 Hello and welcome to NewsClick. We have with us today Professor Satyajit Rat and we are going to discuss COVID-19 and the way now vaccines and the Delta variant, it seems to be the Delta variant which is being discussed so much that is now contesting each other in different territories. Satyajit, if we look at the figures and these figures are a bit surprising that in the United States now we have 100,000 new infections per day. Now, given that US has a fairly high rate of vaccination irrespective of the fact that we have discussed, there are large pockets and there are states which have not vaccinated so well. Even then the 100,000 figure is a high figure because if you see the height of the COVID-19 pandemic in the United States, they were having about 250,000-300,000 infections per day. India at the moment we have very different pictures from different states. Kerala is showing something like 20,000 new infections per day, Maharashtra about 6 to 7,000 other states much lower including Delhi which seems to be below 50. Now, this picture is not consistent it appears from the vaccination rates. So, it does seem that the waves are still there and except that the vaccinations is cutting off some of the shall we say the hills and flattening it out somewhat and of course the issue that that the numbers of hospitalized and numbers of deaths seems to have dropped among the vaccinated but still high among the non-vaccinated. So, shall we can you give us a quick overview of what's happening in this? So, let me go back to what anybody who has been masochistic enough to watch us week after week is familiar with as a gripe that I have made for a long time which is that the idea of a wave, the idea of averages representing the local variable realities is extremely limiting if not actively misleading. So, let me rephrase this the way that the patterns of the outbreaks of infection are occurring now is now overlapping with the patterns of outbreaks of vaccination because just as the infection outbreaks are not one uniform equitable spread so also the pattern of vaccination not simply in the global south but even in the global north is not a uniform equitable slow increase in the percentage of vaccination. There are neighborhoods and communities where it is high, neighborhoods and communities where it is low and this is why what we are seeing is an intermeshing of two patchwork quilts and this is why when we begin to think about our expectations that as percentage of vaccination rises numbers of cases should fall is an is a misleading focus on averages. It's what that's called the statistician's delight if a head is in the fridge and your feet are in an oven you have a comfortable body temperature so what you're saying is we seem to be getting similar kind of statistical anomalies if you will that because there are concentrated pockets where vaccination has not reached the concentrated pockets where vaccines have reached therefore you have this what you call as a patchwork quilt and averaging it is therefore misleading. Not absolutely not simply that the sheer degree of variability or inequity around this average is different in different places so let me give an example in Kerala the equity around the average is fairly close in a place like in a state like Madhya Pradesh or Uttar Pradesh the inequity is huge and as a result patterns and emergence of outbreaks will be quite different in these two places despite perhaps similar vaccination averages for example which they're not but the point I'm trying to make is that the average gives a misleading sense in more than one way. So to put it in a simpler form for our viewers that what we see is actually superimposition of two different things one is vaccines which again are very much local and specific to an area United States, India, other parts of the world this is not very dissimilar and therefore when we talk about vaccines versus infections averaging gives a misleading picture but the point of course is that there are vaccinated people who are falling ill but the argument is they're not falling very seriously ill therefore the hospitalization and the death numbers for those vaccinated were infected and let's understand with two shots not one shot because one shot doesn't give full protection are much less than those who are not vaccinated or only partially vaccinated so would that be correct looking at now the experience of UK and the US and India? That's absolutely correct as a matter of fact let me add a point of perspective to that in the first place what we are seeing is that the frequency of reports of infection simply detecting virus amongst the vaccinated is substantially lower than amongst the non-vaccinated that's the first point to keep in mind the second point to keep in mind that even amongst the people who do have infection despite being vaccinated the frequency of their landing up in hospital in needing critical care is much less and the consequence of that is that deaths have fallen quite substantially but here's the interesting statistic that's useful to look at think about the American numbers the US numbers currently are about 100,000 and if you look at their so called last wave at about 100,000 the death numbers accompanying those 100,000 kinds of numbers are far smaller but remember that only half the people are vaccinated and the bulk of these current 100,000 case numbers are amongst the non-vaccinated so it's reasonable for us to say shouldn't since the bulk of the cases are in the non-vaccinated shouldn't death numbers be about the same or even more perhaps because everybody including the CDC is saying that the Delta variant is a little more lethal which number we should look at with some skepticism but that aside shouldn't the death numbers be larger and what is missing there is the fact that what I'm calling this patchwork quilt of vaccination even in the US the proportion of people at high risk of death meaning people with comorbidities the elderly people in nursing homes have been hugely vaccinated so that the unvaccinated people who are falling ill in the US are primarily younger people without comorbidities and it is therefore a combination of these circumstances this intermeshing of patchwork quilts that I'm referring to that is leading to very very low numbers of death this is happening in Europe it's happening in Canada it's happening in the US all across the global north death numbers have fallen hugely because of this combination of circumstances interestingly enough Kerala has much lower death numbers among the people who fall ill and then that's an interesting figure from the very beginning one is of course the unreported deaths due to covid are much lower in Kerala according to excess death figures but also the number of people admitted to hospitals and those people who have died are also because they have flattened the curve so they're able to take care of the the spikes that really cause a crisis of the hospital so for both reasons they seem to be over and above those two reasons the vaccination reason I suspect is also a contributor our our data are not great but I suspect that the vaccination related reason that I just pointed out for the global north is also a contributor because Kerala's vaccination percentage again is higher much higher than the national average but let's not look at it as though again it's uniform what that has meant is that Kerala has managed to vaccinate a very large proportion of its elderly and its people with comorbidities and that's also going to be a contributor to the decline in critical care hospitalization and death that's an interesting sidelight that essentially when you look at death figures just don't look at only averages of this kind also look at which is the target population which has been mostly vaccinated and therefore the death rates are also correlated to the age groups of people vaccinated and unvaccinated and as we know that the comorbidities increase with age obviously professor Ratan I have more comorbidities than most people in the audience but apart from that that if you vaccinate them then of course the serious cases number of serious case statistically come down though it doesn't mean that the young people do not fall seriously ill either so it is just that the percentage declines and it is not therefore an excuse that we're giving here young people don't have to be vaccinated it's clear if they're not vaccinated they are going to infect others and therefore they are always going to be at risk themselves and for others as well absolutely in fact to add to what you just said about the shifting age groups that's getting infected and that's getting to hospital so to say everybody is worriedly asking is the delta variant now affecting children and the answer to that is we are seeing more children in hospital because we are seeing many many many more children infected number one and number two we are seeing that the hospitalised group is not so much the elderly and is beginning to be more and more children it's actually still mostly elderly but the proportion of children is rising primarily because the elderly group in India even in India the substantial fraction is vaccinated whereas children are neither vaccinated nor because they've been protected over the past year and a half of slow spread of the infection into communities they've been protected from exposure as well and that's why this is happening it's not happening because the virus is targeting and killing children or anything of the sort it's the kind of statistical shift that you are pointing to and obviously as we open up we are going to see more of this particularly when we open up the schools which we possibly will have to because we cannot hope to have children lose two years of school if we go at this rate and it's also increasingly clear that society will have to live with COVID for quite some time and this is going to be our near new normal and therefore the importance of all the other measures which are called the non-pharmaceutical measures that means masking distancing all of those things will also have to be taken into account even if you are vaccinated. Coming back Satyajit the other issue that seems to be in discussion even in India is mixing of vaccines and some argument that by accidentally mixing vaccines in India we have monitored a few number of them and we find better results. Now of course the numbers are very small and if we really want to do conclusions on that is this a basis or should we actually do some active trials of this kind? Alright so since this has been discussed over the past 24-48 hour news cycle quite extensively let me point a few things out in the first place for immunologists like me this is completely unsurprising vaccines are not different medicines vaccines as we have discussed earlier are simply slightly different technological ways of doing the same thing so mixing a dose of one vaccine with a dose of a second vaccine against the same target is it is unsurprising and to be expected that that will work quite well nonetheless as we have discussed again none of public policy decisions should be made on the basis of immunologists feelings they should be made on the basis of good proper evidence this is why we have been discussing since January our surprise in distress about why the government of India and Indian Council of Medical Research have not begun these crossover vaccination trials well designed properly done trials right at that point because it was facing us that both for reasons of vaccine shortage for reasons of vaccine supply logistics and for errors of this are in for kind we are going to have to deal with this point this had not been started until me whether it is current how far along these trials currently are you and I don't know but one hopes that they are in the meanwhile what does the Indian Council of Medical Research do it takes the ICMR it takes the Sarenpur administrative error that people have were given one dose of one vaccine and a second dose of the second of the other vaccine and tests their antibody levels now was this well done yes it was well done was this ever going to be adequate no it was not so it should not have been treated as evidence or leave alone proof of anything at all a sample size of 18 in which you know nothing whatsoever about the participants in in this these sample groups added to this is the fact that technically the work that has been done which is available as a preprint is technically both extremely poorly done and even more poorly presented in the in the preprint and as a consequence even small amounts of possibilities that might have been possible to glean from from this opportunistic effort are really not likely and therefore I am saying this please everybody stop getting anxious about should I take mixture vaccines because ICMR says they are better and I remind everybody that the world health organization the chief scientist Dr. Swami Aswaminathan has pointed out that the WHO is not as yet recommending any vaccine crossovers and mixes at all and I think at this point that is the sound policy decision and in case we have to change it we should do well designed trials for the same which we hope are being done are being done last question good news sputnik 5 results have come they have been in long criticism that they are not well designed trials the Russians have been fudging their data and so on and so forth which we have discussed earlier is how much of it is really worry about the Russian vaccine how much is it a part of the pharmaceutical companies efforts to belittle each other for market is a different question but good news nature now has a report which seems to indicate that sputnik 5 behaves does very well one interesting sidelight and maybe you can comment on that is that they don't seem to have seen the same clotting phenomena blood clots being for micro blood clots which AstraZeneca and Johnson and Johnson both have seen do you think there is enough evidence to indicate this could be because of reasons which we still don't know or do you think it's just an accident of the sample size again so probably one thing we should we should you and I should point out to our audience that we have been misattributing the name of the Gamalaya vaccine you and I have both been calling it sputnik 5 but it is apparently sputnik V for victory okay and this so and so we combined we apologize it's sputnik V so but yes the report is very welcome the data are unexpected but as you point out very welcome and heartening the arguments about how record keeping is done how this is done how that is done we've discussed this about co-vaccine we've discussed this about cove shield it's not surprising that given the additional political tensions similar issues have been raised with the Gamalaya vaccine and of course underlying all of that is the big pharma competition for profits involved playing its own part as well but the TTP problem the thrombosis and thrombocytopenia syndrome the TTS problem sorry the thrombosis and thrombocytopenia problem that has been reported with adenovirus based COVID-19 vaccines as you point out the Astros Oxford AstraZeneca vaccine as you point out the Janssen Johnson and Johnson vaccine the Gamalaya vaccine is also an adenoviral vaccine and yet does not seem to have reported this now one immediate response that we are going to hear is oh well you know one doesn't know how carefully they have looked and so on and so forth but what's important is that the AstraZeneca trials the Johnson and Johnson trials neither trial really threw this up as a problem this came up and despite the fact that the trials all of these trials have been in the 20 30 40 000 group size range this problem did not come up that's unsurprising because even now we are not sure in the first place that the problem is truly vaccine created but even amongst the vaccinated it seems to be at a frequency of 1 in 5 lakhs or 10 lakhs 500 000 to 500 000 so under those circumstances even if it is a true side effect of the adenoviral vector even if that is so it's an extraordinarily rare perfect convergence of very very local multiple circumstances and it's completely unsurprising that the Gamalaya trial being reported has not thrown this up I would again point out that that sort of level of risk is so academic in nature that it really should not form part of an individual decision about whether to take a vaccine or not and for the audience both Satish and I have taken after Zeneca Oxford vaccine Oxford after Zeneca serum Institute of India Oxford after Zeneca serum Institute vaccine so we are both taking this fully conversant about the very very small risk that it portrays but nevertheless the point is that it does seem to show microclotting even if it does not show it in a the form that leads to serious consequences some cases we seem to see microclotting it may be interesting to see whether we also see that with the Sputnik V vaccine or not again a topic for future discussion and quasi-academic at this point because the risks as Professor Rathar said are very very low for all practical purposes not there and almost all medicines have a higher amount of risk which we take quite routinely so it's not that this is only with vaccines it's a risk we do take when we take medicines except we don't read the full chapter and verse which comes to the medicine which says what are the side effects if we really read them you might find it very difficult to take medicines at all thank you Satish for being with us explaining to us the different dimensions how to look at data in the case of vaccines and COVID-19 infections as well as what are the kind of side effects we might or might not expect this is all the time we have for news click today do keep watching news click and do visit our website