On day 1 of the nationwide shutdown, India’s renowned epidemiologist Dr Jayaprakash Muliyil has a warning: “All Indians have to co-operate, or we could lose as many as two-and-half million elderly people in the next three months.” Speaking to TNM, the former Principal of Christian Medical College (CMC), Vellore says that it is vital that every single Indian maintains a physical distance to ensure that fatalities don’t rise and to contain the spread of the SARS-CoV-2, the virus responsible for the pandemic.
Calling it the worst epidemic of his lifetime, Dr Jayapraksh says that community transmission has begun in India despite the Centre denying claims of its spread. He observes that the ‘exponential rise’ of cases is only just starting.
India is now in a 21-day nationwide lockdown. What do you make of the government’s move?
It was the only thing to do, it’s a desperate situation, if you misfire now, if you don't carry on with this planned move, then we are doomed. It needs the support of every Indian. It is not just a joke anymore, we have been saying all kinds of things - it won't come to India, we are special people, no way. This is about to hit us. The only thing we can do is to make sure that every single Indian keeps a physical distance of a couple of metres from everybody else. And if we do it very meticulously, it can make an impact on this epidemic. Otherwise, let me tell you a simple thing, in the next three months, we could lose as many as two-and-a-half million elderly people. I am not joking, these are based on calculations. That is the only chance we have. If you miss it, we have had it.
The government says that there is no community transmission. What is your assessment?
It is absolutely wrong. When you say community transmission, it immediately translates into one thing- ‘ladies and gentlemen, there is a community transmission, we need to do this’. In the absence of a community transmission, such a move is ridiculous. The community transmission is something we can’t see. We need to figure it out. There are smart people in the government who are looking at the information, and it is already clear that it has started spreading. We won’t want to argue about it.
One of the most important things to do now is every Indian in every village, ever street, wherever he is, recognise this one little rule - make sure there is no transmission. And if you cooperate, the power of controlling the whole epidemic is in each of our hands. No government, no foreign country, no organisation, WHO can help us. We have to do it ourselves. There is no time to squabble about is this right or wrong. We know the answer to this problem now and the moment you do it, it will have a significant impact on the epidemic.
If you see the graphs that are coming out, an exponential rise is starting. If you wait for a few more days, it will be all over (the spread of the virus). We have got to do it right now.
As of today, India has done more than 22,000 tests. What is your assessment? Are we under-testing? Or do you believe that given the shortage of kits, it is simply not possible to test everyone?
It will be good to test, and I am for testing. But logically to control the epidemic, there is only one thing we need to know- can we contain the disease? Containment comes from the fact that those who come into the country - because it is a foreign disease - are they bringing the disease in and are we controlling them? We tried to do it, but India is too large a country and we can be very devious to not comply with the regulation, and not do self-isolation, we are not responsible. So if we have come to this stage.
Tests are just about becoming available. So, what they had, they tried whatever they could do. It was not sufficient. That is very apparent now. So I don’t think we need to squabble about that. It is a new virus, a test had to be developed and a tested is now developed. It is just now. Now we will test, we should test. But more importantly, is the three weeks time. And then we test and it shows we have been able to contain the epidemic, then we can congratulate ourselves. It is not a question of government versus people, one party versus another, it is just that us all together - one team.
Now that there is a lockdown, what do you believe should be India’s focus the next three weeks?
We should make sure there is no collateral damage. We should make sure that people otherwise seeking health care or various other diseases are not deprived because there is a lockdown. You should facilitate that. Pregnant women will need to deliver babies. Do you know how many per day? 80,000 per day. You should facilitate that. Others will get pneumonia, others will get different other problems. We have to look after all of them. So this is a crisis, you have to do it with wisdom at every level.
But today, to block this epidemic, you have to ensure that we keep a physical distance. Forget about social distance, we must keep a physical distance. The virus needs closeness of individuals to jump from one to another. If you deprive that new host to the virus, you can really stop the epidemic.
Do you think this is the worst epidemic you have witnessed?
Yes, because I am only 70 years old. And this is the worst. Point is, it’s also a cold-like disease like we had H1N1. H1N1 had a much much lower mortality rate. And you watched what happened in Italy. We don't want a repetition here. I know it will be mostly elderly people who die. I know that children are very safe against this disease. Most middle aged people will overcome this problem. But it will be very difficult to watch as people die all over the place. We have 10 million deaths every year in India. But this is part of the natural process. But suddenly in the next three months, you may lose 2.5 million elderly. It is not going to be a pleasant sight. It will affect our moral fibre of our community, our confidence in ourselves It will be a shock to our system. And it will have a whole lot of implications, beyond the scope of this interview. But we have to win this battle. Handwashing is important, but just keep physical distance. Even within the family, if a person is already infected, he will transmit in the next three weeks. But if you can stop transmission between families that can make a big impact. Let me be clear - If one individual in the family is infected, it may be difficult to control it, but if currently, a family is not infected, and bulk of Indian families are not infected, if you prevent the new infection into families, you can make a huge impact.
In this particular virus, you’ve got to be pretty close to the next person before the virus can jump. It is not a long distance jumper. It is a short distance jumper. Within 2 metres, it can sort of get across. Don’t worry about aerosols. The majority of people get infection from face to face contact. Did you notice that in Tamil Nadu, when the announcement of section 144 (prohibitory orders barring assembly of five persons and more), every street was crowded with people, every bus was packed with people. That one gathering could have accelerated transmission by so much. So we have to reverse the process. We all need to contribute and speak with one voice and encourage each other.
This interview has been edited for clarity.