With the globe is entering a “new and dangerous phase” of the spread of Covid-19, which has infected more than 8 million people and killed more than 460,000, the World Health Organisation remains at the forefront of the fight against the disease, even as its role has been controversial.
In this interview Sree Srinivasan and Amanat Khullar speak to Soumya Swaminathan, chief scientist at the WHO and Sylvie Briand, director of epidemic and pandemic disease at the WHO, about India’s lockdown, what we know about the virus and much more.
Sree Srinivasan: How many people at the WHO are currently working on aspects of the pandemic
Soumya Swaminathan: It doesn’t matter whether you’re in the emergency department or the immunisation department, everyone is in one way or the other working to contribute to the health systems.
Apart from dealing with Covid-19, people are getting infected with other diseases. Babies are being born, children have to be immunised and antenatal care has to be provided. Tuberculosis hasn’t gone anywhere, and neither has malaria, it’s even more important now that we don’t forget about all of those things that have traditionally killed millions of people every year, particularly in the lower-income countries.
Sree Srinivasan: Soumya Swaminathan please tell us about your work as a chief scientist.
Soumya Swaminathan: The Science Division was only set up last year, so we are a year old and I’m the first chief scientist. Everyone comments that this was the right time for the WHO to establish the Science Division because we’ve been at the heart of fighting this pandemic from the first day.
It’s a new virus, so the solutions have to come from science. We have to understand every aspect of this virus and then only can we find the right drugs and vaccines.
Search and innovation has been a part of our response from the very beginning, and I’ve been leading a group from across the organisation that has come together, and we’ve been able to set up global networks of experts. We’re reconvening in a couple of weeks to see what have we learnt in the past six months, what are the remaining challenges and how the scientific community can further come together.
That’s one major activity. The other one is that all of the guidance that is being issued. WHO is monitoring the situation, and we put out guidelines, guidance and standards. These documents need to be carefully reviewed and their quality assured because the whole world depends on WHO’s guidance - or at least a part of the world does - and therefore there’s a whole team that’s working again round the clock to make sure that all the guidance we’re putting out is completely scientifically validated, evidence-based, of high quality and answering the questions that people are asking.
Sree Srinivasan: Could you talk about the science of this virus. Why are we in this situation today? We’ve seen various coronaviruses before, what is the science behind the troubles we’re having right now?
Soumya Swaminathan: First of all, it was incredible that the virus was identified so quickly and we knew that it belonged to the family of beta coronaviruses. We could see the entire genetic sequence on January 11 – very early into this pandemic.
Gradually, we’ve also been accumulating knowledge about how this virus transmits. It’s highly transmissible. We know the groups of people who are more affected: the elderly, those who have underlying conditions like heart disease, obesity, respiratory diseases. We’re still learning about the inflammatory response of the body. For those who get really sick and end up on ventilators, the virus itself is going down in the body by then. It’s the body’s own inflammatory response that is creating havoc in the lungs and in the blood vessels.
We’re also working on clinical trials for drugs as well as the development of new vaccines which normally takes a minimum of five years, usually ten years for a new vaccine. In this case, the global community has set itself the impossible target of coming up with a vaccine in 12-18 months, and we’re at the centre of that.
Sree Srinivasan: Where are we exactly in terms of the development of a vaccine?
Sylvie Briand: There are some candidates – over 10 – that are already entering the clinical trial stage. At the same time, we’re trying to accelerate the process and carrying out things in parallel instead of doing them sequentially just to make sure we have a new vaccine rapidly. Maybe the vaccine will not be the magic bullet, but at least it will be an important addition to our set of interventions and it can be a game-changer in terms of protecting vulnerable populations and making the world a safer place.
Sree Srinivasan: Dr Soumya, could you talk about your sense of optimism about where we are. Do you think this is something that we will have to live with at a low level, or do you see this as something we can battle and win over?
Soumya Swaminathan: In terms of where we’re going with this virus, it’s still difficult to predict, it could go in many different ways. The way that we think that it might pan out is that the virus is very well established now in most countries around the world, in most populations. Though some countries have been able to contain it, bring it down to really low levels and even temporarily get rid of it. But the moment people start moving, the virus will move with them. We’ve seen in Beijing now that after 55 days, they had another cluster of cases.
It could be that this becomes another endemic human virus. It may be that we learn how to keep it under control through public health measures - and hopefully, a vaccine – and you get these occasional cases. That’s one scenario, but till we get to the point where enough people in the world have immunity – about 60-70% – then you can bring down the transmission to very low levels. That is easily achieved through a vaccine. To get there through natural rounds of infection like we’re seeing now, that will take many cycles.
For the immediate future, we should expect that this virus is not going anywhere.
Sree Srinivasan: We’re living in the times of misinformation and disinformation, how do you fight that along with the health problems we’ve to fight?
Sylvie Briand: At WHO, we call it infodemic: an epidemic of information and disinformation. You cannot suppress the infodemic, you can just manage it and make sure it doesn’t affect people because some misinformation and rumours can be dangerous. So we develop tools to protect people and help them to differentiate good information that will help them fight the pandemic and information that is either incorrect or dangerous.
Infodemic management isn’t new, but what is new is that because of social media, those rumours spread very fast – much faster than the virus at least. So we need to have new tools to contain those rumours and make sure that they will not hamper the response.
Amanat Khullar: Dr Soumya Swaminathan, could you comment on India’s response to Covid-19 where lockdown measures have now been eased and on average we’re seeing a daily spike of about 10,000-12,000 cases.
Soumya Swaminathan: India is a complex and difficult challenge, mainly because of the size, the population and the high density in the cities. There needs to be a strategic response based on local situations: decentralised, data-driven, community-based response – which is happening in several places.
It is to be expected that as restrictions are lifted, the numbers will go up. It’s not just the numbers that one should be keeping an eye on, it’s really the change from day-to-day. What’s the doubling time, what’s the R-naught or the transmission rate, what is the testing per million, and what is the positivity rate? That gives a good indication of how much infection there is in that community. Again, when you look at the data, one can see vast differences between cities.
The other big challenge for India is making sure that the rest of the health system continues to perform because we know that there’s a huge burden of both infectious diseases and non-communicable diseases. That has to be balanced with the Covid-19 response.
The focus really needs to be on primary and public health and the one thing that stood out in this pandemic is that those countries that are focused on a very strong public health response are the ones that have been able to bring it under control. Even in countries that have relatively strong health systems and good hospitals, the response in contact tracing and ramping up testing has fallen behind, which has lead to huge peaks.
There needs to be a comprehensive strategy. We know that one intervention alone, even stringent lockdowns are not the solution, so you need the public health response of testing, tracking and making sure that every infected individual is taken care of and the contacts are quarantined. Then you’re supposed to build your health systems, make oxygen available at district hospitals, the training of healthcare workers and the protection of frontline health workers.
Amanat Khullar: There has been some debate about the efficacy of wearing face masks, could you talk about the WHO’s guidelines on it?
Sylvie Briand: We know that the disease is transmitted by droplets. If you keep sufficient physical distancing, normally it is enough to protect yourself and reduce transmission. Sometimes, physical distancing is extremely difficult to maintain. In many places, there is a high density of population, whether it’s in public transport or people living in crowded spaces and confined environments. That’s why WHO recently recommended that people that are in these kinds of situation should wear a mask to protect themselves and others and reduce the transmission.
Soumya Swaminathan: This is a good example of an area where we have had to change guidelines from the beginning to now when we learnt more about the transmission and also learning from countries.
In the beginning, we had guidance on what healthcare workers should do to protect themselves. But the recent guidance talks about those who are sick, are above 60 years – they must wear a mask when they go out. Everyone who is living in places where you cannot physically distance – which is large parts of the world – you should wear a face covering and we’ve provided additional guidance on the most effective kind of mask.