Watch | If Worrying Variants Don't Emerge, India is Near Endemic Stage: Gagandeep Kang

Prof. Kang said the time has come for India to rethink its attitude to COVID-19 in relation to many other health concerns that haven’t got sufficient attention over the last 18 months.

In an interview that will be reassuring for many, one of India’s foremost professors of Virology and, more importantly, a member of the government-appointed Covid Working Group, has said that “in the absence of the possibility of new worrying variants”, India is at or approaching the endemic stage of SARS-CoV-2.

Agreeing with what Prof. Soumya Swaminathan, the Chief Scientist of the WHO, said to The Wire on August 23, Prof. Gagandeep Kang said that India is likely to see ups and downs in specific locations but not a nationwide wave in any way similar to the frightening second wave of COVID-19. Prof. Kang also said that this is not the right time for boosters except, possibly, for immuno-compromised people. Also, in a particularly significant moment of the interview, Prof. Kang said the time has come for India to rethink its attitude to Covid and the predominant importance so far given to it. Now it must be thought of in relation to and with relevance to many other health concerns that haven’t got sufficient attention over the last 18 months.

The ones she mentioned were cancer, diabetes, tuberculosis and problems connected with maternal pregnancy. As she put it: “The time has come not to treat SARS-CoV-2 the way we did at the start of the pandemic… but think of it in relevance to other illnesses.”

In a 35-minute interview to Karan Thapar for The Wire, Prof. Kang said “we cannot predict a third wave in the absence of a radical change in viral behaviour or a radical change in human behaviour”. She said she cannot understand the basis of the fear and apprehension of a looming third wave as well as the comments made by ‘experts’ on television and in newspapers. She said whilst new variants could emerge “because of mutations or because of some form of recombination”, as yet we don’t know of them and, therefore, she cannot understand the basis on which people are predicting or fearing a third wave.

Elaborating on her view that India is at or near an endemic stage, Prof. Kang said the time had come for India to rethink its attitude to SARS-CoV-2. She cited the example of typhoid to illustrate how we should, perhaps, start thinking about SARS-CoV-2. She said typhoid is endemic, we know how it’s caused, we know how to handle it and we also know we can do better. It’s not a prime concern. SARS-CoV-2 is heading in that direction. And, therefore, we should now balance our time and attention to COVID-19 with our attention to other illnesses, which haven’t got the importance they deserve in recent months, such as cancer, diabetes, tuberculosis and maternal problems connected with pregnancy.

Prof. Kang also said that the time had come for us to rethink our attitude to testing. The original emphasis on test and trace, which was at the core of our handling of COVID-19 at the start of the pandemic, now needs to be rethought and altered given the present situation where we could be at or near an endemic stage.

Speaking to The Wire about the overall COVID-19 picture in India at the moment, where the seven-day average of daily cases has fallen from 42,881 on September 2 to 37,237 on the 9th and 31,074 on September 16, Prof. Kang said that whilst the “trajectory is good” it’s also true that “wherever you look at the Delta variant, after a sharp spike is over, the number of cases haven’t returned to the lowest pre-Delta point”. That is also true of India. It’s possible that cases can plateau at a level of around 30-35,000 a day for a fairly long period. Something similar is happening in Britain at the moment.

Speaking specifically about Kerala, where the seven-day average of daily cases was 29,804 on September 2, 26,794 on September 9 and 19,505 on September 16, but daily cases have once again increased to 20-22,000 levels, Prof. Kang said “we can’t expect the trajectory to be maintained day after day”. She suggested that as long as the weekly average of daily cases is going down that is a sign that numbers are diminishing.

Prof. Kang also said that another positive note in Kerala is that the state’s vulnerability, because its sero-positivity levels were so low, is now increasingly being countered by the very high levels of vaccination and, therefore, the size of the vulnerable population is diminishing.

When asked by The Wire if, despite India’s record-breaking performance of 25 million jabs in one day on the 17th, the country fails to fully vaccinate every single adult by the end of the year how much of a concern that would be, Prof. Kang said “it would not be the end of the world”. She suggested the high levels of sero-positivity (68%) have given a fair measure of protection. She also said targets are often set and missed. This would be one more.

Asked by The Wire about booster doses, which are now being either considered or given by countries like the US, UK, Israel and much of Europe, Prof. Kang said “the time is not right for boosters for anyone except, possibly, immuno-compromised people”.

Prof. Kang pointed out that whilst vaccine efficacy against infection does diminish over a period of six months the efficacy against serious disease remains high. Therefore, she asked, whilst boosters may have to be given what is the right time to do so? She said the research available internationally does not present a clear and decisive answer. We need more information. A second concern is if boosters are given which vaccine should be used? Should it be the same one or a different one?

In the interview to The Wire, Prof. Kang was asked if there is a percentage level of adult vaccination at which India can feel relatively secure in opening up, as the UK has done, and she said it is very hard to answer this question because the percentage of the population in India comprising children, who are unvaccinated, is much larger than in the UK. So, as she put it, even with every adult vaccinated India’s situation will not be analogous to that of the UK.

Finally, Prof. Kang agreed with Anurag Behar, the CEO of Azim Premji Foundation, about problems affecting vaccination in rural India. Please see the interview for details of this. However, Prof. Kang explicitly said the government must make a deliberate and conscious effort to reach people in rural areas, who are distant and also uninformed, to ensure that they get vaccinated. Otherwise they could be left out and that could be a serious problem.

The above is a paraphrased precis of Prof. Gagandeep Kang’s interview to Karan Thapar for The Wire. Watch the full interview here: