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'If everyone wore a face mask, this thing will be gone tomorrow!'

By VAIHAYASI PANDE DANIEL
Last updated on: July 22, 2020 09:06 IST
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'The majority of the spread is by people coughing, or sneezing or talking loudly, in a very short distance, two metres from one another, and a mask will prevent that sort of transmission.'

Photograph: Yawar Nazir/Getty Images
 

Dr Ian Lipkin has recently recovered from COVID-19.

He says he had been very sick with this viral infection, caught from a "social exposure" in March.

One of the world's foremost experts in viral diseases, Dr Lipkin has firsthand knowledge and actual interaction with the SARS-CoV-2 virus, which causes COVID-19, in, now, more ways than one.

Apart from having lived with the virus in his body -- and using that unfortunate opportunity to study it, like his lungs were a petri dish under the microscope or a viral incubator -- he also visited China, in January 2020, when COVID-19 began.

He was there to gain information, on the ground, from the original epicentre of this pandemic and to collaborate with experts at Sun Yat-sen University, Guangzhou, like well-regarded pulmonologist Zhong Nanshan, who were studying the origins of the virus and the illness it causes. He also went to advise the Chinese government.

Dr Lipkin didn't visit Wuhan, fearing that his return to the US would be prevented and quarantined after getting back. Ironically, he picked up the virus later in New York City.

The John Snow Professor of Epidemiology at Columbia University, New York, Dr Lipkin has been described by The New York Times as a man from whom a 'virus cannot hide' and, repeatedly, in this article, and in every article anywhere ever since, as a master virus hunter, whose alacrity and innovation in recognising new viruses is rather well known.

These submicroscopic infectious organisms take Dr Lipkin, the virus shikari, around the world.

There is hardly a virus that Dr Lipkin hasn't worked on -- right from HIV and Bornavirus to the West Nile virus and the acute encephalitis syndrome or AES that started killing little children first in Gorakhpur, Uttar Pradesh, in 2017 (that necessitated another visit, among many, to India that year).

GiDEoN or Global Infectious Disease Epidemiology Network is the newest brain child of Dr Lipkin and several other epidemiologists, and a reaction to the frightening ongoing COVID-19 outbreak.

It aims to 'stop the next pandemic, before it starts' by uniting specialists informally all over the world in an effort to create a surveillance system that will keep an eye out for any future nasty virus that comes along.

It is, he says "focused really on sort of the medical intelligence, if you will, trying to figure out what's out there, how is it spreading, and then other people develop the solutions for it."

The virologist was virtually in Mumbai last Friday, July 10, to deliver a presentation titled A Vision for Ending Pandemics on viral diseases and the novel coronavirus at Mumbai's Columbia Global Center for the Yusuf Hamied Fellowships Events lecture series.

After his lecture, Dr Lipkin took a stimulating range of questions from the audience, from Dr Hamied, chairman of the drug company Cipla, and from the Indian media in a separate session.

Vaihayasi Pande Daniel/Rediff.com listened in and also had the opportunity to have a number of questions answered by Dr Lipkin.

Do please read the excerpts, presented as Part I and II, starting below, to discover how Dr Lipkin feels that a simple thing like a mask could have stopped COVID-19 in its globetrottng tracks, early on, if everyone had been wearing them from Day One in December 2019, why young people are spreading the disease, how the remdesivir drug is not as magical as everyone thinks it is and why Bollywood has to urgently help in fighting this villainous virus, that often brings death, if not fever, chest pain, breathing issues and chronic and persistent fatigue.

 

SEE: Virologist Dr Ian Lipkin offers a true picture, via maps and statistics, of the vigorous global movement of people, cargo, meat, livestock, pets, wildlife, illegal wildlife, illegal wildlife body parts. He also gives details about the cost of the COVID-19 pandemic. Video: Kind courtesy Columbia Global Centers, Mumbai

 

How do you explain why WHO did not interpret COVID-19 right?
And for not looking at COVID-19 as a human-to-human contagion?
What could be a way in which WHO can regain its credibility?

WHO is in a very challenging position.

They have to be invited into a country in order to visit, in order to do their research, and to issue some sort of a statement as to what they think is going on.

In fairness, this particular virus has surprised us right along.

I first heard about it on the 15th of December. On the 31st, I was told by one of my colleagues in China, that it was not spreading human to human. And he truly believed that that was the case.

I was uncertain.

I went in January, as soon as I could, to see for myself, and it became clear to me, while I was there, that in the two weeks since I'd spoken to him, the picture had changed.

It was initially linked to the seafood market in Wuhan and there were a series of papers that came out, suggesting that there had been one animal, animal or another, that had been the source.

We now think that what was more likely, is that people who are engaged in contact with wildlife met one another in this market.

And that's why there was a sense that the epicentre was around this wild market, when in fact, it was likely that somebody was infected outside and then went to this market.

But it's very easy on Monday morning to figure out what might have happened differently in a cricket match on Saturday. Right (smiles)? So, one has to be fair.

The other thing is that they need more resources. One of the things that GIDEoN can do, that WHO can't do, because we're not a governmental organisation, we would be outside of that, is that we would pose no threat, we don't have the ability to close down a border, or to suggest to travel advisory, or anything that might be viewed in a negative fashion.

And because it's a roundtable, everyone makes decisions collectively, and the data is collected in real time, so that you do know about it more rapidly.

And as I've shown you, you can make the argument that anything that is here, is going to be there in 24 hours.

Therefore, it's to everyone's advantage to be open about sharing these kinds of data, because ultimately, it will get out anyway.

The sooner you move together, the sooner you will contain it.

IMAGE: Health workers in a COVID-19 containment zone in Goregaon, north west Mumbai, July 15 2020. Photograph: ANI Photo

It seems India might eventually hit the top of the list of highest cases in the world, accompanied by a high level of mortalities.
But that would still be a small proportion of the population.
And then you think of China's population and look at their caseload and death rate today and wonder what India might have done differently?
And how is China succeeding in keeping down their cases and mortality rates?

What we're looking at here really is a comparison of two very different political systems and two different cultures.

In China, the Chinese government after starting slowly -- because it was a regional problem and wasn't really appreciated at the national level -- had a wide spread within Wuhan province.

Once, however, it moved to the national level there was an effort to shut things down.

The Chinese government decided that they were really going to push very hard with isolation, so not only did they identify with track tracing those individuals who were infected, but within individual households, which they'd forced to isolate, they separated family members who are infected from those who are not infected.

So even though, you know, they were first hit, and there was very little known about how to prevent disease by sequestering people, they had a huge impact.

I was in China in January, and people were, saying that the efforts that were being made were draconian and inappropriate.

And there are lots of things with which we have disagreements politically.

But I have to say that their approach to controlling the outbreak was admirable.

And in India and in the United States, I think, partly because we're democracies, it's been much more difficult to get this particular outbreak under control.

And yes, I think India may at some point, be in the situation of having more cases than anyone else.

IMAGE: Health workers check the temperature of a resident at a housing society in Mumbai, July 17, 2020. Photograph: Francis Mascarenhas/Reuters

This question is a bit more open ended: How does the situation in India with COVID-19 look to you from your vantage point?

It is it's devastating. I don't know what else to say.

It's like what we had in New York.

When you start looking at hundreds of people dying, it's devastating for physicians and scientists, who feel helpless.

I wish the Indian people well. If there's any way that I can be helpful, I will.

IMAGE: A mobile swab collection bus at the Indira Gandhi stadium in Vijayawada, July 15, 2020. Photograph: PTI Photo

How effective are antibody tests in determining how infectious a person is?
Once a person has had a vaccine, how long will the immunity of these vaccines last?

So, these are very good questions, for which unfortunately, we don't have answers.

There are basically two broad categories of these antibodies.

One is the antibody test to tell you whether or not you've been exposed to this virus.

The other the antibodies that have the ability to neutralise or, if you will, kill the virus.

And there are people who have evidence of exposure, who don't have these antibodies to kill the virus.

We're trying to find ways in which we can rapidly detect the antibodies to kill the virus.

Right now, we actually take live virus and place the antibodies in contact with it and see how powerful they are.

And that's what we use for the plasma therapy, for treatment of individuals who've been exposed.

We also don't know how long the neutralising antibodies will last.

So, these are critical points. They're excellent questions for which unfortunately, we don't yet have answers.

Now, the same thing follows from the vaccines side, right? We don't know yet how long/well vaccines will take.

With influenza vaccines, at least in the United States, we give four times the dose to elderly people than we give to people were younger, because their immune systems are less capable of mounting a response.

We need to do all sorts of studies on ways in which we can enhance the immune response.

And even then, I imagine that we're going to be continuously checking these concentrations of antibodies, to understand when someone needs to be re-vaccinated.

 

SEE: A sample ideal but true life case study, presented by Dr Ian Lipkin, on the way one particular harmful mammalian virus spread and how it was immediately contained, with minimum loss of life. Video: Kind courtesy Columbia Global Centers, Mumbai

 

A couple of questions about the lockdown.
Looking at Sweden's response, which was not about lockdown, and they had high mortality rates in the beginning.
Do you think their approach to a lockdown was more appropriate than other approaches?
What is this social distancing lockdown?
How do you how do you view that?

I prefer the term physical distancing to social distancing, because you and I right now are physically distanced but not socially distanced. And so many people are depressed and demoralised right now, that I want to refer to it as physical distancing.

IMAGE: Dr Ian Lipkin. Photograph: Kind courtesy Columbia Global Centers, Mumbai

The experiment that was done in Scandinavia -- that's the only way to describe it -- you had three different countries all operating in different ways.

Norway controlled its contagion, as did Denmark. And Sweden did not.

And Sweden's rationale was that they allowed the virus to proceed in a natural sort of fashion, that there would be the emergence of herd immunity, which would protect the population and they would escape the economic devastation.

In fact, they have been economically hit harder than Denmark, or Norway, and they've had more deaths.

So, I think the evidence there is that the lockdown was essential.

When we began the lockdown in New York City, and in New York state, there was a dramatic reduction.

If everyone wore a face mask>, this thing will be gone tomorrow!

But we don't have people willing to do that.

So, this is a huge problem.

So yes.

Is there transmission on surfaces? Yes. How important is it? That's unclear.

There's some evidence, and people are beginning to talk about airborne transmission. That's slightly different from aerosol transmission that we are all concerned about.

Can the virus circulate in a room in a building?

Yes.

But the majority of the spread is by people coughing, or sneezing or talking loudly, in a very short distance, two metres from one another, and a mask will prevent that sort of transmission.

 

SEE: Virologist Dr Ian Lipkin on the kinds of emerging infectious diseases there are in the world today. Video: Kind courtesy Columbia Global Centers, Mumbai

 

There is now the threat of bubonic plague in China.
What are the kind of infections that we can expect in the future?
Are they going to be worse than COVID-19?

There will be more, of these. There's no question.

There will be sexually transmitted. Blood-borne. Tick-borne. Mosquito-borne. Aerosol. Airborne.

All of these things -- these are continuing.

What we need to do to survive as a species, as humans, is to create an integrated network that allows us to detect these early and to respond to them as a world.

We cannot respond individually. It's not going to work. Because we are too interconnected at this point.

There is no way that we can do this by ourselves.

So, yes!

And in addition, there's anti-microbial resistance. There are all sorts of things.

And the reason I mentioned what the (United States) department of defense did back in March of '99, in looking at viruses on the Internet, and so forth, is most of modern agriculture is monoculture.

People have larger rice fields. Corn. Wheat. Anything that goes into one area, can spread like a fire and wipe out huge amounts of crops and so forth, that we need.

So, viruses are not living things. They're just bad news. That can rapidly spread and cause food instability, economic instability, and cause deaths and starvation in their own right.

Feature Production: Ashish Narsale/Rediff.com

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