‘Govt should refrain from knee-jerk reactions, have SOP in place’

Mumbai: With the state appointing a new task force for Covid-19, HT speaks to its chairman Dr Subhash Salunkhe on the present surge of cases, vaccine hesitancy and the need to have a standard operating procedure to handle viral respiratory infectious diseases. Salunkhe has previously led the state’s measles task force.

1. What is the current status of the Covid-19 pandemic? What steps are being taken to control its spread?

We are in a comfortable situation throughout the country. Maharashtra, along with states like Kerala and Tamil Nadu, have comparatively more cases than other states. Within Maharashtra, a few districts, including Mumbai, Thane, Raigad, Pune and Nagpur, are recording a higher incidence. We are now aware that the Covid-19 pandemic stage has reached endemicity. We are also fully aware that the Omicron variant XBB.1.16 is predominantly milder. Though the rate of infection is very high, the incidence of hospitalisation is very low, placing us in a comfortable situation.

2. What are the recommendations put forth by the task force to the state government?

While the immunity conferred by vaccines has helped, more than 95 percent of our immunity to Covid-19 is via natural infection. But though that may be a fact, we cannot ignore even one death or the percentage of the population that is developing complications. We have to research this, and as a task force, we plan to provide evidence-based guidance to the state. We are also working with the Maharashtra University of Health Sciences (MUHS) to identify areas of research, which includes work on antibody status on selected populations in a few districts.

3. Going forward, shouldn’t there be preparedness to tackle infectious diseases like H3N2, H1N1 and Covid-19? Shouldn’t there be an SOP?

As a task force, we have asked the government to refrain from knee-jerk reactions. We are going to expand the scope of this task force with infections that are similar to Covid-19, such as viral respiratory infections, including H3N2 and H1N1. We will have them all covered under one spectrum rather than focusing only on Covid-19 or only H1N1 (swine flu).

We also have to take into consideration the health system’s preparedness for pandemic-prone diseases. SOPs should be in place rather than acting when cases go up. The entire health system needs to be designed in such a way that people have clear-cut roles and responsibilities. This will be our recommendation and within a fortnight, we will submit a broad framework on the SOP to the state government for consideration.

4. How effective are current Covid-19 vaccines? Are there any concerns about vaccine hesitancy or resistance?

In the public sector, we have iNCOVACC, which has a very low protective value of 30 to 40 percent, and I would not personally recommend it. However, even if we get a better vaccine, I am not sure if, in the present situation, people will come forward. Vaccine hesitancy is playing a significant role at this stage because I find that despite some district and city administrations’ best efforts, people are not coming forward for booster doses. Acceptance of the vaccine by vulnerable populations is also very low because of certain factors, among them the fact that Covid has become milder, and hospital admissions and mortality are low.

The task force has recommended that the government negotiate with manufacturers like Serum to have a better vaccine, especially for the vulnerable population. We also need a logistics system where vaccine procurement should be based on the uptake to avoid wastage, and a mechanism to exchange excess vaccines with other centres.

5. How important is it to continue wearing masks and practice social distancing even after vaccination?

As task force chairman, I had strongly recommended mandating masks for the vulnerable population but there were others who thought it should be an advisory. However we all unanimously agreed that the high-risk population should wear masks as a preventive measure, especially in crowded and poorly ventilated areas. We are seeing that mortalities are more in the high-risk population and people with co-morbidities.

6. What are some of the key challenges in managing infectious diseases on a global scale, and what can be done to address them?

Under-preparedness in many developing nations has been a major challenge. We have seen knee-jerk reactions by most nations. China remains a challenge because of the way the population is exposed to animal diseases. The country has been the originator of most pandemics. It is also opaque in terms of sharing information, which becomes a challenge. In the Indian scenario, we need diagnostic facilities and robust disease surveillance in not only the state but the entire country.