WHO chief scientist Dr Soumya Swaminathan
Soumya Swaminathan. Credit: Youtube

Today 9 July 2020 India’s most talented journalist Rajdeep Sardesai took a very interesting interview of WHO chief scientist Dr. Soumya Swaminathan on India Today news.

Here we have described the conversation between Rajdeep Sardesai and Dr. Soumya Swaminathan in detail

Here you can find complete information about Is the coronavirus disease airborne transmitted? COVID 19 vaccine? and Corona Virash’s current status in India.

Rajdeep Sardesai: Lets with the lot of questions kills swimming around coronavirus go to the chief scientist of the World Health Organisation Dr. Soumya Swaminathan appreciate mam you joining me here today start for by the big question “that become a controversy at the moment a group of 239 International scientists from across 32 countries name of a claim that the virus is airborne wants the World Health Organisation to revise its rules and Recommendation when it comes to Physical distancing where does the W H O stand of the concerned that the coronavirus could be Airborne”

Dr Soumya Swaminathan: when somebody speaks of simple even there are a lot of droplets that come out of a of our mouth and these properties are of different sizes and What happens is that a larger droplets they fall to the ground on some onto the surface within one and certainly within 2 metres and that is why this whole recommendation on maintaining a distance so that you don’t have these drop falling directly from one person to onto another person there are also smaller droplets less than 5 microns in sizes are sometimes called aerosols and a small they actually form they can stay in the app for little bit of time and they take a little longer actually to settle to the ground can also be moved around by gusts of wind and things like that and so these particles could be inhaled by other people who are in the vicinity is could be called airborne transmission but it’s very different from viruses that measures extra which are truly a born in that they get thread through the air that then I know it’s in the error and people who cannot in the room and who come in later can breathe the than I think the distinction really here and there be no proof of that as far as covid-19 is concerned but we have seen many instances of what we call Super Splendor events where there is a Choir practicing are there is a nightclub or some other closed the meatpacking factories and so on but people were close together and large numbers of got infected so so that could potentially be person to person if you are in close contact it could also be a little further away but exposed to the virus within the next few minutes with us by this could stay in the app for 10-15 minutes and if your breathing that and your still in close proximity

Rajdeep: But let me get this very clear WHO still maintaining the coronavirus disease spread is primarily from person to person through small droplets and only in exceptional cases could there be in a limited way and Air transmission I am I correct mam?

Dr Soumya Swaminathan:yes there are special situations so we don’t say that it doesn’t happen but it’s not like it’s air born it’s everywhere and therefore there is nothing that can be done you can see the from the public health action of being able to isolate and track contacts and Quarantine them that many many countries have successfully controlled if it was truly air born in that if it was everywhere then all of a sudden been infected by now so even logically speaking that’s that’s not it so I think it’s the science but it needs to be also explained to people properly because it’s very very important what precautions individuals are taking and what what methods country ministry’s are putting in place and that is why the majority is still be says is the droplet transmission and if you can control that you can you can control most of most of the transmission

Rajdeep: but again to understand this ma’am there will be a concern if your are in the crowded place with poor ventilation then physical distancing may not be enough that’s the concern am i right? crowded places with poor ventilation is specially Indore could be a big concern going ahead.

Dr Soumya Swaminathan: exactly one and one of the things that we have recommended for that is if you are in such a setting to wear cloth mask for face covering and in fact If you everyone does that mean that reduces to a large extent because these droplets are then blocked from actually coming out of the person’s nose and mouth but these need to be worn properly wherever possible ventilation is good for doors and windows can be kept open that’s good, air conditioning that precautions that could be taken by increasing the exchange of Fresh air by putting in heap of filters and so on so there are things that could be done in different settings to make them safe for but I think for people is important to either try to avoid this whenever possible like for example if the power Elite club or some kind of social gathering if possible to avoid that second is to improve the ventilation in such places and the third is for everyone to wear a mask when they are not able to physically distance .

Rajdeep : other issue which is now fiercely being debated among the medical community at the moment herd immunity early set based on a Spanish Shero server concluded man that herd immunity against covid-19 is difficult to achieve in some level about 60,000 people were tested only 5% developed antibodies you believe herd immunity is going to be very difficult to achieve in a country like India given the sheer size of the population

Dr Soumya Swaminathan: Yes so .. most of the world’s population is still susceptible including in India and that’s come from the antibody studies even and place the study were mentioned in Spain which was so badly affected that had so many that’s only 5% of the population has antibodies so achieving herd immunity first bowler to take very long time in seconds is going to come at a cost of cost in terms of loss of lives as well as illness in the community and prolonged lock down something like that so the best way or the achieve Herd immunity in fact the word herd immunity is usually used in the context of vaccination For example measles if you want to eliminate measles in a community you vaccinate covid-19 95% of children that then achieves what is called herd immunity immunity of 5% children who didn’t receive the vaccine they are protected because the remaining 95 of our immune and therefore they don’t spread the infection to break the transmission unit 50 to 60 % of the population to have immunity against this virus and I should add that we are still understanding what is immunity against this virus by measuring antibodies and so we know more about it but there are also other immune responses cell mediated immune responses that play a role will learning about that any case if you have 50 60% of people who have that immunity than the virus tops transmitting from one person to the next week and we think that probably the best way the safest way to achieve that would be through a vaccine

Rajdeep: you use the word vaccine the question of all time in this country in the last week does with much talked with the ICMR claiming that the 15th of August along with Bharat Biotech a we hope to have a vaccine for Corona setting a deadline trying to speed up the three critical clinical stage is how you will see this duty is dangerous of trying to set up a deadline of the six weeks for a vaccine when the rest of the world seemed to be suggesting that the very minimum it will take 12 to 18 months

Dr Soumya Swaminathan : it’s really see the kind of vaccine development efforts that happened all over the world and to see that India is very much in the forefront of developing vaccines not just as a manufacturing hub that can still up the production of generic generic vaccines but developing innovative vaccines through local R&D and so I think kudos to all the companies that have been working on vaccine development and of course to the government Ministries live DBT-ICMR and so on the Ministry of Health been supporting them i know 7 Indian manufacturers and companies who have vaccine development efforts and I believe the two of them are not proved going to human clinical trial the first page is when you inject tens of people may be 20 30 40 people to get an idea of the safety of the vaccine that’s called Phase 1 and that usually happens after you done your lab tests and the small animals like missed rabbits monkeys but that could be done in parallel is as a thing done in humans once you’re satisfied about the safety of the vaccine in the small group of people who can take it to a face to which is usually hundreds of people would be sometimes thousand where you are testing the safety in a larger number and you also testing what is called the immunogenicity how good and immune response is the vaccine actually stimulating in the body and will that be enough to protect now here is a million dollar question because we don’t know what is protective immunity for this virus and at this point of time globally that is not one test that would say yes if you achieve this then you achieve immunity against the virus that will come over a period of time and then you need to go to Phase III trial which is it will be in tens of thousands of people potentially is let say 30,000 people they have them to receive the vaccine half will get the placebo or some other Standard bike scene and then you can you all of them over a period of time could be months to see how many get infected in this group was this group and what you’re looking for is that in the group that receive vaccine you know you have a significantly lower number of people than 60% less infection then you get in the control room

Rajdeep: what what I’m trying understand ma’am to given this elaborate process can this be done in 6 weeks as the ICMR claims is going to take by all accounts 12 to 18 months isn’t it?

Dr Soumya Swaminathan: no it is not possible to do it in six weeks this this is going to itself is a shortened timeline you know most vaccine development efforts take Years but because this is a pandemic because the world everyone wants a vaccine as soon as possible so shorten timeline in a very optimistic estimate is 12 to 18 months from the time that you start your your vaccine .development efforts and maybe the clinical portion of that may take anywhere from 6 to 9 to 12 months again depending on how smoothly everything goes to there are Shorting timeline that can be done to shorten the timelines but the processes which need to be followed cannot be circumvented especially since these are all new vaccine candidates have not been tested in i mansion important point we don’t know the immune correlate we will be able to use a blood test

Rajdeep : ma’ams should prove that is it weekly questionable to set news headlines put pressure on the lab to go ahead with clinical trials with this deadline is in this earth ethical question that should worry the W H O when India’s leading medical body sets up a deadline of the six weeks and wants a vaccine in 6 weeks?

Dr Soumya Swaminathan: No because I think that the Indian system is robust enough with not the first time that a vaccine or a drug has been developed and tested in India and we have Institutions and mechanisms which will protect and which are there to basically Overseas this process so you have institutional ethics committee which have to give approval for any human study before they can be started you have the drug controller general of the cdsco oversees the regulatory Pathways and every company has to submit a dossier and can only go to the next page once they submit the results of the first phase of the study and and then of course you have the Institutions within the government which will be involved in supporting these and the vaccine developers and manufacturers have done this before and so there is enough experience I think in the country that this would be done properly

Rajdeep: but I am right in saying that August 15 unrealistic deadlines for anything?

Dr Soumya Swaminathan: so august 15th is i think not a deadline for anythings it has to go to face by face of the Phase 1 May be completed in the next four to six weeks ago and it depends if everything goes well but it then you still need to go into phase 2 and eventually into Phase 3

Rajdeep: so we looking 2021 is very earliest for vaccine are one of the very earliest for vaccine am I right to get mam

Dr Soumya Swaminathan: realistically yes will be looking at the first quarter of 2021 to see the results of these trials and then of course depending on how quickly the manufacturers can scale of the production and it could then be given and we have to remember that in the first year or so we we think that they will be more demand and supply of any vaccines we know that there are about 20 vaccines and clinical development across the world were hoping several of them will be successful including some of the Indian candidates that candidates from China as well as to the Europe and and USA and Canada so but even then there will be limited to those of vaccine available and that’s why WHO working with our partners we to accelerate R&D but also to come up with a Framework for the allocation equitable allocation of the limited dozers so then the policies side of it also needs to be thought through who are you want to pursue this vaccine to were those virus people the most vulnerable you want to protect an and the and arrangements to enroll out of vaccine program would also need be

Rajdeep: the other concern Dr. swaminathan while we wait for this vaccine lots of drugs for a few drops the sun is coming in the market remdesivir is being sold in large numbers now be as being sold in Mumbai due believe this drug treatments are actually a cure or do they have very limited a value earlier we saw a push for hydroxychloroquine which the WHO was now rejected how do you see this pushes for drugs is cure?

Dr Soumya Swaminathan: yes there is a hues amount of interest in in in developing treatments Cured for this virus we wait for the vaccine what we need to do is to actually prevent people from getting really second end of the sea from dying and so the initially set of drugs that depict trials were those that are what we call repurposed drugs drugs like hydroxychloroquine and the anti HIV drugs some of the immune dividend like interferon so this because there are already widely used in humans we know the safety profile accept or they were easy to put into trials quickly and those that of trials are now giving us the results are not under is a drug that was developed for another corona virus was not shown to be effective for a bowler and then was repurposed to test against this virus with and what it is shown so far is limited benefit in the sense that it seems to reduce the duration of hospitalization so perhaps is adding in recovery but has not yet been shown in any of the trials to reduce the death rate among people were severely ill so what we need to do is to continue to study remdesivir to see at what stage of the disease that can be most useful perhaps it’s to be given at an earlier stage before people get very very real and and and and to to use it in that group of patients for for maximum benefit and at the same time many groups Around The World are looking for other drugs and and walks on the Horizon now is a monoclonal antibodies so these antibody is a very specific against the virus and if the given especially early in the course or we could even be given as prevention those trials are going to start now to see if you can use monoclonal antibodies to the prevent people for export from getting it ok to give it to people before they get sick so to prevent the progression of the disease so there’s a lot of movement on that front

Rajdeep: so WHO at the moment for a drug that can be used to have a specific write recommendation ?

Dr Soumya Swaminathan: so one durg is a promising results from a dexamethasone the results of the show that in people who are receiving oxygen or ventilation for really those who have respiratory impairment they have a significant benefit in reducing that by using dexamethasone, Shoaib Roop now the guidelines group is looking at all of these drugs and the evidence and will be coming out shortly but dexamethasone you know I think is already becoming standard of care in many places but we will also come out with recommendations On The Other Drugs they are all based on evidence which is been accumulating over the last several weeks now and I think whenever there’s enough evidence to make a recommendation that isn’t you make a conditional recommendation and say we need more evidence

Rajdeep: three is more concern ma’am… people have expressed in recent weeks of a relapse measuring a people who find the test negative after having the home to the Quarantine period but that they feared relapse and the fierce justify can someone with covid-19 have long-term lingering symptoms breathlessness other symptoms that could linger on

Dr Soumya Swaminathan: yes..so we absolutely learning more about the longer term effects of this virus and they have been publications coming out of a cohort studies people who’ve been followed over a period of time and certainly it appears that certain percentage of gana minority but particularly those who had severe illness was to be hospitalized they seem to take weeks or months to recover they’ve been some descriptions of neurological deficits even minor stroke something like that of lethargy extreme fatigue of breathlessness of lung function taking a long time to come back to normal and as we follow these up elearning more popular most of them will recover over a period of time but it’s the virus has gone away from the bodies of the virus is no longer a detectable in these people but somehow it’s affected by the through the the circulatory system the blood vessels and so on it has impact which which names to last for longer so it’s not a relapse it’s more long-term effects of the acute infection

Rajdeep: There is very important lets see ask the WHO team is going to China this week that has been the case of the warning coupling reported the inner Mongolia province of China is there a concern that they could be other viruses out there from China emanating from China that could spread or should we not be too much into it

Dr Soumya Swaminathan: we get reports of plague a constantly from around the world is one of the diseases that be monitored through the emergency operations center and so yes there is a report but you know I think our team is looking into it that isn’t anything to be really concerned about this at this point of time the team that going to China the who team and that’s going will discuss with the scientists on the ground that already been working on coronavirus is to try to layout plan for how to really because this is not going to be something you can solve within a matter of days it will have to be a well-planned scientific investigation and effort into finding out the species where the sum of the virus originated from how is jumped the species barrier when it might have jumped but there was one event or multiple events what can be done to prevent to the whole idea of finding that out is to prevent future episodes because we know this is how pandemics come be known for a long time that pandemics when a pandemic came it would come most likely respiratory virus most likely from the animal kingdom it would be a synoptic infection and it would jump the animal human behaviour so we really need to work with a Veterinary College and so on to understand how these things happen and how they can be prevented the future so that’s really the goal of of the investigation

Rajdeep : just finally question the month of July cases continue to Mount across the world India 20000 a day a cores the world more than two hundred thousand you believe in this country the worst is yet to come the virus which is now principally within the big cities good now spread to smaller towns will be have to live with the virus for several months until the end of 2020

Dr Soumya Swaminathan: I think we’ll have to live with the virus Rajdeep it will be very difficult to to eliminate the virus you know we have a vaccine and that’s going to take a bit of time to have enough immunity but what we need to focus on is how do you keep it under control at a level that manageable that’s not impacting people’s lives not impacting the economy and not impacting the day delivery of other health services and so I think over the last few months the these States have prepared themselves they were they will be blunt Laut collectively right I think countries have learnt from each other states of learn from each other so I would say that going forward what’s important is that local data local decision-making leadership local leadership local accountability government of the community in developing and delivering the response is going to be critical CEO at the national level of course the policy and the strategy and perhaps certain Benchmarks could be set but the more the centralised approach I think the most successful it will be in the long run and testing as we said earlier as going to play an important role but in conjunction with the with other Public Health measures which we know and many places in India shown that became very successfully contain even outbreaks which looked as though they going out of control setting important message is not to give up not to think that it’s too late that it can’t be contained in it can be done and I think predicting peaks and predicting is it doesn’t really help I think the effort should be to to try to contain and to try to mitigate and manage the outbreak as I think has been done so far but things will happen at different times in different states and I think for one state which has done well and recovered to be able to provide support to another state when they may need to search the pot I think very good to to plan the future

Rajdeep : soumya swaminathan you use the word manage the crisis as a critical challenge that lies ahead thank you so much for joining me here on the news today thank you

Dr Soumya Swaminathan: Thank Rajdeep.

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