‘Mumbai may witness the peak next week’, Dr Shashank Joshi

With Mumbai witnessing a spurt in cases, Dr Shashank Joshi, member of the Covid-19 task force, talks to Rupsa Chakraborty about the road ahead and the steps the city needs to take to prevent a further rise in infections and hospitalisations over the next few weeks.

What has been observed in the last three weeks of the third wave?

The burden of active Covid-19 cases will be higher than the earlier two waves. But as Omicron is causing a lot of upper respiratory symptoms such as cold and flu, without much involvement of the lungs, it has decreased the dependency on oxygen, and fatality rate. Since December 1, over 1.5 lakh cases have been recorded but the case fatality rate stands at 0.36%. However, as deaths generally have a lag of around three weeks, we have to keep a close eye on it.

When are Mumbai, and Maharashtra, expected to reach their pandemic peak?

I had originally predicted that the peak for Mumbai would come by January 15, followed by Delhi after two weeks, but considering that doubling rate in Omicron is very short, Mumbai is likely to witness the peak next week. Maharashtra would witness the peak in the first week of February and India would peak around the middle of February.

Considering the explosive geometric proportionate growth rate of Omicron, all the numbers are coming too early. We had expected that Mumbai would bypass the mark of 20,000 cases after 2-3 days, but it came earlier due to the high infection rate.

At present, we have two models—-South Africa where it peaked very fast and plateaued faster. Only 3% of the patients were hospitalised. Then we have the UK model where it peaked very fast but the plateauing was delayed until recently. Nearly 6% of the patients required hospitalisation.

Sero-surveillance showed high sero-prevalences in Mumbai. Despite this, how did Mumbai turn into an epicentre in the third wave?

Right now, all herd immunity models and theories have failed.

There are ongoing debates about treatment protocol for Omicron patients. What is your opinion on it?

Omicron patients require symptomatic treatment. First thing, people who are senior citizens above 50 years with multiple comorbidities would require specific drugs. Now, we are growing through a transition time, there will be Demicron— with the presence of both Delta and Omicron variants.

Monoclonal antibodies are an option. People with Omicron need to be carefully scrutinised. If a patient has persistent fever and cough with severe comorbidities, new-age antivirals like molnupiravir might have a role.

There is no need to over-explicate the adverse effects of molnupiravir as it is not even documented among human beings. It has got emergency authorisation and the US FDA has documented it. Studies have shown that it has helped to contain hospitalisation by 30%. But it should not be used indiscriminately.

Also, it shouldn’t be used among asymptomatic patients and those who aren’t at a risk of deterioration. Remdesivir injection, given intramuscularly, should be the last resort for symptomatic patients with comorbidities.

How is the state planning to contain the spread?

Our laboratories and testing facilities are under strain. So, people who have tested positive in a Rapid Antigen Test (RAT) shouldn’t opt for an RT-PCR test. If you test positive, isolate yourself, contact your medical health providers and get treated. Labs are overburdened, the appointments are waiting and Mumbai is already feeling the dent now.

So, Maharashtra government has suggested ‘augmented restrictions’ — some smart restrictions to contain the spread instead of a complete lockdown.

This would mean more restrictions on non-essential activities that could attract crowds.

A complete lockdown is not needed at this stage. But crowds need to be curbed.

What does the future hold for Mumbai?

The only silver lining is that the severity is less but dismissing the infection as mild is not correct because we have to identify the asymptomatic patients who constitute 85% of the total cases. To make them stay at home is a challenge and they are the one who are contagious and can spread the virus.

We have to filter out those at high risk — people with low immunity, the unvaccinated population or those with life-threatening diseases which can turn severe and need hospitalisation. We have to study how Omicron behaves epidemiologically among all age-groups. The next 3-4 days will stand its test.

Omicron can mark the ‘endemic’ by replacing the Delta variants. As a virus evolves, it may mutate more but become less virulent, which is a silver lining. We just have to keep an eye on other variants of concern.


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