 Hello and welcome to NewsClick. We have Dr. Satyajit Rath with us and we'll discuss how do we look at the COVID scenario today. Satyajit, we have got the recent reports which the Government of India is claiming that the numbers are going down at a rate by February. They think this will be over and the Prime Minister has said also that unless people break social distancing and other norms due to the festivals, he thinks the numbers are going to go down. But there is absolutely no evidence, no data to support this. In fact, we are seeing second waves, third waves in different countries. So what is the basis of the statement that since numbers have been going down for three weeks, therefore by February it will be over? So this is an enduring problem and part of it is our wishful thinking. We hope that the pandemic will be over soon, whatever soon means for all of us differently. The reality is that the virus spreads by contact but the spread by contact is not precisely modulable. In fact, there are repeated supporting data coming up to say that most infected people don't transmit to anybody very much whereas a few infected people transmit to very large numbers. I am a little unwilling to use the term super spreader because it makes people responsible and I am trying to be careful. That's why I said super spreader events rather than super spreader individuals. Absolutely. And super spreader events one can certainly hold the US President responsible for. But because of that variation, the idea that you can simply model how the pandemic will spread and how it will recede is itself significantly mistaken. It's not mistaken in the sense that it's going off in the wrong direction but it is mistaken in the sense that we can't say today what our monsoon will look like next year. And in a sense that's what we are trying to pretend we know with the pandemic six months from now, which we don't really. Just to add to that that US has now I think seeing the third wave after two waves receding somewhat third wave again increasing. And it is sometimes as we have seen in Europe, for instance, it is happening in the same places which had already seen quite significant numbers of cases. In India's case, we have not seen a fall. In fact, we have been steadily going up something we have talked about. This is the first fall we have noticed from 90,000. Now we have come down to something like 50, 55,000. And again, this could spread to new areas. It could spread to the same areas may not be Dharavi, which has 60% looks like antibodies in the people. 60% people have antibodies, but the places which are five, six, 10%, it can very easily spring up again. So this whole myth that you can actually predict because you have a so-called statistical model and you say, okay, we have done this and done that. And then you make all kinds of claims is really what we have been saying from the beginning mistaken that these are not modelable in the statistical mechanistic sense. These are really event driven, human driven. And it really, these are not something you can either predict except for a week or 10 days. Looking at current trends, you can say seven to 10 days, this is likely to happen. That also within a certain range. So this is what I meant when I said, much of this forward projection, more than a couple of a few weeks into the future is really just wishful thinking. Number one, number two, and I will remind both you and me and our listeners of something that we said many months ago, when it was looking as though Kerala was doing particularly well with its systematic community participatory outreach for, as a response to the pandemic. And even at that time, we pointed out that this was an absolutely stellar response in a variety of ways. But even so, we said that we should be careful about ascribing cause and effect relationships about saying, oh, because they are doing this control is guaranteed. And we pointed out that control was not guaranteed. Exactly similarly, this notion that somehow if we all behave just so, then we can predict is a doomed wishful notion. Clearly, the Prime Minister is fond of doomed wishful notions, but the rest of us should have other figures like Trump, Bolsonaro. Who are keeping a company in this respect. And Kerala or any other state or country for that matters, what we have control over to some extent is the hospital based treatment that you can provide by which numbers can be reduced. And Kerala in that sense in terms of number of people to that has been lower, considering they also have a slightly more aging population than the rest of India, because of their earlier good health indicators. But nevertheless, that's all that you can really talk about. You can talk about Germany doing better, for instance, in Spain or Italy. But those are the only things you really have control over, unless you are able to get either the vaccine, or you have the response that China has shown, and some of the other countries as well, but they have been able to do really this kind of follow ups like contact tracing testing much more rigorously than most countries have been able to. Coming back to the other issue, which is the solidarity trials of WHO, this is again something that we have discussed earlier, that antivirals work, and you have been saying it time and again, antivirals work not really too well, modestly, I think your words were modestly, that also the initial phase of the infection. But once it gets to a serious stage where you are hospitalized, antivirals don't work in any significant sense. And Remdesiver, which came with a lot of fanfare pushed by Dr. Fauci himself, and I remember you saying that he said it's a pig, is it lipstick on a pig, and he said it's a nice looking pig at least. Now it seems that the solidarity trials show that Remdesiver hasn't really worked in any sense for reducing either the mortality which the earlier results have also said, but even reducing hospital stays. Absolutely. So let me sort of add nuance to what you said. We've been saying for many months now that unlike antibiotics, antivirals work spectacularly well if used very early during infection, during the course of infection. But antibiotics work spectacularly well commonly, even in late severely ill stages of infection, bacterial infection, whereas antivirals in these kinds of severe COVID-19 situations of acute infection have not traditionally worked. And this is not to say that in chronic viral infections, they don't work very well. They do. HIV control is precisely that. There are other chronic viral examples. But in acute viral infections, they don't. Unsurprisingly, hydroxychloroquine does not work. The two antivirals that the Solidarity Trial has recently reported on, one is Lopinavir, I think, and the other is Remdesiver, and neither of them does anything very much. We should keep in mind. Also Lopinavir and also they also looked at Interprenu. I haven't come to Interprenu yet. So we should keep in mind that trials don't simply say yes or no. In other words, that it works or it doesn't work. What you pointed out that if something works modestly, then in terms of reliability, the findings become noisy because in some trials, if it works modestly, the reliability may not be great. And the trial says it doesn't work. In some, if it works modestly, but just a little more modestly and it looks reliable and they say it works. This is what has happened with Remdesiver. It's also what's happened with interferon. Interferon is not an antiviral drug, but it is an antiviral response of the body, which is being used as a biologic drug. And again, it's unsurprising. It's a little depressing, but it's unsurprising that it doesn't work. It's unsurprising that what really works is still blanket suppression of the inflammatory response of the body, such as with corticosteroids like dexamethasone or Remdesiver. So in other words, we are pretty much in known territory that we had identified. I think this was the UK trials, which showed recovery trials. It showed that corticosteroids, particularly dexamethasone, which is cheap, not patented, works very well. All the others, a lot of them quite expensive drugs have not shown efficacy. We have discussed, even if they do, it will be not very significant. And again, it will work in the early phases, not later. And unfortunately, in early phase, you're not likely to use it or get access to it anyway. So those are the issues that we have that at the phase it can work, you don't have access. When it doesn't work, it's only then it is being made available. So apart from helping Gilead stock price significantly and enriching some of the shareholders in Gilead, it doesn't seem to have done much, seems to be now the opinion. Coming back to the one medicine, which now Trump has claimed has made him very strong, unbelievably strong and so on, the monoclonal antibodies. Now, monoclonal antibodies, I think again, something that you've explained are really things that are concentrated, body's responses bottled in some sense, biological drugs, and they have more potential to act. Can you tell us something about the monoclonal antibodies and how is it going to be used? Can it be used in a large population who are ill? What are the prospects of that? Assuming that Trump was not an accident, but this is something which can really be shown in solidarity equivalent trials. So I'm sorry to be depressing today, but I'm going to stick my neck out and hazard a guess. And that guess is based on the fact that we should remember that antibodies, monoclonal or plasma therapy antibodies, both do in effect what antiviral drugs or interferon do. They prevent viral infection from going forward in the viral life cycle. And therefore, I'm guessing that the outcome of the effectiveness testing of monoclonal antibodies in severe COVID-19 is likely to show the same modest and somewhat statistically unreliable effects that we are seeing with the rest of antiviral therapy categories, because it's another antiviral therapy category. So I am not holding my breath. I would be delighted if I was wrong, but I am not holding my breath thinking, oh, the maps as they are called are going to work. Once again, what we are seeing, and let me make a frankly political point here. Once again, what we are seeing is a hype of medications that are being looked at as intellectual property. And the only substantive effect size to use the term that pharmacologists use is not in how much it helps patients get better. It is in how much money it allows through stock pricing. Entrepreneurs and the private sector to make. On the other hand, let us point out again, and I will never tire of this, that our mortality rates in severe COVID-19 have steadily fallen across the world from February to today. And they have fallen not because we have discovered intellectual property miracle drugs. They have fallen because we have had earnest, sincere, hardworking health professionals. I don't simply mean physicians. I mean health professionals at all levels. Talking to each other across political divides globally in the interests of public health and working their brains out to make the small incremental improvements in therapy to adopt pronation, to turn patients so that they can breathe easily, regularly, to give rather than putting people onto ventilators, to give simply high concentration oxygen through tubes in the nose and a variety of similar relatively small seeming, small additions which have together added up across the world to a steady improvement in how patients are treated in hospitals and how effectively patients are treated in hospitals and therefore in survival rates. That is our combined community miracle. That's a socialist miracle, if you like. Thank you, Satjit, for being with us and we will continue the discussion next week over the vaccine issue, which is now gathering heat. This is all the time we have for Newsclick today. Do keep watching Newsclick and do see our COVID coverage in our charts, in our interview discussions and interviews.