A Window Into The World Of Women

Dr. Priya Abraham: Covid-19 Third Wave is Likely to Happen

Dr. Priya Abraham, a renowned virologist, is the director of ICMR and is heading the National Institute of Virology (NIV) Pune.

Q) Ms. Rakhee Bakshee: Welcome Prof. Priya Abraham, I welcome you to the show.

Dr. Priya Abraham: Thank you for having me in your show and I look forward to this interaction.

Q) Ms. Rakhee Bakshee: Recently we read that the mixture of Covaxin and Covishield actually benefitted people and boosted immunity. Would you like to throw some more light on it and tell us whether there are confusions or whether it is the right direction?

Dr. Priya Abraham: In our experience, we were led to look at a serendipitous mixture of doses. It happened unintentionally and we looked at the response rate. Those who received a heterogeneous combination, that means, one vaccine followed by a different vaccine as the second dose, we found that it was not unsafe and did not cause any extra symptoms or side effects. The immune response was a little better but the numbers are modest and very few at this point in time. Time will tell when we will be able to give an official recommendation that this is a safe way to go and also in some way a little beneficial. So right now this is not a formal recommendation.

PC : The Financial Express

Q) Ms. Rakhee Bakshee: Looking at the full journey of the pandemic, even a month back the situation was scarier than it is now. However, we are hearing reports about the increase in cases in places such as Kerala and North-Eastern India. As far as this pandemic and SARS-CoV-2 is concerned, where do we stand as of now?

Dr. Priya Abraham: First thing we have to understand is that India is a large and complex country and each state is like a “country”. So we might have multiple surges across our country, it’s not like the surge comes simultaneously over the different states of the country. So, it may be related to, one, the level of protection that people have. Or even, people may have low levels of antibodies because they have adopted very good public health and social measures, such that, many people are not protected. So should there be a spread in the community, many people go down with it.  Another factor that contributes to differential positivity rates is, one of course there has been a general laxity in that region; otherwise, it is also because of the manner in which they test. Are they testing intelligently? Are they actually catching the more symptomatic people who are likely to be positive? Maybe in some regions we are not testing intelligently. We are catching people who are at a lower risk, the asymptomatic individuals, and they will come positive. So the percentage prevalence will be low. You have tested n number but you have not tested the people who really are likely to be positive. So these are the factors that lead to variation between the states. And I think now, both Kerala and the North East are just going through their wave. Other states have already completed their wave. This is likely to happen and it is going to be different as the festivals approach us. Each state has its own regional festivals which are very big things for them, and if we open it out, then we are going to have multiple small surges based on the level of crowding and merry-making that are happening, which are done in a callous way.

Q) Ms. Rakhee Bakshee: In fact, Ma’am, I would really like you to give out a message here, as you, being in Maharashtra, has rightly said that all over India the festival season is starting and in spite of spreading the word about social distancing, festivals create an emotional surge. Would you like to give a message here saying how important it is to behave in a Covid-19 protocol manner?

Dr. Priya Abraham: I think the more sensible approach, at the point where we are today, is to continue to mask up. I think now is the time where you can take out your designer masks so you can have a nice, snazzy mask that goes with your pretty outfit; but masking is a must, physical distancing is a must, overcrowding is a big no-no, hand hygiene and respiratory hygiene are also very important. We could go with the flow of things and be really excited about our festivals approaching, but this has to be celebrated in a different manner where we can have fun but we have to be sensibly celebrating.

Q) Ms. Rakhee Bakshee: Sensibly celebrating is the message that Prof. Priya Abraham of course is giving, apart from many others who really understand the severity of the situation as it is and only the current Covid-19 protocol behaviour really gives us that safety cover which is important. We are very happy that we have crossed 50 crores in India as far as vaccination is concerned. However, despite two doses of vaccination, we are seeing cases of breakthrough infections. How would you like to make us understand what it is all about and how we can deal with it?

Dr. Priya Abraham: I want to make two points very clear. One is that, no vaccine is hundred percent effective in stopping acquisition of infection. What a vaccine does is it protects you against serious forms of illness should you pick up SARS-CoV-2. Those of us who are vaccinated and who are going around in and out of malls and festivities, we could pick up the infection. The infection could enter our bodies through our nostrils, it could cause a localized infection, we might not get very sick because we are vaccinated but we could potentially be the roots of transmission to others, especially, vulnerable people at home, elders at home, such as our grandparents and parents who have other health conditions. So we need to be cautious and celebrate knowing that even though we are vaccinated, we could pick up and continue to transmit the infection to others who are more vulnerable.

Q) Ms. Rakhee Bakshee: Another thing we read and also heard about from the director of AIIMS Dr. Randeep Guleria is the R factor. How serious and severe is it? How much do we need to look at it?

Dr. Priya Abraham: R factor is the reflection of ratio; when one person gets infected, how many other people can that one person infect. So when that R factor crosses 1, what they call the Rnaught, that means, if I am infected, I can potentially infect two or three people and those two or three people can infect two or three people and you can see that becomes a very quick spread of infection in a particular area. So R-naughts going up, definitely crossing 1, is not a good thing for any region. And again I come back to our behaviour, which will be able to keep this R-naught lower just by virtue of the way we behave in public and even in our homes, or even when we are interacting with our colleagues and friends.

Q) Ms. Rakhee Bakshee: What about the 3rd Wave that one has been talking about? How do we really need to look at it? Is there any trend which shows that the 3rd Wave could be just around?

Dr. Priya Abraham: The 3rd Wave may happen. We have seen it happen in other countries, even Delhi had more than two waves. So 3rd Wave is likely to happen; when it will happen, how big that wave will be is dictated by us. So, to all your questions, I have the same answer to give. The more careful we are, the more responsible we are, we can at least delay the wave and even if a wave was to come, the size of the wave will depend on how good our measures are.

Q) Ms. Rakhee Bakshee: Coming to children, some people are saying that children’s health might get affected. How true is that? How do we need to look at children and their health in the current SARS-CoV-2 scenario?

Dr. Priya Abraham: Well if you see the results of the most recent surveys that ICMR did, you will know that large number of children were exposed and they were positive antibodies to the virus, which means, they were exposed. The majority of children handled this virus very well. They usually have an asymptomatic illness and we may not even know that they are infected. It is the children that have some other medical complication which could make the outcome serious for them. Otherwise by and large, children, especially younger children, handle the virus very well. At best they have mild symptoms or no symptoms, but as I said it is only in a fraction of children who have some other medical complication that the infection can take a bad turn.

Q) Ms. Rakhee Bakshee: We always say that women should lead from the front. We talk about female health workers and I must appreciate and also share with our viewers here that we feel delighted that someone like you is leading NIV in Pune, leading in the health sector and creating a very scientific understanding for us. Looking at India, if we focus on the whole sector of virology, the scientific study, the scientific temperament that we should all have, and the new learnings from the pandemic, how have we really behaved?

Dr. Priya Abraham: In terms of the health care sector and in terms of a potentially future pandemic hitting us, we need to have very robust healthcare infrastructure. Just like our armed forces, it is a preparedness that we need to have, to be able to handle an outbreak which will come from the most unexpected quarters. So, the preparedness is very important. But having said that, if we reflect on how the entire bunch of the health care workers as well as the indigenous kits and equipment that we were able to put out, I think as a country we have done well. ICMR-NIV itself, we were the first to report the virus, and within two weeks, we had taught thirteen lakhs how to do the RT-PCR Test. Today we have taught 107 virus research diagnostic labs which are under the department of Health Research and over 1300 government labs are using the technology we taught them. So day and night we taught people virtually, online, how to do a test which they had never done before. So from very low levels of expertise, people have come up to a very good level of expertise. They have risen to the challenge and we have a number of labs today, over 2000 or perhaps as I talk maybe 3000 labs, both government and private, that are able to do testing for our country.

Q) Ms. Rakhee Bakshee: So basically we did stand up to the challenge Ma’am.

Dr. Priya Abraham: Yes we stood up to the challenge. The very good reporting network and the portal we have to enter results set up by ICMR, even the government responding to making Personal Protective Equipment (PPE), ventilators, now we increasing our oxygen production capacity, every day we are hearing that we are inching up more and more and a lot of indigenous kits and equipment have also come into the market. So I think we have not really been lackadaisical from that angle. But as the public of India, we don’t need anybody to tell us. By now common man should be made to understand that this pandemic will behave the way we behave, in the sense, if we behave responsibly, the pandemic will slowly ebb away.

Q) Ms. Rakhee Bakshee: But as we see around Ma’am, people have started travelling. Using a mask and social distancing are very important, but people are not only travelling domestically but there are plans of making admissions for children and tour plans for business, outside the country as well. What would you really advice at this point of time as to what exactly the kind of precautions we should really take?

Dr. Priya Abraham: So again I would say vaccinate as much as possible. Be vaccinated and the mask is a wonderful “kavach” for us. So no matter where we are, whether we are at the cafeteria, of course we have to eat but try to find a place where it is not crowded, where you have a little space around you so you can take off your mask and consume your food, especially when you are going to the washroom, the mask has to be on. Again when you are crowded in an aircraft or in a lobby, look at the place and you will find that there are many people around you, so there is no scope for letting down your guard. In fact, I was in an aircraft recently; I had to go for work. I was sitting across the aisle with a man who was quietly letting his mask down. Twice the cabin crew told him to put up his mask and when they disappeared, he brought his mask down. Then I spoke to him from across the aisle and I told him, “Excuse me Sir, this mask is first to protect you and then to protect others. So please don’t do it for anybody else, please wear that mask.” So I think we should also step out of our zones of comfort and actually tell people who are wearing chin masks, who have their nose sticking out of the mask, who put aside their masks. We are a vehicle to pass this message around so that all of us collectively become more responsible.

Q) Ms. Rakhee Bakshee: We get most of the information online, or by reading newspaper or by watching television, of course ICMR is putting out information, the Health Ministry is also, through its conferences, telling us about what is happening. Talking about the recent scenario, the vaccination is taking place; women’s health is also of priority. What is your message to women as to how they should protect themselves and take care of themselves? Recently we heard that pregnant women can get vaccinated as well. What would say about the confusion regarding women taking the vaccine, taking the right kind of precautions and dealing with this pandemic and SARS-CoV-2?

Dr. Priya Abraham: Women are just as vulnerable as men for this infection and women need to understand that vaccination is very important. It does not interfere with their menstrual cycle or fertility issues and can be taken during pregnancy and while they are nursing. This is the first thing they need to know. A woman is a pivotal person not just at her place of work but I think she is the pivotal person in a family setting. She is important for her children, her husband, her parents and for herself. So I think that women should not put this on a back burner, they should take every effort to get themselves vaccinated if they want to stay healthy and also this Covid-19 appropriate behaviour is very relevant for her too. She is very much a person who should be handling this very responsibly and there are no additional risks to a woman.

Q) Ms. Rakhee Bakshee: Thank you for sharing that and I am sure that all the women out there feel confident. Please go and get vaccinated as the experts say that this is important. As far as vaccination is concerned, and you also spoke about testing, how are we going ahead? Where do we stand?

Dr. Priya Abraham: If you are asking me about testing, I think testing has to continue. Testing, tracing, quarantining, isolating, all of these are extremely important and we need to be maintaining a quality. It is not just any test, but a test that will give the result. I need to remind the public that there was this talk about RT-PCR Test not performing optimally when the peak of the second wave hit us. That was because the health care system and the laboratories were overwhelmed by the sheer load of tests they had to do. And I know for a fact that many of the staff who were in the lab were themselves infected. So we need to help each other; like I always tell people that let us not put that load on the doctors and nurses and other health care workers. We are responsible. We do not need to be an agent of putting more load on the healthcare system. So yes, to some extent, both the hospitals and the laboratories were reeling from the load but I think our labs are well up to meeting that challenge and we just need to keep up with it. There is no time for laxity.

Q) Ms. Rakhee Bakshee: At this point of time we know that there are a lot of confusions and rumours regarding the pandemic, although we don’t want it and we keep telling others not to spread misinformation but sometimes through some inputs one gets apprehensions. So post Delta variant, will there be a new variant which will be worse, as some people say?

Dr. Priya Abraham: I will take the question a little differently. I would say that the vaccine and the mask are your protection against any variant. Yes, the Delta variant was extremely transmissible, so it raged through our country, it has raged through so many other countries, well over 132 countries and I think my figure is conservative. It is probably more than that. So you know how many countries now have the Delta variant. Even in the United States of America, the Delta variant is raging. Now knowing this virus, the more you give it a chance to spread amongst a population, it is going to keep changing its avatar a little. So variants are likely to come, and for that most of the nations have now geared up to do very good surveillance and sequencing of strains that are circulating in a region. So every region, including the WHO, is alerting us that there is a new variant about. And again, like I said, if we allow the virus to spread more amongst us, the virus will keep changing just a little bit. That’s the nature of the virus. So what we can do is stop its spread.

Q) Ms. Rakhee Bakshee: Talking about virology, in this pandemic, we got to understand the whole importance of this area of health. But tell us about this whole pattern of understanding the virus. It took some time, of course, to understand the pattern, the nature. As far as virology in India in concerned and you are heading one of the important institutions, how much do you think have we really gotten hang of it now? You said that we stood up to the challenge and we have really been able to come together and gain good results to preserve or take care of the healthcare system.  But as far as virology is concerned, can you give us more insights on that in India?

Dr. Priya Abraham: I think there has been a huge amount of awareness not only among the lay people, who are not scientists themselves, but in the whole healthcare system and among laboratories, I told you how we had empowered 107 laboratories, and now virtually every medical college has developed capacity to test viruses. People had this bigger, larger discipline of Microbiology, people knew about TB, people knew about those kinds of bugs, to some extent they knew a little about the H1N1 which common man refers to as the Swine Flu. But at that time, the spread of the virus wasn’t so much and we also had an antiviral drug for it. The drug combined with vaccine could quell the spread of the previous pandemic to some extent. Now we are finding that this virus is spreading like really crazy and now I think awareness has come up to a great extent among the non-scientific and the scientific communities; and I think this will hold us in good strength but we should keep up the awareness and preparedness so that we will be well braced and ready for another potential pandemic in the future.

Q) Ms. Rakhee Bakshee: We work here with a lot of young people, we work with colleges and many of them are young girls; if we talk about virology and the scientific stream as a subject, what would be your message to some of these young people who are looking at careers in the areas of science and scientific research?

Dr. Priya Abraham: I think we have come a long way. In fact, earlier when I used to say that I am a virologist, people would say, “Oh you are a biologist?” They could not distinguish what virology is and what biology is; I think that awareness has come up and I think this whole discipline of virology is really the place to be. I think working in a discipline such as this, you will never be out of business. I say it not out of an inflated sense of confidence, I am just saying it out of our experience from the recent past. As I am speaking to you, you know we found that there was Zika both in Kerala and in Maharashtra. We are constantly finding new things, so being in this specialty is perhaps one of the best places to be if you are in the overall discipline of science.

Q) Ms. Rakhee Bakshee: And that leads to another small question about convergence, that is, how do we join together and understand something which poses a challenge for us? Within the health system, let’s say, you are in the field of virology right now, but there are different scientific streams, expertise and researches; what would you say about the convergence of it all happening in India as of now?

Dr. Priya Abraham: I think between different disciplines, whether you are a cancer surgeon or you are a person who looks after kidney diseases, a nephrologist, or a cardiologist or a pharmacologist who looks at drugs, or an immunologist or a vaccinologist or a virologist – this particular pandemic has just driven home the fact that we have to work in a very complimentary fashion. Our inputs in a complimentary manner, in a cohesive manner will bring out the best outcomes. Nobody can work in isolation. We are interdependent at a time like this.

Q) Ms. Rakhee Bakshee: That is very well said Ma’am; the interdependence and also understanding and learning from each other, and then working together to face the pandemic. Do we have some other questions team? Is there somebody who would like to ask a question here?

Q) Tishya Majumder: When we talk about common objects such as money or coins which people handle every day, what percentage of the virus can enter our bodies from objects such as money?

FILE PHOTO: People shop at a crowded roadside vegetable market after authorities eased coronavirus restrictions, following a drop in COVID-19 cases in Ahmedabad, India, June 15, 2021. REUTERS/Amit Dave

Dr. Priya Abraham: Money or anything that can be touched by common man, be it the railing, or even when you travel in an airport shuttle which takes you from the airplane to the lobby of the airport, that is touched by innumerable people. For all of us, when we touch anything that is handled by anybody and everybody, we should periodically sanitize our hands. Definitely we shouldn’t take the unsanitized hands to rub our face, our nose or even consume food especially if we are not using a fork and spoon, if we are eating Roti or whatever; without sanitizing our hands or washing it well with soap and water or using a good sanitizer, we cannot consume food. We must assume all these could have been touched by somebody who is not as careful about transmission of infection, following strict Covid-19 protocol, not taking hands to the nose or face; so we have to assume that these objects are potentially infected.

Q) Ms. Rakhee Bakshee: Tishya, thank you for asking that question. One more thing Ma’am and I can’t let you go without asking you a little bit about your personal and professional journey, reaching here and leading here at NIV; and also when we are looking at the health sector in the times of pandemic, how has it been understanding something specifically and having huge responsibilities at a time like this? How has it all been for you Ma’am?

Dr. Priya Abraham: I will be honest, it has not been easy and obviously to lead an institute that is doing so much work at a critical time, we started our work in January of 2020, so we are almost 18 months into this, it has not been easy. There has always been pressure from all quarters because everybody was stressed and did not know how to handle it, be it from individual entrepreneurs, scientists, from the government, from the ministry, because everybody was under stress. But looking back, I think, because of the excellent teamwork in the institution that I am heading, we were able to contribute in several ways and I look back with a feeling of contentment, some sense of accomplishment and gratitude that things went fairly well, nobody became very sick and there were no transmissions of the virus within the institute, we didn’t close down a single day. The days we closed down were for the machines to be rehauled and recalibrate because machines also need some time. It has been a very hectic and eventful rollercoaster journey but I think, looking back I feel, we have been able to serve the nation.

Q) Ms. Rakhee Bakshee: Another small question again about our health workers actually. We need to salute our health workers, the entire spectrum, from doctors in ICU to paramedics to nurses to other medical staff, I think they have really worked 24/7 and I think as a team, as you are saying, at the institution ICMR-NIV, and apart from that, all over India I think health workers have really done a commendable job.

Dr. Priya Abraham: I have to completely agree with you. I think we have to salute people who are frontline staff, frontline workers, be it qualified as a formal frontline staff in terms of doctors, nurses, physiotherapists and even in the non-formal sector, they were there facing the suffering and putting themselves at immense risk because they were going back to families after having been at work for long hours in the midst of all this suffering and lot of infection around them. So that is what I had earlier mentioned that we can truly appreciate them and we can truly salute them for their services by being responsible citizens and making sure we don’t either pick up the infection or transmit infection to others; that would be our best tribute to the work they have done for this whole period of the pandemic.

Q) Ms. Rakhee Bakshee: Thank you so much Ma’am for your valuable time, for all your insights, for all the valuable information that you have shared here on Her World India Talk Show and we really feel very grateful to you and we also show our gratitude to all the health workers here and of course to you! More power to you for leading from the top as you are from NIV, an institute as prestigious as that, and ICMR, our Heath Ministry which is keeping an eye on things as they are happening. Prof. Priya Abraham, thank you so much for talking to us.

Dr. Priya Abraham: You are welcome.

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