolates in society. They are a part of a larger matrix. And of course, all of that also play up on each other. We'll come back on these and other issues with Satjit and we'll continue to discuss not only COVID-19 but a whole bunch of other issues surrounding it. Thank you for watching NewsClick and do visit our website.