 Hello and welcome to Newsclick. Today we have with us Professor Satyajit Rat and we are going to discuss some of the issues which is relevant to the COVID-19 debate, particularly the role of Remdesivir, how well it's going to be able to be effective against the COVID-19 epidemic, the SARS-CoV-2 virus and the linking of the Wuhan laboratory and trying to cut funding, talking about how the bad virus was being funded by various agencies including the National Institute of Health and why this is a problem. Now Satyajit, let's first discuss the Remdesivir issue. Interestingly, Dr Fauci seems to be related to both the issues at the moment. Now the Remdesivir trials have taken place and we don't really have what will be called the double-blind trial results in a peer-reviewed form even as a pre-print. What we have is reporting of this using the White House actually to promote a particular trial. Now while it may be that the trial was really useful and so on and therefore this is justified, how do you feel as a scientist about a double-blind trial results being announced in this particular way which seems to have influenced a huge number of people in thinking this is a real treatment and that's what everybody should be using. Yes and it's disturbing in part because Anthony Fauci has so far been correct and evidence-driven despite the precedent that he serves but for him to announce the Remdesivir results the way he did is disturbing because clinical trials should be formally reported in a full publication with all necessary details that are looked at by people in the field at most at the very least as a pre-print. None of this has been done. What has been done is an announcement from the National Institute of Allergy and Infectious Disease Director from within the NIH that's formally Dr. Fauci's title has been for many decades now and that's unusual to say the least. Not only is it unusual, it leaves me a little puzzled about why the hurry because despite the fact that it was presented as though Remdesivir was efficacious the data that were claimed in support of this efficacy are not startling or spectacular improvements. Medically we can call it modest improvement rather than really a magic cure so to say. Oh it's certainly not a dramatic cure. If I remember the numbers correctly hospital discharge median periods went down from 15 days to 11 days. In the first place let us agree that this is not back. It's useful but in the second place let us also agree that this is not a dramatic cure. In the third place also let us remember that the decline in mortality in this trial did not appear to be statistically reliable. It went down from some 11 or percent to some 8 or percent. Fauci himself said statistically not significant. Which reminded me of the paper that was published in the Lancet just a few days ago from Chinese researchers who did a Remdesivir trial perhaps a somewhat smaller one but did a Remdesivir trial and had data that are actually remarkably similar in their conclusion to the mortality data that Fauci has reported let us say. And that is that there is a trend to reduction that's not as yet statistically reliable. All of this put together makes me think two things. Number one is Remdesivir making a difference? Probably yes. Modest difference. Is Remdesivir going to change qualitatively how seriously ill patients of COVID-19 are treated? I don't think that that's going to be the case. In other words it's not a magic bullet cure. And if it's not a magic bullet cure then this much of enthusiastic prepublication publicity is a little difficult to understand. So one can think of all sorts of other reasons for doing this. One can think of generous reasons such as the fact that this is a US presidential administration that is not known for being science and evidence driven and is desperate for good news. And here is one piece of kind of sort of science and evidence driven good news. And therefore it got pushed forward let us say. One can also think all said and done this is Gilead and NIH collaboration driven outcomes. And one can also be a little more cynical and think of this as a means of establishing Gilead's credibility shall we say. And global push for Gilead therefore. So one can think of all sorts of practical reasons why this was done. But let us be clear about this. Regardless of the absolute rights and wrongs step by step of how and why this was done Remdesivir is likely to be used in modest fashion. So the two follow up questions. One is a lot of the scientific community has said this is going to distort all other drug trials because people are going to say don't use as guinea pigs already established Remdesivir works give it to us. So in effect you are also going to therefore distort all other drug trials. This is one issue that has been raised. And the second issue which of course did your round has raised who is the hydrochloroquine guy if you will. He has said why is it the clinical trials what was originally set out as a criteria the endpoint. And one of the criteria was reduction in mortality. Why was it taken out of criteria midway through the trials. It's as if you are changing the rules of the game midway when the game has already started. Yeah. So the first question that you raise I'm not as seriously worried about primarily because I think that everybody concerned even distally professionally with COVID-19 is going to look at the data of Remdesivir and say it's useful but we need more. So I'm I would seriously doubt I grant the point that you're making but I seriously doubt that anybody is going to stop looking for drugs. And let me come back to that point about drugs antiviral drugs for COVID-19 in a while. Let me address your second point of the rounds criticism. And to an extent how shall I put this. It's a little bit a case of as it's currently called. What about is it. Professor Raul has been accused of fiddling with his inclusion exclusion criteria in the hydroxychloroquine trial that he reported. And he's understandably just if I believe not but understandably upset about it. And therefore he now has a chance to indulge in what about this. Is he is he reporting correctly that the primary and secondary readouts were altered in the in the trial? Yes. Is it that unknown? No. Many clinical trials do this. It all essentially boils down to egos clashing, to people getting upset and to storms in a teacup. We keep coming back to the core point which is remdesivir is not more than modestly effective even if you take everything at base back. And but really from the public health and from the societal point of view that's all we are interested in. We don't really care who's quarreling with whom and calling whom. The only question is dressing it up a bit more attractively. Of course has an effect on gillian share price. Exactly. That of course does make a difference. Which is why that's the second issue I brought up. And I said one is for the administration for the current US administration to look good. The other is for gillian to look good. And both of those I have very serious reservations about his intentions. But from the broader point of view I would say this is not a terribly effective drug. That is the central point that does emerge that it's a modest gain. And in fact this that is a question that you actually should be able to really show some light on. Dr Fauci also said well you know when the AIDS drug started they had also only modest benefits but they have worked. Okay they have really changed dramatically. Correct. Do you see any parallel in that? So this now risks bringing my personal opinions and speculations in the biology of infectious disease into contention with people like Dr Fauci for example. And I bring that up to underline point that this is now a public airing of a civil disagreement. And our audience should take it as that. But that said and those are caveats that I'm advancing. But that said they point out two things. Number one let me point out that the HIV infection that Dr Fauci was alluding to where antivirals over the course of about a decade from the late 80s to the mid 90s came to protocols that really were effective treatments. And I'm using the term effective very carefully. There are two issues there. The first one is that unlike COVID-19 AIDS is a chronic infection. Lifelong disease. It therefore does not either kill you or leave you cured in a matter of days and weeks. It goes on and on and on with the viruses ebbing and flowing and growing in your body if you're infected. It therefore gives you the operating space in which you can prevent the virus slowly painstakingly carefully and hope over time to make a difference. That's the first point. This is not how SARS-CoV-2 and COVID-19 are facing us today. Severely ill patients of COVID-19 tend to die in days. So a 30% reduction over 15 days is very different or a 30% reduction every 15 days over a year which is what we are talking about. Which in a sense is what we are talking about. There are more even more striking differences because of these differences in the rates. But yes, broadly that's what we are talking about. Secondly, let me point out something. The HIV treatment doesn't cure you. It's lifelong treatment. What the treatment allows your physicians and you together to do is to keep the virus under control so that you can live a close to normal life. HIV cure is still nowhere on the horizon in any practical sense and this brings me to my second and broader point that most of my friends and colleagues think I'm being pessimist about which is once a virus has established in the body and is growing controlling virus growth is unlikely to have as dramatic an effect on improving illness as the same thing with bacterial infections and antibiotics. I've said this in some of our discussions in the past. See bacteria grow by one becoming two becoming four becoming eight becoming 16. So you interfere and this is the rate of growth that you bring down. You never bring it down to zero but you bring it down. Viruses don't go from one virus to two viruses to four to eight in their rate of growth. They go from one to a thousand to a million. Even when you bring this down with great efficiency you're you're interfering in an extraordinarily steep growth curve because effectively it takes over our sense to produce copies of the billions of copies of the virus and therefore I think that both biologically and empirically effective antivirals will not be as dramatic game changing treatment as effective antibiotics are for material for acute bacterial infections. But coming back to Dr Fauci making this kind of claims and then we put it very crudely is to put a bit of a lipstick on the pig. Well to be fair if I'm being unkind since I don't have to be civil but it does seem to have dressed up the results a little more attractively than perhaps science wanted. To be fair to him in his press conference he did repeatedly say that this was a pig. He just pointed out repeatedly also that it was a pretty good looking pig. Okay okay coming back to the second issue of which Dr Fauci also is there and this time I am going to ask you questions from his corner so to say. Now here is the attack that has come on National Institute of Health for having funded bat virus program and collaborating with the Wuhan Institute Wuhan lab which was researching bat viruses. Now the whole world on the issue of pandemics knows that bat viruses have cost repeated possibilities of pandemics. We have for instance the Zika virus the Deepa virus the Ebola all of this are there. So we have almost looked on the bat as a reservoir of possible pandemic viruses and with SARS the earlier version which is the SARS-CoV effectively one if you will that virus also came from bats so did the Mars virus the Middle East respiratory syndrome. So bats being researched would be the first line of defense world over and collaboration would be something which is in the scientific community taken for granted. Why is it becoming so controversial? Is it that the United States the huge number of cases having failed to protect its population now really looking for shall we say complete bogus arguments and bogus pointing of fingers. In some sense China did it it was either China hid it or China did it. This seems to be the new shall we say narrative coming out from the US. Absolutely and do I think that the NIH the National Institutes of Health of the US were wrong in participating with a multi-institutional collaborative study with the Wuhan Institute of Virology for studying coronaviruses in bat not at all the NIH funds has for decades funded these sorts of efforts. I think even in India we're right. Yes we have collaboration absolutely the world over the NIH has funded this not simply the NIH a large number of shall we say prosperous economy funding agencies have funded exceptionally multilateral multinational collaborative efforts to understand zoonotic viruses. There's just no question that this was the right thing to do it was right scientifically it was right ethically it was simply the obvious thing to do. So for the NIH to be forced as one gathers what I don't know if this is a certainty as yet but one gathers that the NIH is being or has been forced into cancelling the funding that or at least holding in abeyance the funding that involves the Wuhan Institute of Virology is clearly therefore a purely political especially when you consider two things number one is there any evidence whatsoever that the SARS-CoV-2 virus is anything but yet another natural animal to human zoonotic transmission of infection no all available evidence says that that's what SARS-CoV-2 is that's what MERS was that's what SARS-CoV-1 was that's what Ebola was that's what Margot Margot fever was that's I can go on and on and on naming zoonotic viral infections they all came like that this is yet another in a long list and therefore to hold the Wuhan Institute of Virology which was working on the original SARS-CoV-1 virus in common let me point out with the whole range of laboratories across the world all of whom including the Wuhan Institute of Virology have been complaining and grumbling under their breath for the past decade that funding has been drying up and is being withdrawn because people have forgotten SARS and it's not been a problem only 8,000 people infected so people didn't bother after that and and and we haven't seen a case for over a decade so and and and this is the normal everyday bread and butter stuff of life science and biomedical science research so for for for the US okay let me be careful for components in or elements of the US government to suggest repeatedly without providing evidence that this is an engineered virus or that this is a laboratory virus at the very least that escaped or was released is irresponsible and is clearly therefore so did it when you say irresponsible you're being very scientific absolutely finally that's why i needed to look for the appropriately balanced work and is clearly in pursuit of a political objective that's not supported by science and the evidence in the case so in fact it would also be that those who have been in the front line and the researcher in Wuhan she's known popularly as a bat woman who spent a very large part of her time in inaccessible places hunting for the virus as a protection for the people who could be exposed to pandemic this is really trying to make scapegoat of people who are in the front line of science against such pandemics and researching on such pandemics so this is really in some sense making somebody the victim or largely or essentially political ends as you put it yes let me let us let us also point out while we are in the um in the unfamiliar territory of defending my fellow scientists um let me also point out something else that biologists are being scapegoated for you see when there is an outbreak of a new infection that is a dangerous at least for some people infected by and large the physicians and the biologists involved tend to be looked at suspiciously when they point it out first as are you just trying to make yourself sound more important than you are after all your funding has been drying up you've been complaining we've heard that you've been complaining now you are suddenly discovering that there is a SARS-CoV relative um out there again um how sure can we be that you're not making this up is what the bureaucracy of government the world of response with and it takes some time and accumulated evidence and many a miscommunication and misstep driven by this this this this shall we say mutual unhappiness that invariably and inevitably delays matters beyond what in retrospect we would have liked to see did this happen in this case in all likelihood it did because it happens in every case it has never I think not happened under those circumstances I'm a little resentful that that inevitable likelihood of delay is now being used to beat up on biologists and physicians who've been trying their damnedest in China and elsewhere um keep in mind that the Chinese scientists working in this have been collaborating the NIH grant is evidence of that with their colleagues the world also and they put up the genomic sequence January 11th January 12th they announced it a couple of days earlier and it's also interesting once you shut down Wuhan you sent a clear message that you think this is highly dangerous so to see that after one and a half months two months of that people still thinking that it's a mild flu now that speaks volumes over the seriousness with which you took the message well let me point out there seems to be reason to believe that on the third or the fourth of January the Centers for Disease Control of the US were told by people in authority in China Dr. Gao who heads the CDC China and he was in tears when he was talking to Dr. Redford this is reported by New York Times you know was this a case of related discovery when it should have been discovered in November it should have been discovered in December in hindsight we can say many of these things but let us point out also that country after country from the end of January onwards told by the WHO still did exactly the same thing delayed it said oh it's not here we haven't found any cases with the parenthesis that we haven't looked for any cases and therefore really we haven't found any cases every country did this in their own peculiar way of trying to minimize the upset the damage the turmoil in administration in society that would inevitably result we in India did something similar by not undertaking testing on a wide enough front early on in fact we just instead took the easy way out of not just imposing the lockdown but imposing the lockdown and giving our people the impression that the lockdown itself would solve the problem which clearly at the moment it's not thank you Satyit for being with us essentially therefore the accusations on the Wuhan lab is much more politically motivated and a gimmick to rescue President Trump's shall we say disastrous handling of the of the epidemic in the United States it's it's five one third the one fifth the population of China and seeing figures which are many many times more than that both in terms of people infected and in terms of deaths so of course he needs a narrative now and so I guess does the United U.S. media to admit that they no longer are the global's leading power being able to control everything including themselves thank you very much for being with us and hope that we can continue discussions in this vein again or the COVID-19 which doesn't seem to be going away and next time we shall discuss Indian issue that you have raised because that I think is also something we need to take stock of now this is all the time we have for news click today do keep watching news click and do visit our website