Beware the second wave

Dr. T Jacob John talks to Jagdish Rattanani about Kerala’s strong response to the pandemic, shortage of testing kits and possibility of a second wave  

 

Kerala tested the first Wuhan arrival on January 30, okay, and two more in early February. Kerala did it from the first arrivals. Where did they get the kits from? By the time NIV was ready with test kit. And there is an NIV presence in Kerala, a field station in Kerala.

JR- so NIV had already come up with a testing kit.

Yeah. See, the Chinese announced the gene sequence for primers by January 11 or so, everybody, all virologists, would synthesise those gene sequences and be ready. CMC was ready but CMC was asked not to test, explicitly,  They obeyed the orders and they did not test, until they were released from this what do you call, order of do not test

JR- Okay, which came later?

That came much later. I think it came in March ….. Towards the end of March or beginning of April I don’t know when, I did not check. So, they have not taken the lead in this Coronavirus thing and apparently. The flight that came from Wuhan, that is from China somewhere, had either a stopover or passengers were transferred from one plane to another plane in Calcutta,

JR- okay.                                                                                            

So, these girls who came,  with no alert in Kolkata; the moment they landed in, I think Cochin airport I think….Cochin or Trivandrum I don’t know, immediately they were taken off, tested, quarantined. So the lead was taken by one state. , Medical students from Wuhan also came to Tamil Nadu and to Andhra Pradesh. The central government had not done any homework, these states had not done any homework. So let it be there. Students arriving in these states were not tested. So, then gradually different states began thinking about infection and doing something here and there; Tamil Nadu, Karnataka, Telangana, Andhra Pradesh, Delhi, little by little many States began doing their own thing. And it's only end of March, beginning of April that the Prime Minister seemed to become the leader. By about April 7, I think he had convened empowered groups and assigned them tasks, . And he appeared on national television saying that he's the leader of the fight on 21 March ……

March 21 is when the Prime Minister came and said, I'm leading in from front. He announced a 14 hour stay home order. So I think his tactic was wait and see. Let state’s play the game. And then anyway, he is the team leader and so he assumed the leadership by 21st of March. Then he appeared again on...24th of March and announced the lockdown from the same midnight. And so he asserted his leadership. And thereafter he seemed to be the leader. But it was after a long delay in response to the problem.

JR- where Kerala had taken the lead...

Yeah, and they had  gone ahead well ahead of everybody else. Now, the point I'm driving at is in today's Hindu newspaper, as I said yesterday, the social vaccine is a counter to the administrative authoritarian decisions imposed without people's understanding or participation or designing true behaviour change, with information and understanding, rational knowledge, instead of the 'do as you are told'. And, that they're doing what they're told. That’s okay, that's all right. And the social vaccine that we're talking about is not in place. That is social vaccines is that we take actions in our own self interest, driving our behavior, like the response to HIV in 1986-87. So the, somebody has written a piece  saying that Modi is risking too much.

If he wins, okay; if he loses, he will not be accepted as a leader. If he stood for election, he may not win, I saw it fleetingly, but I didn't pay much attention. There is somebody who wrote that. So that's what I'm driving at. I think he has taken a big gamble. And he came forward, this is my guess (I have no proof). He came forward only after people began saying that India may not be badly affected. So there is a bit of optimism in various people's thinking and which is reflected by the BCG story and the slow expansion. So, that's what encouraged him to now say, Okay, I'm the leader, and I have achieved all this. What he did not achieve, what happened naturally, and what leadership states took, ….he now lays claim for the successes. And pretends that it was his design and he shows up the leader up in front. So my question is, what if gamble goes wrong? If we really have a huge outbreak on hand by May June. Then what will happen? Then what will he do? That's, that was what I was thinking about today.

So then why is India’s numbers low? I have three explanations. Number one, the numbers are truly low, for 1.3 billion population we have low numbers and the explanation may be we must have some hidden advantages.So the lockdown per se, nobody would say was successful. Some places good, some places not good and some places could not work like in Dharavi.

One factor is BCG, we have universal BCG. One my colleagues, Dr Sheshadri, brought out this point and we have written a short piece and submitted to the journal 'Current Science'. And I can share it with you because you're not going to share it with anybody else. If you look at the dengue map of the world and superimpose the COVID map of the world. India is dengue positive and COVID, negative. South Asia is dengue positive and COVID low. We're waiting for Brazil, dengue positive. We don't know whether Brazil will pick up or not. So, if there is a negative  correlation between widespread dengue and COVID, it is a hypothesis, that we both have written and submitted to thea journal There is a small chance that...it's plausible...possible that dengue stimulates the immune system very, very what shall I say vigorously, somewhat like BCG stimulation. And the stimulation is more innate immunity.

When it comes to the antibody, adaptive immunity most viruses are the same in that each infection induces its own specific antibody. But when it comes to the early innate immunity, both BCG and dengue seem to have made the innate immunity extra alert and if that is true, then COVID comes, the innate immunity is extra alert and there may be some mechanisms to put down the early fires and if you do that, then your virus dose infecting may be low. That is very crucial thing. If you get infected with a heavy load of virus, heavy dose of virus, you tend to have more severe disease. But if we have escape infection, that is if you got infected in spite of wearing a mask and glasses, and one time contact and we got infected, it is likely to be due to just one virus or a tiny dose, and the leads to a long incubation period and very mild disease, this is in general.                   

So, if you're working in a hospital for COVID and you get infected, your dose is more heavy and you will have more problems. It is a general phenomenon. The  more the frequency of infections, the more likely the innate immunity is more alert. So, innate immunity might be doing some good. Reduce the infection dose and that gives you a little bit of protection. Okay.

So, number one theory that it is for real that there is low risk or some hidden protection. The second possibility is that the numbers are not true. You tested less, you found less. Okay... And okay. The, in support of that we are finding…. we testing more we are finding more today. Today is 17,000 and almost 600 deaths. So the curve is not flat.

JR- Correct. It's not at all…not at all.

Yeah. So, so the second hypothesis maybe tue…you test more, you will find more. The third hypothesis is that's what I tend to favour now and I found it in comparison with Italy, Spain versus Germany, UK and Germany versus, UK...that is India got infected not from China. India got infected from our Western side countries, that is Europe and Middle East, particularly Dubai. So therefore, China exported viruses to Europe in December. Europe began exporting to India in February, March. So we are the third generation and so give us time and...we'll go the European way with a two to three months delay. Okay. If their peak is in April, we have to think in terms of June…May, June, July, nearly by the time delay and the time it takes to expand the infection road.       

So therefore the third theory is we have time mis-match comparing with the countries. Okay. We cannot compare it with China. Because we had very a few importation from China as far as we know, and then came Europe, so, we got transmitted from Europe. That is the second generation we have the third generation. So, we have to be careful, you know, we cannot compare with China because we are way mismatched, we cannot even compare with Europe because we are the next generation infection so, we have to be time mismatch has to be adjusted, so, give a one to two months. So, earlier on I calculated April will be our month that'll shoot up numbers based on the introduction in February.

But do you know that there was not a single introduction in February. Other than the two in Kerala. So, the numbers are January 30th – one, February 2nd- one. February 3rd - one, total three, Okay. March 1st  total three no more than the original three. Isn’t that strange?   

JR- yes, very true…

Okay whereas in both Italy and Spain, 1st  March, India three, Italy 1694. Wow!! that is a difference, therefore three theories. Number may be true and there may be some reason in our favour, possible, unlikely. Second, we're testing less finding less, if so, partially true. And as we test more,  will probably find more. Three, our time mismatch, we cannot compare with any other country, we can only compare with the South Asians countries and we are a group and if one South Asian country takes off, then we have a problem in other countries If none of that has taken off,  that means at least part of them are 3rd generation infected…But they will…… 

JR- it will only be in time difference not in any other virulence of the virus?

Exactly, only time mismatch.

JR- Nothing else will be mismatch, the virus won’t get weaker and weaker in the third generation? 

Yeah nothing else, maybe, maybe different. In other words, these are not mutually exclusive hypothesis. If there is an inherent protection by say let's say dengue. We will have some some

JR-Some cover…

Yeah, some advantage. But not to explain that we will be solidly protected, okay, I mean, there is no likelihood of cross protection by the antibody. But then we are, you know, touching the nose, encircling the head saying that, yes, innate immunity, etc. 

JR- yeah, I got it. Now, if it is the third choice, the peak is coming in June.

Yeah, that is our introductions from Europe. And our introductions were mostly in March, by March, April and so, give two months.. March, , April, May, June, a two months gap. So May, June is what the time match with European countries in March-April. What we have do is to look back in the European countries as of March, April, which will be for us in May June.

JR- And where are you placing your bets of the three?

The third one, that's My own concept. The second one a lot of people have talked about. And you can only see the evidence that has been produced. And that evidence is low testing and low result. But that does not tell you whether if we have tested more the proportion will be higher or not. But it's an assumption that if you test more, you will find more is an assumption. Yeah, I will say two more things, but that is, so I put my emphasis on the third possibility, like don't think that we have some inherent protection and dengue BCG are not really a help.

One caveat that the natural extension in May, June has been dampened down or suppressed by the lockdown. Okay, lockdown that was a bit premature,  it was announced with absolutely no notice. So, therefore we are not getting the full bang for the buck. .

Yeah, I remember, one thing was that if you kill a snake, you come and move the Snake….Snake is dead. That’s proof. Yeah. The lockdown has two parameters for success: Is a lockdown by itself as success? That is, is it efficient, that is it is actually a true lockdown or a leaky lockdown. Then,  if it was true lockdown has it made a difference to the curve. So you need to look at both. Now, I didn't understand why people were so worried about proving that the lockdown was successful. Now I realize that they all knew that the lockdown was very leaky therefore, we need to justify the lockdown by showing success by the flattening of the curve. Okay. Now lockdown was leaky, therefore lockdown was not efficient, not effective, it could not have achieved the results that we could have. That's the most important thing: we  could have achieved much success  if we had done the lockdown correctly. Preparing social vaccine, prepare everybody this is for your good, your grandparents good, your children's good, your future’s good, your business, your income, your ….. everything. This is good for you. The day when we reach 1000, we will lockdown, so be prepared. Don't panic. There is clear 4 days of advance notice and the……..interruption…

So the lockdown per se, nobody would say was successful as a lockdown. Don't worry about anything else, you wanted a lockdown you announced a lockdown, was it successful, the answer is only partial. Very Very Very leaky. Some places good, some places not good and some places could not work like in Dharavi. In various bastis and the migrant labor. So, lockdown as a lockdown as government administrative procedure was a failure, not a complete failure but  not as successful as it could have been, if it was planned and done well. Therefore, you have to scramble and find if the curve has been flattened. So, for one week that was a debate in Delhi. Time to prove that lockdown  is successful. The numbers don't show success.                                                                                                                              

JR- Correct

So now nobody's talking about this anymore. So that is one thing that I want to say. That is the lockdown’s, success has been measured two ways. If a prescription is not you cannot look at the efficacy of a medicine because you have prescribed it, the medicine has to be taken, swallowed on time, as you said. And then only see whether the disease was treated. So here we have a prescription and we are looking for the effects of the treatment. So that is one thing that I want to mention so that is done. The second thing I can't remember what it was Ah yes, I remember my son in the United States….I have a granddaughter who studies - the second thing I can't remember what it was……..Ah yes yes, I remember, my son in the United States……I have a grand daughter who studies in Volgograd in Russia.

JR- Okay. Oh she studies in Russia.

Yeah. Career medicine. Okay. Why in Russia that’s a long story? So, we have been asking her, what is,…. what about this Coronavirus? No, news….nothing….no Coronavirus anywhere, all that. So then she one day said, “hey, our university announced that tomorrow onwards no student comes to class. All classes will be online, you stay where you are. And don't move out…..look after yourself. Get your food and everything extra careful.” So, she didn't understand why. So she was talking to family and we all told her that this must be because they know about COVID. The virus already has reached Russia. So my son who is in the United States is a PhD scientist in geology. But he doesn't do in geology, he is running a NGO for the development of under privileged people.

JR-Okay.

So he sent her a paper, which says that somebody who is a westerner was in Russia for a long time, gone back to US. And when this COVID became kind of known widely and Russia was claiming that they didn't have any COVID, he contacted his friends asked them to search out. And he said, pneumonia deaths involved at Volgograd was something like 10 times higher in this early 2020s than in early (2019s).

JR- Early 2020 was higher than an early 2019.

Yeah, it was 10 times higher. That is the March, February March, April period pneumonia deaths were 10 times higher and Volgograd.

JR- Which is a place where she studies?

Exactly. So this guy then contacted people in Moscow. February, March 36 times higher than in 2019. Okay. I haven't seen the paper yet.

JR- Has the paper been published? 

Yeah, in some western media. So then he asked me to look at India's data on pneumonia deaths. So I began Google search on Ministry of Health India, and integrated disease surveillance for pneumonia cases numbers. Blank…..the numbers are pertaining to 2017, I can get 2018 there are something there. Nothing in 2019, nothing in 2020. What nonsense. What? What surveillance is it? If it is two years, three years delayed the numbers in public domain, what is it they're doing? So I can't find any comparison of pneumonia deaths of March 2020 with March 2019.

JR- 2020 I can excuse, but 2019 should be there

No, it's not there, it’s not in the public domain. I mean 2020 should be available. See surveillance is a daily business. So they must accumulate on a weekly business and they should have data on weekly business. You know, in US and all every week they have data out in the public domain. So there we are, we are blind and inefficient. And we only rely upon our luck and so...

JR- yeah, yeah, I understand. I just read a report that the neighbouring district of Bombay and Thane has been sealed off as fully contaminated. So that is an indication of where we are going?

Yeah.

JR- doesn't look good to me.

Yeah, wherever the population density is high, things are bad. Except in Kerala. Kerala has managed it so tightly and with full participation of the people So, Kerala will be able to delay the peak by considerable amount of time, several weeks,

JR- but there also the peak will come?                                                          

Yeah. They will break through. A second wave is predictable in Kerala. Today somebody sent me a paper for Coments, CDC, Atlanta has come up with 5.7 R0  instead of 1.9 to 2.1 R0

JR- Oh, 5.7

Yeah. So then I was scratching my head and I had to explain this and I explained this like this. Most likely, the Chinese R0 and the early R0 One disease resulting in two diseases. The CDC calculation is one infection resulting in five point seven infections and most of them are hidden.. So it's possible if CDC is correct, the herd immunity necessary to have a herd effect to reduce transmission speed so that the bell shaped curve takes it down flow. If it is two, it is 70% if it is between five and six, it must be 80%. So, we need 80% herd immunity before the curve will turn down. So, I've been saying so far 70%, based on the R0 2.

Dr. T Jacob John talks to Jagdish Rattanani about Kerala’s strong response to the pandemic, shortage of testing kits and possibility of a second wave  

 

Kerala tested the first Wuhan arrival on January 30, okay, and two more in early February. Kerala did it from the first arrivals. Where did they get the kits from? By the time NIV was ready with test kit. And there is an NIV presence in Kerala, a field station in Kerala.

JR- so NIV had already come up with a testing kit.

Yeah. See, the Chinese announced the gene sequence for primers by January 11 or so, everybody, all virologists, would synthesise those gene sequences and be ready. CMC was ready but CMC was asked not to test, explicitly,  They obeyed the orders and they did not test, until they were released from this what do you call, order of do not test

JR- Okay, which came later?

That came much later. I think it came in March ….. Towards the end of March or beginning of April I don’t know when, I did not check. So, they have not taken the lead in this Coronavirus thing and apparently. The flight that came from Wuhan, that is from China somewhere, had either a stopover or passengers were transferred from one plane to another plane in Calcutta,

JR- okay.                                                                                            

So, these girls who came,  with no alert in Kolkata; the moment they landed in, I think Cochin airport I think….Cochin or Trivandrum I don’t know, immediately they were taken off, tested, quarantined. So the lead was taken by one state. , Medical students from Wuhan also came to Tamil Nadu and to Andhra Pradesh. The central government had not done any homework, these states had not done any homework. So let it be there. Students arriving in these states were not tested. So, then gradually different states began thinking about infection and doing something here and there; Tamil Nadu, Karnataka, Telangana, Andhra Pradesh, Delhi, little by little many States began doing their own thing. And it's only end of March, beginning of April that the Prime Minister seemed to become the leader. By about April 7, I think he had convened empowered groups and assigned them tasks, . And he appeared on national television saying that he's the leader of the fight on 21 March ……

When it comes to the antibody adaptive immunity, most viruses are the same in that each infection induces its own specific antibody. But when it comes to the early innate immunity, both BCG and dengue seem to have made the innate immunity extra alert and if that is true, then COVID comes, the innate immunity is extra alert and there may be some mechanisms to put down the early fires and if you do that, then your virus dose infecting may be low.

March 21 is when the Prime Minister came and said, I'm leading in from front. He announced a 14 hour stay home order. So I think his tactic was wait and see. Let state’s play the game. And then anyway, he is the team leader and so he assumed the leadership by 21st of March. Then he appeared again on...24th of March and announced the lockdown from the same midnight. And so he asserted his leadership. And thereafter he seemed to be the leader. But it was after a long delay in response to the problem.

JR- where Kerala had taken the lead...

Yeah, and they had  gone ahead well ahead of everybody else. Now, the point I'm driving at is in today's Hindu newspaper, as I said yesterday, the social vaccine is a counter to the administrative authoritarian decisions imposed without people's understanding or participation or designing true behaviour change, with information and understanding, rational knowledge, instead of the 'do as you are told'. And, that they're doing what they're told. That’s okay, that's all right. And the social vaccine that we're talking about is not in place. That is social vaccines is that we take actions in our own self interest, driving our behavior, like the response to HIV in 1986-87. So the, somebody has written a piece  saying that Modi is risking too much.

If he wins, okay; if he loses, he will not be accepted as a leader. If he stood for election, he may not win, I saw it fleetingly, but I didn't pay much attention. There is somebody who wrote that. So that's what I'm driving at. I think he has taken a big gamble. And he came forward, this is my guess (I have no proof). He came forward only after people began saying that India may not be badly affected. So there is a bit of optimism in various people's thinking and which is reflected by the BCG story and the slow expansion. So, that's what encouraged him to now say, Okay, I'm the leader, and I have achieved all this. What he did not achieve, what happened naturally, and what leadership states took, ….he now lays claim for the successes. And pretends that it was his design and he shows up the leader up in front. So my question is, what if gamble goes wrong? If we really have a huge outbreak on hand by May June. Then what will happen? Then what will he do? That's, that was what I was thinking about today.

So then why is India’s numbers low? I have three explanations. Number one, the numbers are truly low, for 1.3 billion population we have low numbers and the explanation may be we must have some hidden advantages.So the lockdown per se, nobody would say was successful. Some places good, some places not good and some places could not work like in Dharavi.

One factor is BCG, we have universal BCG. One my colleagues, Dr Sheshadri, brought out this point and we have written a short piece and submitted to the journal 'Current Science'. And I can share it with you because you're not going to share it with anybody else. If you look at the dengue map of the world and superimpose the COVID map of the world. India is dengue positive and COVID, negative. South Asia is dengue positive and COVID low. We're waiting for Brazil, dengue positive. We don't know whether Brazil will pick up or not. So, if there is a negative  correlation between widespread dengue and COVID, it is a hypothesis, that we both have written and submitted to thea journal There is a small chance that...it's plausible...possible that dengue stimulates the immune system very, very what shall I say vigorously, somewhat like BCG stimulation. And the stimulation is more innate immunity.

When it comes to the antibody, adaptive immunity most viruses are the same in that each infection induces its own specific antibody. But when it comes to the early innate immunity, both BCG and dengue seem to have made the innate immunity extra alert and if that is true, then COVID comes, the innate immunity is extra alert and there may be some mechanisms to put down the early fires and if you do that, then your virus dose infecting may be low. That is very crucial thing. If you get infected with a heavy load of virus, heavy dose of virus, you tend to have more severe disease. But if we have escape infection, that is if you got infected in spite of wearing a mask and glasses, and one time contact and we got infected, it is likely to be due to just one virus or a tiny dose, and the leads to a long incubation period and very mild disease, this is in general.                   

So, if you're working in a hospital for COVID and you get infected, your dose is more heavy and you will have more problems. It is a general phenomenon. The  more the frequency of infections, the more likely the innate immunity is more alert. So, innate immunity might be doing some good. Reduce the infection dose and that gives you a little bit of protection. Okay.

So, number one theory that it is for real that there is low risk or some hidden protection. The second possibility is that the numbers are not true. You tested less, you found less. Okay... And okay. The, in support of that we are finding…. we testing more we are finding more today. Today is 17,000 and almost 600 deaths. So the curve is not flat.

JR- Correct. It's not at all…not at all.

Yeah. So, so the second hypothesis maybe tue…you test more, you will find more. The third hypothesis is that's what I tend to favour now and I found it in comparison with Italy, Spain versus Germany, UK and Germany versus, UK...that is India got infected not from China. India got infected from our Western side countries, that is Europe and Middle East, particularly Dubai. So therefore, China exported viruses to Europe in December. Europe began exporting to India in February, March. So we are the third generation and so give us time and...we'll go the European way with a two to three months delay. Okay. If their peak is in April, we have to think in terms of June…May, June, July, nearly by the time delay and the time it takes to expand the infection road.       

So therefore the third theory is we have time mis-match comparing with the countries. Okay. We cannot compare it with China. Because we had very a few importation from China as far as we know, and then came Europe, so, we got transmitted from Europe. That is the second generation we have the third generation. So, we have to be careful, you know, we cannot compare with China because we are way mismatched, we cannot even compare with Europe because we are the next generation infection so, we have to be time mismatch has to be adjusted, so, give a one to two months. So, earlier on I calculated April will be our month that'll shoot up numbers based on the introduction in February.

Kerala will be able to delay the peak by considerable amount of time, several weeks

But do you know that there was not a single introduction in February. Other than the two in Kerala. So, the numbers are January 30th – one, February 2nd- one. February 3rd - one, total three, Okay. March 1st  total three no more than the original three. Isn’t that strange?   

JR- yes, very true…

Okay whereas in both Italy and Spain, 1st  March, India three, Italy 1694. Wow!! that is a difference, therefore three theories. Number may be true and there may be some reason in our favour, possible, unlikely. Second, we're testing less finding less, if so, partially true. And as we test more,  will probably find more. Three, our time mismatch, we cannot compare with any other country, we can only compare with the South Asians countries and we are a group and if one South Asian country takes off, then we have a problem in other countries If none of that has taken off,  that means at least part of them are 3rd generation infected…But they will…… 

JR- it will only be in time difference not in any other virulence of the virus?

Exactly, only time mismatch.

JR- Nothing else will be mismatch, the virus won’t get weaker and weaker in the third generation? 

Yeah nothing else, maybe, maybe different. In other words, these are not mutually exclusive hypothesis. If there is an inherent protection by say let's say dengue. We will have some some

JR-Some cover…

Yeah, some advantage. But not to explain that we will be solidly protected, okay, I mean, there is no likelihood of cross protection by the antibody. But then we are, you know, touching the nose, encircling the head saying that, yes, innate immunity, etc. 

JR- yeah, I got it. Now, if it is the third choice, the peak is coming in June.

Yeah, that is our introductions from Europe. And our introductions were mostly in March, by March, April and so, give two months.. March, , April, May, June, a two months gap. So May, June is what the time match with European countries in March-April. What we have do is to look back in the European countries as of March, April, which will be for us in May June.

JR- And where are you placing your bets of the three?

The third one, that's My own concept. The second one a lot of people have talked about. And you can only see the evidence that has been produced. And that evidence is low testing and low result. But that does not tell you whether if we have tested more the proportion will be higher or not. But it's an assumption that if you test more, you will find more is an assumption. Yeah, I will say two more things, but that is, so I put my emphasis on the third possibility, like don't think that we have some inherent protection and dengue BCG are not really a help.

One caveat that the natural extension in May, June has been dampened down or suppressed by the lockdown. Okay, lockdown that was a bit premature,  it was announced with absolutely no notice. So, therefore we are not getting the full bang for the buck. .

Yeah, I remember, one thing was that if you kill a snake, you come and move the Snake….Snake is dead. That’s proof. Yeah. The lockdown has two parameters for success: Is a lockdown by itself as success? That is, is it efficient, that is it is actually a true lockdown or a leaky lockdown. Then,  if it was true lockdown has it made a difference to the curve. So you need to look at both. Now, I didn't understand why people were so worried about proving that the lockdown was successful. Now I realize that they all knew that the lockdown was very leaky therefore, we need to justify the lockdown by showing success by the flattening of the curve. Okay. Now lockdown was leaky, therefore lockdown was not efficient, not effective, it could not have achieved the results that we could have. That's the most important thing: we  could have achieved much success  if we had done the lockdown correctly. Preparing social vaccine, prepare everybody this is for your good, your grandparents good, your children's good, your future’s good, your business, your income, your ….. everything. This is good for you. The day when we reach 1000, we will lockdown, so be prepared. Don't panic. There is clear 4 days of advance notice and the……..interruption…

India got infected not from China. India got infected from our Western countries, that is   Europe and Midle East, particularly Dubai. So therefore, China exported viruses to Europe in December. Europe began exporting to India in February, March. So we are the third generation and so give us time and …. we'll go the European way with a two to three months delay.

So the lockdown per se, nobody would say was successful as a lockdown. Don't worry about anything else, you wanted a lockdown you announced a lockdown, was it successful, the answer is only partial. Very Very Very leaky. Some places good, some places not good and some places could not work like in Dharavi. In various bastis and the migrant labor. So, lockdown as a lockdown as government administrative procedure was a failure, not a complete failure but  not as successful as it could have been, if it was planned and done well. Therefore, you have to scramble and find if the curve has been flattened. So, for one week that was a debate in Delhi. Time to prove that lockdown  is successful. The numbers don't show success.                                                                                                                              

JR- Correct

So now nobody's talking about this anymore. So that is one thing that I want to say. That is the lockdown’s, success has been measured two ways. If a prescription is not you cannot look at the efficacy of a medicine because you have prescribed it, the medicine has to be taken, swallowed on time, as you said. And then only see whether the disease was treated. So here we have a prescription and we are looking for the effects of the treatment. So that is one thing that I want to mention so that is done. The second thing I can't remember what it was Ah yes, I remember my son in the United States….I have a granddaughter who studies - the second thing I can't remember what it was……..Ah yes yes, I remember, my son in the United States……I have a grand daughter who studies in Volgograd in Russia.

JR- Okay. Oh she studies in Russia.

Yeah. Career medicine. Okay. Why in Russia that’s a long story? So, we have been asking her, what is,…. what about this Coronavirus? No, news….nothing….no Coronavirus anywhere, all that. So then she one day said, “hey, our university announced that tomorrow onwards no student comes to class. All classes will be online, you stay where you are. And don't move out…..look after yourself. Get your food and everything extra careful.” So, she didn't understand why. So she was talking to family and we all told her that this must be because they know about COVID. The virus already has reached Russia. So my son who is in the United States is a PhD scientist in geology. But he doesn't do in geology, he is running a NGO for the development of under privileged people.

JR-Okay.

So he sent her a paper, which says that somebody who is a westerner was in Russia for a long time, gone back to US. And when this COVID became kind of known widely and Russia was claiming that they didn't have any COVID, he contacted his friends asked them to search out. And he said, pneumonia deaths involved at Volgograd was something like 10 times higher in this early 2020s than in early (2019s).

If you're working in a hospital for COVID and you get infected, your dose is more heavy and you will have more problems. The more the frequency of infections, the more likely the innate immunity is more alert. Reduce the infection dose and that gives you a little bit of protection.

JR- Early 2020 was higher than an early 2019.

Yeah, it was 10 times higher. That is the March, February March, April period pneumonia deaths were 10 times higher and Volgograd.

JR- Which is a place where she studies?

Exactly. So this guy then contacted people in Moscow. February, March 36 times higher than in 2019. Okay. I haven't seen the paper yet.

JR- Has the paper been published? 

Yeah, in some western media. So then he asked me to look at India's data on pneumonia deaths. So I began Google search on Ministry of Health India, and integrated disease surveillance for pneumonia cases numbers. Blank…..the numbers are pertaining to 2017, I can get 2018 there are something there. Nothing in 2019, nothing in 2020. What nonsense. What? What surveillance is it? If it is two years, three years delayed the numbers in public domain, what is it they're doing? So I can't find any comparison of pneumonia deaths of March 2020 with March 2019.

JR- 2020 I can excuse, but 2019 should be there

No, it's not there, it’s not in the public domain. I mean 2020 should be available. See surveillance is a daily business. So they must accumulate on a weekly business and they should have data on weekly business. You know, in US and all every week they have data out in the public domain. So there we are, we are blind and inefficient. And we only rely upon our luck and so...

JR- yeah, yeah, I understand. I just read a report that the neighbouring district of Bombay and Thane has been sealed off as fully contaminated. So that is an indication of where we are going?

Yeah.

JR- doesn't look good to me.

Yeah, wherever the population density is high, things are bad. Except in Kerala. Kerala has managed it so tightly and with full participation of the people So, Kerala will be able to delay the peak by considerable amount of time, several weeks,

JR- but there also the peak will come?                                                          

Yeah. They will break through. A second wave is predictable in Kerala. Today somebody sent me a paper for Coments, CDC, Atlanta has come up with 5.7 R0  instead of 1.9 to 2.1 R0

JR- Oh, 5.7

Yeah. So then I was scratching my head and I had to explain this and I explained this like this. Most likely, the Chinese R0 and the early R0 One disease resulting in two diseases. The CDC calculation is one infection resulting in five point seven infections and most of them are hidden.. So it's possible if CDC is correct, the herd immunity necessary to have a herd effect to reduce transmission speed so that the bell shaped curve takes it down flow. If it is two, it is 70% if it is between five and six, it must be 80%. So, we need 80% herd immunity before the curve will turn down. So, I've been saying so far 70%, based on the R0 2.

JR-Yeah.

Yeah. So anyway, every day there's something new.                                          

JR- Yeah. Yeah. Correct.

And, you know, I discovered something?!!

JR- which is

That in 2019, there was a major meeting of the best brains of the world looking for what would happen if a pandemic like influenza, respiratory transmitted with higher mortality hit the world.

JR- okay

Vijay Raghavan was a member of that group. Dammit. He never, ever mentioned anything to anybody. He probably didn't pay attention to what the meeting was all about. That last meeting report is almost…………….

JR- precursor?

Some kind of premonition, (prediction?), kind of an inkling that something is about to happen. Okay, I have downloaded the report, I have not read it. It's a precious document. You know who the chairperson was,  I think (he is talking about H.E.Dr.Gro Harlem Brudtland) German woman who was the head of WHO

JR- sustainability. Yeah, the report on sustainability ….. woodland report?!

Yeah. It's not sustainability.It is about….

JR- earlier the report was the Brundtland report on sustainability

No, it is about preparedness for pandemic. (Name of the Report: A World at Risk: Annual report on global preparedness for health emergencies. Global Prepardness Monitoring Board). And this was the woman who ticked off China, when China had the SARS. She just ticked them off saying that you did not tell us ahead of time. You did not tell us the whole picture you do not tell the truth. Don't do this here after, your wet markets are a risky place, etc. That woman had the guts to tell Chinese. Anyway,

JR- so the same Vijay Raghavan, who was the scientific adviser?

Exactly. And this report is available in the public domain. How come nothing has been applied in India from those recommendations when the coronavirus started spreading out from China in January 2020?…

This conversation was recorded on April 20

I didn't understand why people were so worried about proving that the lockdown was successful. Now I realize that they all knew that the lockdown was very leaky therefore, we need to justify the lockdown by showing success by flattening of the curve.

JR-Yeah.

Yeah. So anyway, every day there's something new.                                          

JR- Yeah. Yeah. Correct.

And, you know, I discovered something?!!

JR- which is

That in 2019, there was a major meeting of the best brains of the world looking for what would happen if a pandemic like influenza, respiratory transmitted with higher mortality hit the world.

JR- okay

Vijay Raghavan was a member of that group. Dammit. He never, ever mentioned anything to anybody. He probably didn't pay attention to what the meeting was all about. That last meeting report is almost…………….

JR- precursor?

Some kind of premonition, (prediction?), kind of an inkling that something is about to happen. Okay, I have downloaded the report, I have not read it. It's a precious document. You know who the chairperson was,  I think (he is talking about H.E.Dr.Gro Harlem Brudtland) German woman who was the head of WHO

JR- sustainability. Yeah, the report on sustainability ….. woodland report?!

Yeah. It's not sustainability.It is about….

JR- earlier the report was the Brundtland report on sustainability

No, it is about preparedness for pandemic. (Name of the Report: A World at Risk: Annual report on global preparedness for health emergencies. Global Prepardness Monitoring Board). And this was the woman who ticked off China, when China had the SARS. She just ticked them off saying that you did not tell us ahead of time. You did not tell us the whole picture you do not tell the truth. Don't do this here after, your wet markets are a risky place, etc. That woman had the guts to tell Chinese. Anyway,

JR- so the same Vijay Raghavan, who was the scientific adviser?

Exactly. And this report is available in the public domain. How come nothing has been applied in India from those recommendations when the coronavirus started spreading out from China in January 2020?…

This conversation was recorded on April 20