 by the COVID trajectory in India could be on a downward slide. The nation's tally has risen by around 49,000 to about 80.9 lakh. That's the number in the last 24 hours. But active cases continue to decline and they have been declining now for the 27 day narrows, slipping below the 6 lakh mark. Over 10.77 crore people have already been tested. Around 11,64,000 people have been tested in the last 24 hours. So what explains this downward slide? Earlier this week renowned epidemiologist Dr Jayaprakash Mulial in an exclusive interview with me said that signs of herd immunity was perhaps the only plausible explanation behind the fall in active COVID cases. On the other hand, Avelu Mani, the founder and MD of ThiroCare has alleged that authorities in certain districts in certain states were trying to control the testing process in order to show a better scorecard. Meanwhile, the latest ICMR study has highlighted that the BCG vaccine, primarily used to protect against eubochelosis, can enhance both adaptive immunity in elderly people. The study, however, is yet to be peer reviewed. Well, to get a sense of what is happening on the ground, joining me on the program, Dr Sandeep Devand, the director and HOD of Critical Care at Fortis Memorial. Also with us are Dr Sandeep Budhiraja, the group medical director of Max Healthcare. And joining us is Dr Sakinarayanan Mysore, head of department and palmyology consultant at Manipal Hospital. Drs, thanks very much for joining us here. On the point of testing, let me bring in Dr Mysore into the conversation as well. Dr Mysore, this is a point that was made by Avelu Mani here on the program, the founder of ThiroCare, suggesting that in some states, there is a hesitation to test and there is also a hesitation to report even if tests have been done. So the data may not be going back to the ICMR. Now, this is a claim that he has made. But even if you look at what the test numbers look like, there are some states or some regions where the test is disproportionately higher than others. Delhi, for instance, significantly higher than other cities or other states. Yes, there is a significant portion of anti-gen tests that are being deployed, but also RT-PCR, but the absolute number is significantly higher. So how do you attribute or what do you attribute this decline in active cases to and what do you seek on the ground? The unwritten rule of any pandemic till date over the centuries is as the cases search to appeal, the number of cases, newer cases or incidents will come down. Mechanism isn't herd immunity. It could be. Even the neutralizing antibodies have not been shown to, you know, absolutely shown to confer immunity. Is it the other way around? Is there an innate response that develops? Nobody knows, not yet to one. Testing on the matter of testing, I was part of deliberations of the Karnataka government through the Vice-Chancellor office. I think for a country of this population, like Dr. Divan mentioned, I think targeted testing should be the way to go. There is absolutely doesn't make sense spending the resources on testing a hundred and thirty per hour population. You need to identify population risk, prioritize people who need to get tested and test. Otherwise, there are, you know, chances that inappropriate use of resources in the testing quarter. South Korea has probably spent any other country on testing alone. Of course, their rates are low, but even a resource rich country in the US has not been able to, you know, test at will or at random. Even though in India we can do on-demand testing, that of course has been allowed by most state governments as well. But as Dr. Mysore is pointing out, targeted testing will perhaps be the appropriate response from here. Outside of Delhi, ample capacity, both in the general COVID wards as well as the ICUs. So that's good news that's coming in from Dr. Sandeep Divan of 40s. But Dr. Mysore, if I could ask you now to explain to us what you make of the trials that the WHO has done on the efficacy of the use of remdesivir, the ICMR saying that plasma doesn't necessarily work. It's not particularly beneficial. Now on the ground, you are the doctors who are treating patients. What do you make of what the trials are suggesting? What is working currently with patients? So from our standpoint, I am in the process of looking at more than 2000 patients treated here at Manipal and looking passionately and statistically at the data, comparing it with pre-remdesivir days that is before 24th of July to after 24th of July, when the remdesivir era started. Often I can tell you that mortality substantially improved after introduction of remdesivir. However, this is not a double blind placebo-controlled realm. It would be a retrospective audit that went in two different time zones before the drug came to Bangalore and after the drug has been used in our hospital. Now coming to focusing on the WHO trial, WHO as we all know has backtracked on six occasions earlier. Now with the solidarity trial and the interim results of the remdesivir, we find that there are a number of points that can be debated. There is one control group which was up to four or five treatment arms. Therefore, there is a partial overlap of control subjects. The interim report does not talk about diagnostic confirmation of the infection in the first place. Then what we found in our experience, timing has to be explicitly fine, whether it is remdesivir or tosalism. Whatever you use, if you do not use it at the right time, it is not going to succeed. However, in the interim results, we don't find that they have declared the timing. Baseline physiological activity or severity score is not found anywhere in that paper. So supportive care is also not defined. Here, the clear winner is a placebo and in most occasions, placebo does enhance down in the trial is not designed. And there is no, it's not a peer-reviewed paper yet. Therefore, I would not unless until there is a peer-reviewed process to that, let us look at the MTA. The MTA clearly states remdesivir is to be used and they have put out the criteria when to use it. So that is where we stand. Okay. So you're saying that, right. So you believe that there are questions with the WHO Solidarity Trial and of course, in your assessment, which is not a double-blind trial, but the data that you've been able to assess since the 24th of July, that's pre-remdesivir to now, which is post-remdesivir in your experience with all the caveats attached, you believe that it has brought down mortality rates. But as you rightly pointed out, it also depends on the timing of the administration of the drugs in the patients that have come to you. But Dr. Mysore, let me ask you again, if you share that view there that we just heard from Dr. Divan and also, you know, now there are reports coming in on antibodies and how long the antibodies last, whether it's four or five months. What is your experience at this point in time, sir? Thank you. I do agree with Dr. Divan last week. Manipal being a referral hospital, we do see post-COVID patients coming back with lots and lots of issues rather than complications. Complications are, you know, lung fibrosis, but I think that Dr. Divan was quite right. Structural changes do not translate into functional disability. Just because the CT is abnormal, it does not make someone, you know, breathe inefficiently or have low saturation. That apart, you know, one in 300, 400 patients may have a transient decrease pumping in the heart, which actually improves on its own. You catch one or two of the 300 and minimal intervention is required. Then we also find people do require general rehabilitation and physiotherapy and also pulmonary rehabilitation. There are issues related to overuse of steroids and people may require little medical help and intervention. Neurological complications we have seen are, you know, less than 0.01 percent people coming in with tremors and other issues. Liver function, derangement of this virus also behaves like a viral hepatitis kind of a virus, but even that is self-limiting most often than not. If you don't overuse medications and just assume a supportive role, this kind of gets sorted out. The most important thing is, remember patients either in home isolation or in morts or in ICU will have a lot of anxiety, stress, psychological issues and they may require a little bit of comfort and that, I think, is in excess of... Counseling. Well, doctors, you have given us reason for hope and reason for confidence, as you've heard here, from three doctors on the panel that what we are seeing is a decline in active cases. Of course, there are regional variations. For instance, Delhi at this point in time is seeing a spike, so this is not the time to be complacent, but there is also something to be said about the development of natural immunity, which seems to be acting as a shield at this point in time. Be careful about the overuse of medication and, of course, do consult your doctors if you feel that there is a problem, but, you know, anxiety and panic is not the order of the day that is needed. Dr. Sandeep Budhiraja, Dr. Sandeep Devan and Dr. Mysore, thanks very much for joining us here on CNBC TV 18 to take stock of COVID-19 and what we make of it today. We'll take a break. There's a lot more coming up. Don't go anywhere. We're back in a moment.