Young population, chloroquine use no shield for India, Africa against coronavirus

[Edited excerpts from a webinar hosted by Nature India, Translational Health Science and Technology Institute, The Wellcome Trust DBT India Alliance and the IAVI on 28 March 2020. Shahid Jameel is a virologist and the chief executive officer of Wellcome Trust DBT India Alliance.]

Q: Is there any regional variation on the impact of COVID-19? Given Indian and African population is vastly young, could this reduce the number of people affected by COVID-19?

Shaheed Jameel : One thing is quite clear from the experience of China, Italy and some other places that people who are older suffer worse and their mortality is also higher if your age is 60 or above, especially if you are 80 or above. But to think that younger people are not going to be affected is a wrong notion. Examples in the US have shown that even younger people are coming down with infection and disease. In India as well as in Africa, we also have the problem of poor nutrition. So how that will play out in the people getting disease, we don't know. So my message is don't be complacent thinking that India is a younger population. India also has the world's higher number of people with diabetes. India also has very high numbers of people with poor lung function because of air pollution, smoking and indoor firewood cooking. So how this will intersect with the virus, we don't know yet.

Q: Does hydroxychloroquine as a prophylactic drug have side effects? There have been suggestions that in malaria-endemic regions of Africa or India, which have a history of hydroxychloroquine use, the possibility of infection is less? What’s the truth behind these claims?

SJ: In a small trial on 40 people in France, chloroquine has been seen to improve the clearance rate of the virus. This was not a random controlled trial. Chloroquine has only been approved by the US FDA as well as by government of India to be used as an experimental drug in clinical trials. This does not mean that people can go around popping chloroquine tablets and think that it will prevent infection. There is no basis for that. On the contrary, chloroquine can lead to some toxicity. So chloroquine should not be taken as a preventive.

I have seen some scientists trying to relate the use of chloroquine in malaria endemic areas to protection against COVID-19 saying that chloroquine is a long-lasting drug and its half-life is long or it gets into the groundwater when excreted. These are all conjectures. Nothing is proven. Till somebody does a careful study, it remains only an interesting correlation. There is really no basis for it.

Q: The World Health Organisation has repeatedly called upon all countries to augment testing for COVID-19. Where is India right now?

SJ : Testing is being done right now using a real-time PCR test which tests for the genetic material of the virus. And India has currently ramped up its capacity to do about 10,000 tests a day.

It started off slow but has picked up speed. The challenges are the logistics, the availability of these tests, enough trained people and containment facilities. Initially the government had ordered about one lakh (a hundred thousand) tests. But subsequently orders have been placed for up to 10 lakh tests. So in the days to come there would be enough tests available. And clearly the testing has increased. It should go up even further. Unless we do that, we will really not have any data on community spread of the virus.

This test cannot be done by the bedside or in a physician's office. This needs special facilities. The government of India has now contracted out to a private firm which claims to be putting together a test that will give results in about two and a half hours. But that is yet to be verified and its sensitivity and specificity are yet to be checked.

Q: Where exactly is the world on vaccine research and trials right now?

SJ: As per WHO there are about 40 different vaccine candidates in development. Two are in Phase 1 clinical trials - a candidate vaccine from Moderna, a biotechnology company in Cambridge, Massachusetts in USA; and another developed by CanSino Biologicals in China. Besides these, two candidate vaccines are in late preclinical development – an inactivated virus vaccine from the Chinese company SinoVac, and an attenuated (weakened) virus vaccine developed by a US biotechnology company Codagenix in partnership with the Serum Institute of India, Pune.

[Update on 4 April 2020: There is also news of the Hyderabad-based Bharat Biotech partnering with the University of Wisconsin, USA to use their flu vaccine platform to build a COVID-19 vaccine; this is also in the preclinical development stage.]

The closest we are from a licensed vaccine is about 18 months away. We must understand that at this stage these are all candidates. There is no guarantee yet that any of these will show efficacy.

Watch the full webinar here:

Q: Are there any efforts to make specific testing available to communities at risk, for example individuals who do not necessarily understand the risk?

SJ: We have some constraints in our health system – both in infrastructure and in human resources. We should think how to address these challenges. So, we should get more isolation beds prepared, more ICU units, more ventilators. We have a limitation of trained staff and should think of training paramedical staff in a short time to run these machines. We need to urgently build capacity so that we have backup staff available to step in.

Q: Will a 21-day lockdown be enough for India to flatten the curve of the virus?

SJ: The lockdown is necessary and timely but if anyone believes that we are going to be free of the virus after 21 days, they are dreaming. This is not going to happen. Most likely the government will have to take a decision to undertake further lockdowns, maybe in phases and open up for some time, followed by another lockdown. I think we are in this for some time to come.

Q: The FDA has now allowed treatment of critical COVID-19 cases with blood from patients who have recovered from the disease. How does that procedure work?

SJ: The blood from recovered patients that we're talking about is essentially plasma and the logic is that people who have recovered already have antibodies in their plasma against COVID-19. When this is given to a patient, it will neutralise the virus. There is sound logic to it and this is has been practiced in the past. It is called passive immunity prophylaxis. It will not transmit other infections because the plasma is treated at 50 degrees Celsius for 30 minutes, which inactivates most viruses, and it doesn't destroy the antibodies. So it is safe. There's a lot of past experience with this procedure in the world for this.

[Nature India's latest coverage on the novel coronavirus and COVID-19 pandemic here. More updates on the global crisis here.]