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Episode 19: The middle Road interviews Dr. Chandrakant Lahariya Thought Leader — Public Policy & Health Systems Expert

https://www.podbean.com/media/share/pb-bc8ei-107de2a

Viruses stand at 1031 compared to the human population at 8 billion i.e.  8*109, a telling figure of how dangerous our ecosystem can become. 

Dr. Chandrakant Lahariya on COVID-19 Pandemic with Nishant Malhotra 

In this episode, Nishant Malhotra has an in-depth conversation with Dr. Chandrakant Lahariya, one of the foremost healthcare experts and thought leaders in Asia about the COVID-19 pandemic. Our conversation covers various aspects of the pandemic and a must for anyone interested in understanding the efforts of global actors within the healthcare ecosystem in fighting the COVID-19 pandemic. Learn more about mRNA vaccines, difference between Mucormycosis and Black Fungus, Remdesivir divergent results, overview of the randomized controlled trials (RCT), steroids as a COVID-19 response, Delta variant and much more.

Dr. Chandrakant is a leading epidemiologist, public policy and health systems expert based in India. He is also the co-author of the book Till We Win, an extremely insightful, informative, and fluid book on COVID-19 and India’s fight against the COVID-19 pandemic. Dr. Gagandeep Kang and Dr. Randeep Guleria are the other co-authors of the book. Dr. Chandrakant Lahariya is the youngest fellow ever to be elected to the Indian Public Health Association (IPHA), that works with leading healthcare experts to design healthcare policies and programs at the state and national level in India. He is presently focusing on universal and primary healthcare in India.

                                                 Hello, Dr. Chandrakant delighted to have you for a thought-provoking conversation.

First, I highly recommend people to read Till We Win for getting an excellent perspective about viruses, drugs and therapies, and the evolving COVID-19 response significantly in India during the pandemic. Let’s go top-down and understand a bit about viruses. Edward Jenner developed the first vaccine using the cowpox virus against smallpox. From Black Plague to the Spanish Flu to the COVID-19, humans have been ravaged by pandemics for a long time. Till We Win shares a vivid history about viruses so we being our discussion with the coronavirus.

Q1) Apart from size, what would be the differentiating factor between virus, bacteria and fungi.

            Coronavirus are a large group of RNA viruses with about 26,000 to 32,000 bases of RNA carrying a sequence of ~30 proteins. They are complex                                                                                 but how different are they from other viruses?  Do elaborate on this aspect.

Q2. Pfizer and Modera use cutting-edge technology in making vaccines. There are three defenses in our body. Antibodies, Killer T cells, and Helper T cells. T cells are the key player once the cells are infected with viruses. Pfizer and Modera vaccines target spike protein using mRNA technology. Please articulate about mechanism behind this vaccine and how is it different from other DNA or inactivated vaccines.

Q3. Do speak about various “repurposing of drugs” i.e. using available drugs for treating COVID-19 as discussed in your book significantly Remdesivir. Remdesivir was developed to treat Ebola and had mixed success in treating people suffering from COVID-19. Americans approved Veklury (remdisivr) in a healthcare setting for use in adult and pediatric patients 12 years of age and older and weighing at least 40 kilograms (about 88 pounds).  The approval of Veklury was backed by positive results from three randomized controlled trials of patients hospitalized with mild to severe COVID-19. Even early Chinese reports were positive on the drug. But the results from the Solidarity trial did not showcase any benefits from the drug. Today, WHO doesn’t recommend the use of Remdesivir antiviral drug against COVID-19. Do talk about this divergence in the findings.

Q4. Clinical randomized controlled trials include the study of counterfactual with factual. Do take us through an experiment wherein patients are given a placebo and a treatment articulating the process example double-blind experiment etc. This method is increasingly being used in the social sector to evaluate the social impact of interventions. Good to understand the methodology in detail.

 

Q5. Coming back to trails, RECOVERY (Randomized Evaluation of COVID-19 therapy) led to the recommendation of steroids like dexamethasone and methylprednisolone for COVID-19 treatment. How should these drugs be used?

Q6. You published an article on Mucormycosis and how it is distinct from the Black Fungus. India had cases even before the recent surge in Mucormycosis cases leading to the declaration of Mucormycosis as an epidemic. You mentioned mucoromycetes, the causative fungi that are causing the infection during the COVID-19 especially infecting sinuses, gastrointestinal tract, and brain. Both Black Fungus and Mucormycosis are a subphylum of fungi. Can you articulate the difference between the two as many media sources don’t differentiate between them ? What could be the reasons for the explosion in Mucormycosis cases in India during the second wave of COVID-19. You mentioned one of course is the lack of immunity due to prolonged intake of steroids. DO YOU THINK that the oxygen crisis example the refilling of oxygen cylinders could be one of the significant reasons behind the proliferation of this disease?

Q7. Convalescent Plasma Therapy is a time and tested therapy to treat vulnerable people especially people with weak immune systems in fighting diseases. Although there are mixed results this therapy is being used in the US for emergency authorization use. I am a donator of plasma. Don’t you think the Government of India was hasty in dismissing plasma therapy especially when India is facing the worst healthcare crises of all time?

Q8. The Delta variant, B.1.617.2, a variant of SARS-CoV-2 from lineage B.1.617 was first detected in India in late 2020. Today, according to WHO Delta Variant is the most dominant SARS-CoV-2 variant in the world due to its high transmissibility. Dr. Chandrakant Lahariya, how could the Government of India and other actors within the healthcare system especially the Indian government be so complacent in declaring premature victory over COVID-19 pandemic?

a. In my publication on COVID-19 What did we learn? I mentioned the importance of vaccination drive and a strong healthcare system. India ranks low in both these                                                aspects. India had only 0.86 physicians per thousand in 2018 compared to 1.98 in China, 4.25 in Germany, and 2.61 in the US.

                                                                                The figures for China, Germany, and the US are from 2017.                        

Do speak about the vaccination program and steps to structurally change the healthcare system in India. Example Universal healthcare system.

Q9.  President Biden plans to invest $3.2 billion from American Rescue Plan as a part of anti-viral development strategy to build cutting edge next generation of treatments for COVID-19, so the country can be better prepared to fight future virus threats. Termed as Antiviral Program of Pandemics (AAP), this is a great proactive initiative for a better social good. When do you think the world will have antiviral pills and how best the world can collaborate for a positive social change and impact within the global arena?  This is the first time in human history a vaccine is developed within a year beating the previous record of four years.

Q10. Please share advice for people who have recovered from COVID-19 but have complications. Any specific activity and nutrition that will help.

Q11. I thank you for sharing deep insight into many aspects of the pandemic. As a co-author of a best seller and a leading healthcare expert, do share any message with the audience and all actors within the healthcare system. The world owes caregivers and doctors a special thanks.

Q12.  Please do share any aha ah moment that brings a smile to your lips despite the challenges and tragedies everyone faced and is facing during the pandemic.

Thank you Dr Chandrakant Lahariya for sharing your thoughts and views on the COVID-19 pandemic.

References


Till We Win: India’s fight against the COVID-19 Pandemic by Dr. Chandrakant Lahariya, Dr. Gagandeep Kang and Dr. Randeep Guleria.
Pic Till We Win The middle Road | Nishant Malhotra
The Lancet India’s COVID-19 emergency

 

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