A conversation about COVID-19 with Dr. Rakesh Kumar Mishra, Director(CCMB).
It wasn’t military power, economic clout or diplomacy that proved to be the leveller. A mystery virus said to have originated from Wuhan in China took the credit, seamlessly crossing borders, hosted in the bodies of victims across the developed, developing and backward regions of the world. The dreaded Corona virus COVID-19 known for its unique manner of spreading almost with the speed of lightning has paralysed the world, even as the medical and scientific community are grappling with methods of containing the pandemic. Test, Track and Isolate the clarion call of the World Health Organisation (WHO) is being seen as the best option to stop its onslaught and various wings like the ICMR (Indian Council of Medical Research) and CSIR (Council for Scientific and Industrial Research) are part of government efforts in India to contain it. As the number of deaths and infected persons rise, the fight intensifies and research institutions have become crucial for testing to identity the virus. Centre for Cellular and Molecular biology (CCMB) the premier multi-disciplinary research organisation in the country, located in Hyderabad is actively involved in testing and training to identify the virus from samples provided. Working in tandem with the state government, it has the infrastructure and expertise to conduct as many as 1000 tests per day. The affable, pleasant and unassuming Director of CCMB, Dr. Rakesh Kumar Mishra gives insights about the virus and its ways in a freewheeling interview with Aruna Ravikumar. “We will beat the Virus’ is his inspiring message which is like a beacon light as a pall of gloom encompasses the world.
What was the first reaction at CCMB to COVID-19?
“COVID-19 kinds of things are expected to happen because of the nature of the world we live in and in that sense we are not surprised. These viruses evolve, they change depending on the environment they are in and suddenly become more or less dangerous or infectious and based on the new properties they start to show their presence. This virus seems to be of Zoonotic origin, that means it was growing in some wild animal environment. There is no evidence that it is from bats but indications are that it is from the wild. Once it comes to humans it spreads very fast. Contact with wildlife or in a market where they were kept could have led to it. That is one idea.”
We have had other scares in the past like Ebola, SARS and even HIV. But this one has put the whole world in a tizzy. How do you explain the number of deaths across the world?
“One important feature of this virus is that it spreads very efficiently. Scientists are working on it and may soon decipher the molecular nature of certain proteins in the virus that makes transmission quicker. But there is nothing to panic and most of the affected recover. Those who are dying are mostly the 1 to 2% people who are already in a compromised situation which means they are either 70 or 80 years old, have some medical history, are diabetic or have low immunity. These are the primary risk group. The worrying aspect is of people who can be cured and who may die because they do not get medical attention. Let’s say 10 lakh people get infected in Hyderabad. That will be a disaster. Even if 10% need hospitalisation where will you take them? We don’t have enough respirators, beds or even simple masks. That is why the whole idea is to prevent the spread. Instead of panicking we have to break the spread. Close the bus stations, trains, control flights, close schools and offices and prevent gatherings of more than 30 people. Social distancing, frequent hand washing with soap, curtailing unnecessary travel and other measures can control it. The good news is that once people recover they are immune to the virus and there is no relapse. A study done recently on monkeys proves this. The serum of recovered persons can also be used as protection as they have anti-bodies for the virus.
In effect you are saying that the speed of spread poses threats because the system is not geared up to it?
“Yes. The speed of infection is what makes it so deadly. A large number of people infected at once can make a great demand on the system not geared up for such an outbreak. In Italy too it was the speed of infection that led to deaths as it was impossible to cater to all those infected. There were no beds or respirators and people were dying in the corridors of hospitals unable to get the simple yet essential treatment. Ideally the older population should isolate themselves, self quarantine, use different bathrooms, wash hands frequently and stay safe since they are the highest risk group.
Is there a shortage of testing equipment to find out the difference say between a common cold and this virus which basically show the same symptoms?
Let’s be practical. We can test but can we test the whole population?
That is not possible. The World Health Organisation (WHO) guidelines say test, track and isolate. That is the way to control this virus. Test as much as possible and keep those who test positive in isolation for two weeks and you are done. If you don’t test people they will be mingling with the general population. The problem is not just testing people with symptoms. We need to go into the travel history of people who have visited infected areas and test them because they may seem normal for several days without symptoms but are spreading the virus to the people they have interacted with. Asymptomatic carriers can spread the virus and that is why those coming from abroad should be tested.
What we have today is quite unheard of. Although there is a history of Spanish flu and other virus attacks we have never seen anything of this magnitude in our life time earlier. Are we fighting something that we cannot control?
“We can defeat the virus.”
Sure?
Yes of course (laughs). We can if we stop all contacts that lead to transmission. See how China where it is said to have originated from controlled it. They were the worst hit. They blocked the entire place and no one was allowed to get in or go out. They stopped all movement.
In India there are some who seem to think all these curbs on movement are over reacting to the situation. Are we?
We are not over reacting. The government has done a great job in sensitising people. The kind of activity going on in the government sector is amazing. We are a research lab but they realise that we can be of use so they are involving us in ways to prevent panic. We had a meeting with the government of Telangana and are going to help in testing. We are meeting all directors of medical institutions to have an alternate back up testing in our institute because we handle such things on a regular basis in our research as a fun, as a game. We can now do it for the government. How do we do this?
We take a swab or blood sample and isolate the RNA from the virus which is converted into DNA. Each organism on the planet has unique genetic material and so does the Corona virus. We then do a PCR (Polymerase Chain reaction) using specific DNA sequences and confirm that a case is positive if our primers amplify the DNA. This can be done in 2 to 3 hours. We are testing 9 samples given to us by the Telangana government in our lab. We have a virologist, two scientists and a medical doctor involved with diagnostics who will be involved in this activity. This is the first time that CCMB is doing something like this and our team is ready to conduct 1000 tests per day.
Is a panic situation emerging from excessive testing?
Some countries have taken the approach that if you test more you will have more numbers and more panic but that is not true. You should tell people that if you are positive it doesn’t mean anything because 99% chances are that you will recover. Why worry? If you test you can arrest the spread. What can you do if you do not conduct tests at all? Countries like UK and USA have taken a different approach. They want to focus on treating the virus without really knowing what it is. It is just three or four months since we know about the virus. We have never seen it before. The best thing is to control, study the virus and then look at developing drugs that control it. That is what WHO is saying. That is what we are looking at in our Country. If we do not know the target then where are we shooting? In the air? Preventing the virus from spreading and then studying it is the best strategy. We are going to analyse all the isolates of this virus and sequence the genetic material and RNA that will tell us which place the virus is coming from, whether it is mutating at high speeds, whether drugs being used are effective and why people respond differently to the virus. This is what we intend to study at length in the next few months.
How soon do you think the spread of this virus can be contained?
The spread will have to stop in two or three months otherwise it will be a real disaster.
Two to three months is a long time.
Yes, it is but then it is the tapering time. How big the peaks will be is the question. If the peaks are high there will be a large number of fatalities. Stage one is the onset where we see the effect of the virus. We are in stage two now where we start seeing a pattern and if it gets to stage three it correlates to community spreading. If it goes to stage three even isolation won’t work because it spreads to the markets and all public places where isolation becomes extremely difficult. We have to contain it in stage two otherwise we have to convert our sports stadia into quarantine zones as that will be the magnitude. Hopefully that will not happen.
What is the line of treatment when one tests positive?
There is no specific method of treatment as of now. Isolation and increasing the immunity is what is being done. Different combinations are being tried and anti-viral drugs that were given for AIDS treatment and other attacks are being tried.
But you said each virus is unique…
True. It is a continuous fight until there is a tilt. The body is fighting and fighting and at some point the body gives up and at some point the virus gives up. If we increase the chances of the body fighting the virus even by 10% by boosting the immunity, we can tilt the balance in favour of the patient.
The body needs time and takes care of itself. The virus will not go away but it doesn’t matter if we get a grip. Right now people are using desperate measures of combination theory and there is no drug to neutralise its effect.
The US they say is already into clinical trials of a vaccine. How long will it take for this to be available and effective?
Although the US has begun work on a vaccine it may take several months or more than a year. Vaccine success cannot always be guaranteed because the virus can change.
This is the first time that Research labs are also taking part actively in containing a pandemic that is a huge puzzle to all. Do you foresee a partnership between research institutions, hospitals and medical colleges to tackle such challenges in future?
I am sure that will happen soon. There are a few things that we lack in India. We do not have epidemic modelling. We are not able to tell how many people will get infected or how long it will take to recover. We don’t have scientific and mathematical modelling of the kind done in Europe and America. We need to put more effort and resources for research on infectious diseases. Today we have the National Institute of Virology (NIV) Pune, which is the only institute for testing and validation. We need five or six other institutions like this. I am sure the government will take note of that.
As the world is a global village today and the virus has been spreading through increased international travel, don’t you think there should be international cooperation and all the countries of the world need to work together?
This is a very important point. There has to be international cooperation. Before AIDS came, even scientists thought TB was gone, it was eliminated. We now know that because of communication and travel that the infection is there and nobody is isolated. There has to be increased communication and coordinated action between all the countries of the world to control the spread of viral infections as people are travelling frequently all over the world. We cannot leave any country out and have to involve all. You cannot leave out say Iran or some other country. The virus can originate anywhere. So everybody has to be on board and WHO has to be given more importance.
Do we also need to make research institutions proactive to meet exigencies?
That is the need of the hour. We need more research development components in medical colleges and hospitals. Most of our hospitals are flooded with patients and do not really have the time for research or updating themselves. But these patients also provide the greatest opportunity for research as there are a number of samples that can be tested. If we inculcate research culture and technology components in our hospitals and colleges, we can beat anyone hollow. We have a national health policy and are gearing up for change and I think these things will come soon.
There is talk about biological warfare and viruses manufactured in labs? How much truth is there in these charges? Is that even a possibility?
There is no scientific evidence for this and the one or two papers in this context too have been retracted. In a biological warfare the biggest problem is how you separate the enemy from your own. I do not think any country would risk this. There is no rationale in such an argument.
Do you think Corona is a wake-up call and we can no longer be complacent?
Definitely! Just like the world changed after 9/11, after COVID-19 too, the world will change because people will realise how vulnerable we are to one infection and how it impacts every aspect of life. I am sure many positive policy changes will emerge from the present crisis gripping the world. We cannot afford to relax and it will be our endeavour to win the battle against the virus.
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