 Hello and welcome to NewsClick. We are now going to cover COVID-19 issues as a part of our larger health coverage and possibly a part of our science discussions which we hold nowadays at not very regular intervals. So we have with us Professor Satish Dhrath and we're going to discuss two things of concern, two virus, COVID-19 viruses, SARS-CoV-2 virus variants of concern. One in India which has been raised by the Union Health Minister himself talking about how we should not continue with jyatras. Obviously attempt to argue that the Rahul Gandhi, Bharat, Jyotra, jyatra should be discontinued. And also what are variants of concern which have arisen in the United States? Satjit, a very strange issue really. Suddenly the health minister asking jyatra to be stopped when if you remember that we had the full election campaign in flow, full flow in Bengal at a point of time where the delta wave was pretty strong in fact peaking at that point and huge numbers of people were affected. Now if you look at the COVID-19 numbers they don't seem to be of any significance. We don't see that kind of pressure in the hospitals anywhere. And in fact with these kind of numbers it has created an unnecessary panic in the people. Suddenly say go COVID has come back when actually we don't see any signs of that. Well, absolutely. There are layers to this peculiar situation that it might be interesting for our listeners to think about. Firstly, let's consider the issue of variants. We've been saying for the past three years of the pandemic that virus variants arise and that different variants at different times become prominent in the community as they compete with each other for transmission. Because variants arise from pre-existing variants there are lineages of variants. There are families of variants and there are lineages of variants. So the current variant landscape, the world over, appears to be almost entirely descended from the so-called Omicron variant that the world began seeing about a year ago, a little over a year ago. But within those that Omicron family, now there are large numbers of variants, descendants of variants, descendants of descendants and so on and so forth. Branching continuously. Branching families of variants continuously. There are two issues that are important for us to keep in mind when we think about what variants mean for us. Firstly, variants succeed in competition with other variants because they are more transmissible. But there are two separate reasons why they may be more transmissible. The first is that the variant sticks to cells more tightly. The variant is not as easily killed off by our body enzymes and so on and so forth. This is, in a sense, a biological transmissibility. This property, this characteristic. And what we have seen over the first two and a half years of the pandemic has been selection of variants for better transmission in a generally uninfected population because the virus has been spreading amongst uninfected people. So alpha, beta, gamma, delta, Omicron, all of these were better and better transmissible as an inherent property of the virus. Over the past six months, what has begun to happen is that Omicron lineage descendant variants are now spreading. But they're spreading in communities which almost all the world over, China perhaps accepted. We will talk about China separately. But the bulk of the world over are either vaccinated with first year virus strain or infected with the first year or two of virus strains. And that means that viruses which are capable of dodging the immune response sufficiently to be transmissible will now begin to get an advantage for transmission. So rather than biologically transmissible, better transmissible variants, what we have begun to see over the past six months or so is immune evasion variants. So that's the first point that we should keep in mind. The session we struggle that we try to protect ourselves and they try to evade the virus and then has immune invasive evading capabilities. That's the evolutionary struggle that takes place. Actually, if you think about it, the evolutionary struggle is between different strains of the virus with each other for survival. And which one can do it better? Therefore, our immune system comes into play. But that brings me to a separate issue that we should keep in mind when we are thinking about these successful variants. And that is the pressure on variants in their competition with each other is for transmission. Because if they spread better, they become more prominent. It's really just straightforward. Nowhere in this is their selection for being able to cause more severe illness. And in keeping with that, over the past three years, we have not seen any major change in any of these variants in their ability to cause severe illness. Delta was the only variant which caused measurably severe illness more frequently. But other than that, there is no general trend of increasing the severity of illness at all. So we need to keep that in mind and not scare ourselves with nightmares of the virus evolving into more and more dangerous strains or anything like that. The virus, in terms of illness, does pretty much what the virus was doing a couple of years ago. It is far more transmissible and it is now beginning to be transmissible even in previously immune communities. That's what we should keep in mind. And it's on this background that we should think about the current discussion of both real variants of concern and what Eric Topol has called scariants, which is simply variants that are being used to scare people for other agendas. We'll talk about the other agent just a little later. But there are two scariants or variants which are also being talked about in the United States. Are they more scary or they are just other variants which are a little more further from the original strain of Omicron and therefore may again reinfect the same people who might have been infected by Omicron earlier. Right. So let me talk about three variants. And our listeners will forgive me for beginning to use acronyms, but beyond a point there is no helping it. So we are talking about three variants. We are talking about so-called BQ1 variants. We are talking about XBB variants and we are talking about DF7 variants. So let me break that up. So I'm not gonna keep using these names over and over again. All I'm gonna say is that the first two variants have a horizon in the United States but have a horizon quite a few months ago and they are seen the world over. They've been reported in India. In fact, a substantial proportion of the inadequate genome sequencing of viruses in India is in fact from those variants. The third, DF7, is the scariant that seems to be a prominent virus strain in China in their current situation. Now, we should keep in mind that as lineages branch further and further, variants will undergo more and more selection. So in general, variants that arose early with fewer changes will be less successful than variants which have emerged into communities with many more changes. Okay, that's not a mathematical equation but it's a reasonable argument. Assumption. From that point of view, the so-called China prominent variant is actually an older variant with fewer changes than the American variants of concern currently which are both variants which have many more changes than the Chinese variant seems to have. All of this information is a little shaky because it's based on sequence comparisons that are not always completely perfect, but even so. And the American variants are beginning to show more and more immune evasion properties. Okay. Which means that a reasonable plausible interpretation of the present situation is that the Chinese variant is spreading in either communities which have never been exposed or were vaccinated a long time ago and vaccines have waned, vaccine effects have waned and therefore these are effectively virus-knife communities, whereas the American variants are variants which are capable of spreading in immunized vaccinated communities. Neither of these is causing more severe illness, mind you. But as far as transmission is concerned, I will leave it to our audience to decide which of these two should be the greater concern for India from an epidemiological point of view in terms of rapidly spreading in vaccinated populations. I will just conclude part of it by saying that we should really watch the numbers and depending on how the numbers rise, we'll have to take not an India-wise response but a community-wise or a more localized response which is what we have been discussing that when the numbers go up in a particular locality, we have to take more COVID-19 appropriate measures which is of course starts with masking which we should still do, particularly in enclosed spaces and larger number of people there, but essentially impose certain restrictions on ourselves depending on the numbers in that area. And it is India's too big a country to think about an India-wide situation unless we have a Delta-like wave or an Omicron-like wave, where given a week or two weeks, the whole country seems to swing in one direction. So that's broadly what we are at. And also from what you have said that we have not only vaccinated ourselves, most of us with two shots, some with booster shots, older people like you and me, but also we have also had infections. So we are relatively, we have hybrid immunization, some from the Omicron virus, almost everybody seems to have had Omicron infections and vaccinations as well. So we are not, as you said, the vaccine naive community. Now, coming to China, the figures for China, of course, depending on which source you read, is either 25 billion, 50 billion, 100 billion, whatever. But let's face it, China is a large population. If there is a peak, it's unlikely to peak in all places simultaneously. We will probably see what we have seen in India. Regions after regions, following different cycles of peaking, but closely connected to each other. Therefore, the peaks may be ahead or follow, but they will not be completely disparate. So you do expect a countrywide peak if you add everything, but that peak is really a submission, as you have said on a number of occasions, a number of independent peaks and valleys put together. The numbers in China are by all accounts high because we have different local reports of senior officials in the Chinese government saying in my region, it's one million per day. So numbers are high. So we are not going to say numbers are very low. They are 4,000, 5,000, they are not. They are in millions. So given that, we would expect that since different regional heads now are giving statements, one million, two million per day kind of figures, we would expect the figures to be really high. Probably Beijing and Shanghai was earlier than others. Other regions are now catching up. And you are likely to see peaks of the kind that we have seen both in Omicron and Delta as well as the initial peaks. China is a large country. We are just about edging them out in population numbers, but the population numbers are very big. And it's also unlike India, which went through a couple of early peaks. Then we had the Delta peak. Then we had the Omicron peak. It's a relatively vaccine-only immunity. And otherwise, what you would call an Omicron, it's a virus-nive immunity. That seems to be, I'll leave Satish to elaborate on these two issues, that we should expect a large number over there. That's expectation. But that doesn't necessarily follow because it's a well-vaccinated population, even though about the older people, there are questions. According to figures I see, there could be anything between 65 to 75% of the population, older people, have had booster doses as well. Otherwise, they seem to have been, their vaccine rates are highest among the world, in the world, probably followed by countries like India. The US is probably among the advanced countries, the lowest in terms of both the vaccinated as well as the booster dose. So given that, what is your expectation of the course of what is likely to happen in China? So the Chinese situation has three components or factors that I think we should all keep in mind. Firstly, China's zero COVID policy was based on a couple of assumptions. One, they assumed that they could do stringent testing, stringent, well-supported, local lockdowns, rolling very rapidly and that they needed to do this because their tertiary care facilities, they thought would not be able to sustain massive, sudden peaks of infection in communities. As a result of this, their zero COVID policy for two and a half years was successful, but it had therefore two consequences. Number one, the entire community barring the small minorities who haven't gotten vaccinations, but the entire community is vaccinated with first-generation vaccines, 2020 virus-strain vaccines. And their ability to control infection and transmission is vanishing legally. So the community is therefore open to transmission. There will still be protection against severe illness and death, which I suspect we will begin to see as numbers begin to be reported, curated and so on and so forth. But the fact remains that transmission is gonna happen. In the rest of the world, because strain after strain, after emerging strains did spread through communities, the combinatorial immunity of generated by vaccination and actual virus infection, what everybody refers to as hybrid immunity for some odd reason, is more likely to provide some better restraint on transmission. So China is therefore, once they lift the zero COVID policy, likely to see fairly rapid expansion. The second issue was that their zero COVID policy was predicated on the calculated transmission efficiency of the 2020 strains. And in a certain sense, the steady and rapid emergence of more and more and more transmissible strains has been an object lesson for biologists. And I suspect that the Chinese system has come to terms with the fact that as transmissibility increases, maintaining zero COVID becomes that much harder to the point where it's not sustained. Absolutely correct, yeah. Absolutely correct what you're saying that what we do seem to very large number of people getting infected because it's a sudden lifting of the zero COVID policies. They had taken a decision before the protests, a week before the protests, they had taken a decision to lift the zero COVID restrictions. Unfortunately, the public health system was slow and there is an inertia, partly because they are unwilling to face the consequences of lifting the due, that once they lift it, there will be an explosion of infections. They were just trying to postpone it to the extent that people came out of the streets. So the protests took place. The same the world over. So that is pretty much there. But the thing is that we can discuss this separately also. The number of deaths from again, all of it is now only anecdotal because unfortunately the Chinese system has stopped really giving figures out, partly because the whole system of reporting from all the places correctly, I think is at the moment also under crisis. We saw that in the CDC as well, the people were giving figures which had no correlation to what the figures were on the ground. So but the real crux of the issue would be whether the vaccination will produce an effect against serious illness and death, considering the Omicron variants have also been relatively lighter on people than this is the Delta wars. So let me change this issue and broaden it a little. And that is, where have we all of us? China, India, the US, the world, innocence fallen on our faces as far as the pandemic is concerned. And we've fallen on our faces in two separate factors in more one factor in some places than others, but generally we have not been systematically sampling and tracking infection. And variant emergence. Some countries, particularly rich countries, as well as countries like China have been doing it far more systematically. Our track record here in India has been nothing to be particularly pleased with. And the bulk of the global South has been even worse off for reasons of both bureaucracy and technological and resource constraints. As a result, we are not keeping as close and as nuanced an eye on the emergence of new trends in the pandemic as we should be. We've pretended that the pandemic is over. But the second problem we share globally across the world, China, India of course included, but even the wanted technologically cutting edge rich countries of the global North. And that is we have not put in place a steady pipeline of generating new generation vaccines, testing them safely, rapidly and deploying them as regular booster doses in conjunction with surveillance so that as new variants emerge, our continuing vaccination patterns should be only one step behind the emerging new variants rather than 10 steps behind the emerging new variants. And this all countries across the world have fallen short of. And it's particularly distressing because with the influenza vaccination network, we had a perfectly good model as we've discussed here earlier in past months and years of how to do this. And instead, we've just chosen the world over as communities to bury our heads in the sand and pretend that the pandemic is over and therefore that there is going to be no COVID anymore. Two quick questions to you out of this, really one conclusion and one question. One quick conclusion is that we should have prepared ourselves for the new variants which are clearly emerging and we knew that and therefore done with the virus by vaccine manufacturers, what is being done routinely with the influenza vaccine and there's a global program replicating that with the vaccine manufacturers would not have been difficult. The problem of course is that a few vaccine manufacturers really my question to you, few vaccine manufacturers claim which is repeated in American mainstream articulate opinion that the mRNA vaccines are the best and China has old fashioned vaccines which had also been India has partly because of the, as you know, one of the vaccines is the same kind. But that the most advanced vaccine are the mRNA vaccines and that is what the whole world should be coming and getting from the Americans. This is the rough sum total of it. Even the adenovirus vector vaccines are sort of airbrushed out of the scenario. Though, you know, India's had also the largest number of I think Oxford vaccine as you like to call it. So which is what the serum institute has been using India. So A, question number one, are there significant differences between what each of the vaccines are when it comes to protection? Because Omicron seems to have not bothered about what vaccine you have used. But the seriousness of the illness has been only seen amongst people who have not been vaccinated largely cost no exceptions aside. So this whole argument is that this great mRNA vaccine should be only used which cost about 20 times what the other vaccines cost at least in India is that does it have any substance? And B, that what we are seeing in China for example, if that it follows what we have seen in India that you will have a very large number of infections but compared to the number of infection the number of deaths will be much lower. It doesn't mean therefore deaths will be in absolute terms low because you really talk to very large numbers and it will depend upon how the hospital system can handle it which is what we have always discussed here. The question is not the infections are more serious the question is can the hospitals take care of that? That's really the issue. Absolutely, so as far as different vaccine platform and the commercially competitive claims being made for that to a certain extent commercial there is some basis to those but it's not free of commercial interests. Let me lapse into Hindi. Brother, there is no water in the river and they are fighting with the agrarian's house. Why are we discussing vaccine platforms when what we needed was a rolling pattern of generating new vaccines with new strains? We've been doing that. It's not that nobody's been doing that. People have been doing that. People were doing VA 1.5, people were doing this, that and the other but we needed a global systematic approach with sets of rules that the world will follow and into which any vaccine platform that provides a new generation virus strain vaccine could have been seamlessly plugged in. And if that had happened, this entire argument about we have to have mRNA vaccines would have in a certain sense lost its intensity and focus. Number one, number two, okay, let's admit for the moment that the mRNA vaccine generate higher levels of antibodies and so on and so forth. Sure, these are real numbers. Has there been a global commitment to convert that technology into openly available enthusiastically transferred technology? No. So forgive us for being skeptical about the commercial components of this debate. Let me make a final point. There is an Indian mRNA vaccine. Yes. That mRNA vaccine, unlike the American and the German mRNA vaccines does not require minus 70 degrees storage. It's a licensed vaccine. It's worth asking, has the government of India placed large orders? Has the government of India talked to this small entrepreneur who's generated this vaccine with a lot of publicly funded support, be it said? To license it to more manufacturers, clearly the technology is feasible and ended here in Pune where I'm sitting. So it's not even as if the technology is some unattainable, unachievable technology for the global South. And therefore, in a sense, this entire argument about vaccine platforms feels much more like a red herring when what we should be focusing on is do we have a global systematic network and agreement to track strains, to generate vaccines in whichever platform feasible locally, to test them quickly, to have regulatory processes that will ensure safety, ensure efficacy in rapid movement and deployment of new strain, new generation vaccines into communities as we call it. For our viewers, this is already something which is done extensively every year for the influenza vaccine. So this is something as again, older people we know because we go and regularly vaccinate ourselves for each year for this flu vaccine. Thank you Satyat for being with us, taking over a very, going over a very large area because this has not been a small area that we're discussing. You're talking about evolution of viruses to evolution of vaccines and what are the likely course of action if A happens or B does not happen. So it's really a large canvas. Thank you for being with us. Well, we'll come back to you on this and other issues, but it does seem that our idea that we don't have to discuss COVID-19 anymore in this week, that we have to jettison and come back to you again and again when it becomes a global event or when it becomes again something that we'll have to address in India, not at the moment, but something still to keep our eyes on and certainly keep our eyes on what's happening in other places in the world. Thank you very much for being with us and do keep watching NewsClick and other shows as well.