 Hello and welcome to NewsClick. Today, we have with us from our COVID roundup. So, Dr. Satyajit Rath and we are going to discuss the issue of vaccines, how much they are protecting is a Delta variant and what is the degree of protection we are seeing. So, Satyajit, good news that the Delta variant seems to be still at least protected by the vaccines that we are seeing or infections against Delta variant is being still protected. What is the degree of protection and what is the quality of the protection? So, that's quite correct, but I think that the nuance is worth getting into just a little bit. So, in the first place, let's all of us keep in mind that what we are now talking about is real-life data of vaccine protection in the community. So, to use the technical terms that were being thrown about six months ago quite a bit, we are no longer talking about vaccine efficacy, we are talking about vaccine effectiveness, being the term used for controlled clinical trial outcomes, effectiveness being the word used for actual real-life evidence. So, we are all now talking about vaccine effectiveness, that's the first point. The second point is, as we have noted for many months, there are two different measurements of the effectiveness of a vaccine. One is how well it protects against serious illness, hospitalization and death, because that's what matters to me as an individual when I take the vaccine. I don't want to end up in hospital, possibly die. And the good news unequivocally is that the mRNA vaccines, the adenoviral vaccines are all protecting very well against even the so-called Delta variant as far as hospitalization, serious illness and death are concerned. So, 90, 95 plus percent protection is being seen against these if some claims are to be believed. Certainly, despite the fact that 50 percent of the population of the adult population in the United Kingdom, in Britain and in the US is vaccinated, 95 plus percent of hospitalized seriously ill and or dying patients of COVID-19 are the unvaccinated. So, clearly, and this is all in the presence of the Delta variant, so clearly the Delta variant mediated serious illness is well protected against. However, the other measurement is how much does the vaccine protect against mild infection and illness. So, there is virus coming in, virus grows a little, I threw out the virus, I'm only mildly sick, I recover. This doesn't matter very much to me as an individual, but it matters to the community, it matters to us, all of us collectively, because it provides for transmission. And it is in this that protection by the existing vaccines against the Delta variant is significantly lower, it's still not absent protection, but it's significantly lower, which means that adding physical distancing, adding masks, adding physical distancing to the vaccine still remains a relevant public health policy intervention. So, those are the sort of complex nuances of vaccine mediated protection. Which would mean also that what you're saying, that the other social norms of control, controlling the pandemic, has to still continue, particularly if there is in countries, in areas, in regions, in cities, the persistence of the infections at the moment, which there is. And therefore, this will need to continue. And a quick question to you on this, the Delta variant seems to produce faster infections, that means it's not the normal six days, it seems to be an average of four days before you see symptoms and it seems to produce much more virus shedding than the other variants. So, that still is a threat for the unvaccinated, but also for those who are vaccinated. Absolutely. So, our audience, if they have seen these discussions earlier, will remember that we've been pointing out that because the Delta variant has been selected for better transmissibility, that a virus can transmit better, certainly allows it to spread from person to person more efficiently, but it also allows it to spread from cell to cell more easily in the same body. And as a result, all the parameters that you are pointing out that it spreads more quickly, therefore, larger amounts of virus progeny are generated more quickly. And even that the proportion of seriously ill people also is likely to increase a little bit from 10% to 12%, 13%, 14%, something like that. All of these are explicable by that property. So, all of those are speculations that are beginning to be supported by the evidence now as you point out. And therefore, the so-called non-pharmaceutical interventions, in other words, masks and physical distancing, remain important. The crucial issue is that over sustained durations, livelihoods, particularly for marginalized communities, need to be protected while providing physical distancing and masking, particularly providing efficient masking, which we have not been doing. We've simply been using one, two-layer fabric masks. All of this, it is upon the state and governance and administration to come up with sustainable policies for. Another part of it is, of course, the unvaccinated are still significant in numbers. India, as we know, our vaccine numbers are not very good. Two vaccines, which is what we require for protection, hardly 6.5%, 7% and single shot is also not very good, but at least better than this. But still, nothing significant. But even in countries where you have 50%, 60% of the population who have been vaccinated, the numbers are rising quite steeply again, particularly when there are large number of unvaccinated states, like in the United States, the so-called red states, which are not red, which are really right-wing Republican government in Balor. But also in the UK, and we've talked about this, there are unvaccinated, because also there are large, poor, unregistered communities, immigrants and so on. So this risk of the Delta spreading among this community still continues. Oh, absolutely. And let's keep in mind that when we are talking about the percentage vaccinated in the United Kingdom or in the United States, we are saying, oh, 50% are vaccinated. That doesn't mean that 50% of the residents of every street are vaccinated. What it means is that there are communities where pretty much everybody is, all adults are vaccinated and there are communities where hardly any adults are vaccinated. And as a result, inequity is sharpening in the measurement of COVID vaccination. And as a result of that, in unvaccinated communities, the virus is beginning to run rampant. And this is the scenario in which large pools of virus variants are constantly being tested against vaccinated communities. And that's where true vaccine resistant variants might eventually arise. So all of this is deeply, deeply troubling and problematic for public health policy and needs to be thought about and planned for. Satya, the other controversy, particularly in India, this has taken a certain partial, I say certain orientation because the government said that this is not true because we do contact tracing, which is nothing to do with excess deaths. Now there have been two arguments regarding excess death. One is that excess death is systematic underreporting, which of course we know that governments do, all governments do underreporting. And because people have co-morbidities, it's also possible to report something as heart attack, pneumonia, and forget what the trigger is, which is in this particular case, possibly COVID-19. So that's one systemic underreporting. The other, which is something that Viral Acharya, one of our members in the Reserve Bank hierarchy, who left and has done some study with one of his colleagues has talked about, that it is really the crisis of the health system when you have a peak, when it overwhelms the hospital system, the public health system, that is when the numbers sharply go up and that is when the underreporting is also taking place. So do you think that truth is actually a bit of both, that it is not an either or case? Well, certainly the truth is a bit of both. So let me quote a couple of sets of numbers. The former economic advisor to the Government of India, Arvind Subramaniam, and his colleagues have done a more than expected death count estimated analysis. And while currently our estimate, our current count is over 4 lakh COVID-19 deaths, the Subramaniam et al. estimate of excess deaths, remember, not COVID-19 deaths, simply excess more than expected deaths during the pandemic is over 40 lakhs, so 10 times as much. However, there is another way of calculating that. So in the first place, that number as the Government of India has repeatedly pointed out is an estimate, certainly that's true. The other issue is that that number is simply excess deaths. We don't know how many of those are COVID-19 and so on and so forth. As you point out, with a crisis in the healthcare system, it's not just COVID-19 deaths that are going to go up, non-COVID-19 related illnesses and deaths will also go up. Here is another little estimate based on Government numbers that might illuminate the debate a little bit. The Indian Council of Medical Research has released the report of its fourth nationwide zero survey in 70 districts. It has done the same 70 districts. It has done a zero survey with 28,000 odd samples collected last month and a month before. Now, based on their data, I take out all my worries and reservations from this calculation. Based on their data, the estimate is 60-something percent of people in India are zero positive, meaning that they have been either exposed or vaccinated. And since most people have not been properly vaccinated, the bulk of this is exposed. So if you take this as exposure, then you come to I'm doing really back of the head, not even back of the envelope calculations, somewhere in the vicinity of say 80 crore people having been exposed. Now, the infection fatality rate of COVID-19 is somewhere in the vicinity of quarter of a percent. So if you apply that, we have 20 lakh COVID-19 deaths as opposed to four lakh something official COVID-19 deaths. So by the Government's own calculations, if you do a little extrapolation, you come to five times as many COVID-19 deaths and then you think, okay, so half the number of excess deaths in the Subramanian analysis are COVID-19 and the other half are non-COVID-19 other illness, healthcare system crisis deaths. Those are the dimensions of the problem, I suggest. I'm not suggesting that these numbers are hard and fast, of course not. They are estimates, but those are the dimensions of the problem that we should be engaging with. And it's also interesting, the other one, which I talked about Viral Acharya and his colleagues, they say three to nine times and they basically focus on the crisis situation. It's also interesting if you take Kerala, which the health system has seen not such peaks, but it's seen basically a steady high numbers, but within the capacity of the health system, the excess deaths are in the range, what we have been seeing in more advanced countries where they keep a better count on the registry of deaths. And it's about 1.6 times what the normal figures are, which is, as I said, in the range of what other countries which have better reporting figures also show. So it does seem that there is some substance, that yes, when you have waves, the excess death seemed to shoot up, which is what we saw in the pictures of the burning hearts, the burial grounds and so on, which were overwhelmed at that point of time. So I think that that is also the reason why if we do have a third wave and according to various predictions by experts, a third wave is almost inevitable and because we don't have the level of vaccination that we could have had, perhaps if we had prepared earlier, so we are likely to see again in a wave, the excess death figures go up even more. So quick summary of all of this is that COVID-19 is not going to go away, at least not in the near future and we have to learn to live with it with various measures that we are talking about, the non-pharmaceutical interventions, as it is being technically called as jargon, but really social or physical distancing, which we have been talking about earlier, and of course, various measures, masks, etc., etc., and non-crowding, if you want to meet friends, meet them in the park, meet them in open air as far as possible. Thank you very much Satyit for being with us, explaining to us all the intricacies of what the technical papers say, which we generally don't understand very well. This is all the time we have for NewsClick, do keep watching NewsClick and do visit our website.