Don’t Spend Blindly On Healthcare, Spend Smarter: Dr. Ketan Desai
What do you think has led to this massive surge of Covid-19 cases in India suddenly?
One of the causes is that India became complacent and people started mingling and started having these big religious festivals and political rallies and collectively the guard was let down, people were not being careful enough and this led to the surge. The other thing is that whenever a virus stays in a population for an extended period of time, it allows mutants to develop and it looks like we have a mutant now in India which is a double mutant and that’s a bit of a misnomer because quite a few of the mutants are double and triple mutants so it is not specific to India.
The mutant that is in India is a lit bit different than those found in other parts of the world and so this mutant is probably more transmissible and also more lethal than the original Wuhan strain. The strain that came after the Wuhan strain, which is what infected the US and Europe was the D614G strain. This was the real parent strain that led to the pandemic, because it mutated into many different forms, subsequently including the South African variant, the Brazilian variant, the two new variants in the U.S - the California variant and the New York variant. Recently we found another variant in Texas, which is now the deadliest of them all, so the Indian strain is actually not as bad as the Brazilian variant but it is more transmissible.
What would it look like two months down the line? Is this going to keep mutating into different versions and cause spikes like the way we have currently?
All viruses mutate but they mutate at different rates, and most of the time not all the time the virus will mutate into a less lethal form because if the virus kills its host then the virus dies too. However, that’s not happening here and we have seen this in other cases too, like Ebola mutated into something more deadly- it doesn’t always work out to human advantage. Unfortunately, there is no fixed timeline by which it will stop mutating. We won’t truly have herd immunity in my opinion and so we will be left with the virus for eternity, just like we are living with rabies, TB and malaria. We should be prepared for the fact that this virus is here to stay
What is your opinion regarding management of the spread of the pandemic- how different has it been in the U.S versus what we have done in India?
The U.S response has been extremely haphazard. Under the previous administration they thought this was nothing bigger than the flu and there was a lot of political pressure on the scientific committee to downplay the virus, and not many states were complying with any of the mandates like masking and social distancing. Things are being taken more seriously now but still there are some states which are flouting the rules. The response has been extremely haphazard and inconsistent, so you will see these spikes in certain states coming up and going down.
In India and we have a problem of very high population density, it's three times or maybe nine times higher than the US. Therefore, it is going to be much more challenging to contain the spread in India. The other problem is that social distancing and hygiene is not as good. I am not sure how well hygiene is really being looked after in India and how well people are taking care of it.
How can we be better prepared, if a situation like this arises in future?
The only two things I would add are from the personal hygiene part that is to avoid smoking and alcohol as they both suppress the immune system pretty badly especially alcohol. Exercise for about 30 minutes a day, exercise has been shown to decrease the incidence of severe flu or severe.
When we had the Middle East Respiratory Virus and this previous version of SARS, certain countries had experienced it but most of the world did not. Countries like South Korea were much more prepared when Covid came because they had the procedures and policies in place to deal with it. If you go to Japan, you'll see people wearing masks routinely. Also, America did have a policy in place during the Obama administration but the Trump administration basically didn't follow any of it and totally ignored it. We do need to have policies in place and implement them and maybe this is a good wake-up call for India to really emphasize personal hygiene.
In India at the moment we are spending less than two percent of the GDP on healthcare and we need to increase funding and better our health infrastructure. Do you agree that if we increase the spend on health infrastructure then we could be ready for any other eventuality that might arise?
I think more important than spending more on healthcare is how we spend on healthcare. I don't think India needs to spend more on healthcare by buying oncology drugs that cost a hundred thousand dollars a year. It is not going to help India a whole lot. We need to target our healthcare spend better. India’s prime need still is infectious diseases. We don't need to be doing expensive angioplasties when more people in India die from tuberculosis and malaria and infectious diseases. We need to focus still on infectious disease and epidemiology and maintain hygiene, sanitation, good water purification and tackling air pollution. Pollution is a huge problem because people whose lungs are damaged from pollution have respiratory disease, they become more susceptible to Covid-19. I do not think we need to just blindly spend on healthcare, but we need to spend smarter.
