Coronavirus may peak in June-July in India, says veteran NHS doctor

Dr Patil says about 7.9 million people in the UK could get infected

Dr Neeraj Patil Dr Neeraj Patil | Supplied

“We are still at the beginning of a pandemic and the worst days are yet to come. The COVID-19 outbreak is the biggest challenge faced by the National Health Service (NHS) in the United Kingdom since its inception. Artificial intelligence predicts a peak in the UK in May 2020 and June-July in India,” warns Dr Neeraj Patil, an accident and emergency consultant in the NHS, who is also a prominent politician of the Labour Party.

The 52-year-old Indian-origin doctor from Gulbarga in Karnataka has served as the mayor of the London borough of Lambeth (2010-2011). Patil championed the project to install the statue of Basaveshwara—the 12th century Indian philosopher and social reformer—in Albert Embankment Gardens, overlooking the British Parliament.

Patil was pitted against Education Minister Justine Greening in the June 2017 General Elections to Britain's Parliament and he lost by 1,554 votes. Last December, Patil openly expressed deep concern over the endorsement of the Labour Party by terrorist group Jammu and Kashmir Liberation Front.

In an exclusive interview with THE WEEK, Dr Patil gives an insight into UK's preparedness to fight the pandemic and the challenges facing India in the weeks to come.

What has been your experience as a part of the NHS over the last few weeks in tackling the COVID-19 outbreak in the UK?

I have been working in the NHS for the past 25 years and I must admit that this is the biggest challenge faced by NHS since its inception. The UK provides a free health care service to its citizens based on their need and not on the ability to pay. We have a very large elderly (over 70 years) population that is at risk. In the last few weeks, we are very busy preparing for the battle against the coronavirus.

What are modelling and data analytics and artificial intelligence(AI) predictions hinting at for the UK?

Around 7.9 million people are likely to get infected, with a mortality of 20 per cent as per the artificial intelligence reports.

Is it possible to make predictions for India too? Is it a cause to worry?

We are still at the beginning of a pandemic and the worst days are yet to come. Artificial intelligence predicts a peak in the UK in May 2020 and June-July in India. I am perplexed to note the self-praise and flattery in the Indian press. It is too early to criticise or applaud. Testing times are ahead in June-July when the pandemic fully breaks out in India.

What do you think of India's preparedness given its huge population?

India is facing a huge challenge because of its huge population and lack of financial/health resources to combat this challenge. I supported the Janata curfew and the strategic vision and leadership of current Prime Minister Modi. But unfortunately, we don’t have a safe and effective care system in India that can deliver and combat the threat like the British NHS system for the common man of India.

What has been the UK's experience in the last few weeks? Does the Italy situation have a lesson for all?

We have learnt from Italy that prevention is better than cure. The entire government sector, private sector, voluntary sector and health sector are working in partnership to combat the threat. Partnership work and community engagement is the best way to combat this great threat faced by humanity.

What is the NHS action plan to contain the virus?

The UK is adopting strict primary, secondary and tertiary prevention measures with strict social distancing and isolation of people over 70 years and high-risk population to prevent the spread of the disease. The UK aims to reduce mortality and economic impact by primary prevention—social distancing, closure of public space attracting a large number, anti-crowd measures, cancellation of all the planned and unplanned events, special measures to keep people over 70 and high-risk groups from the community (High-risk groups include cancer patients, organ transplant patients, pregnant women).

How can we prevent COVID-19 deaths?

Primary prevention is the best way forward until a vaccine is manufactured to cover all the four strains of the virus. Approvals have already been given to skip the animal testing phase and I except the randomised controlled clinical trials to start soon to check whether the vaccines can really work. The coronavirus is a simple RNA virus unlike the much-complicated RNA HIV with reverse transcriptase and vaccine will soon be available.

What is the treatment protocol for COVID-19 at present?

Chloroquine and Remdesvir are used to reduce the viral load in infected patients. We need to focus on tertiary prevention. The main problem with COVID-19 infection is the development of secondary pneumonia and sepsis that leads to multi organ failure. The UK has increased its intensive care beds with ventilators by an extra 5,000. Some predict this may not be enough. We will need more intensive care beds with ventilator facilities. Funeral companies have been advised to increase their capacity to provide funeral services.

Are the currently available drugs effective?

Remdesvir prevents the coronavirus from replication by inhibiting RNA-dependent RNA polymerase and is useful in treatment but unfortunately, we don’t have global stocks of this drug.

Hydro Chloroquine and Chloroquine are used to treat COVID-19 infections and are proven to kill the virus in vitro. Hydro Chloroquine and Chloroquine are the same groups of drugs that are used in malarial prophylaxis, but Hydro Chloroquine has fewer side-effects. Both have anti-viral properties and are proven to reduce the viral load in infected patients.

Is mass testing pragmatic especially considering the overlapping symptoms of common flu and the window period of COVID-19?

Mass testing is practically impossible given the infectivity is only for the first 14 days. How can you test 1.2 billion population of India, while the UK cannot afford to test 70 million of its own population? The cost of a test is about $10 person and this limits the use of resources elsewhere where they are most needed.

In case of an epidemic, how do you protect the health care workers?

Health care workers must wear personal protective equipment (PPE) that includes a double pair of gloves, a scrub, a special mask with a filter and a visor. Strict disposal of clinical waste from infected patients will protect health care workers. Health care workers must be trained on how to wear and safely dispose of the PPE.

Is the disease self-limiting?

The disease is self-limiting in healthy individuals for 14 days, but this is not the same in the elderly over 70 and special groups like cancer patients, organ transplant patients and pregnant women. The mortality is directly proportional to age and co-morbid conditions of the individual.

Have countries faltered in early detection of cases and failure to screen at airports and land borders?

True, we all know that the epicentre of this outbreak was the meat market of Wuhan. Coronavirus was limited to bats and the virus somehow jumped from bats and infected the pangolin that in turn transmitted the infection to meat handlers in Wuhan meat market in December 2019. When multiple cases of pneumonia were reported by Dr Li Wenliang from Wuhan, Chinese authorities ignored him and the outbreak happened.

How did the endemic disease turn into a pandemic?

Wuhan has universities that have students from across the globe. The Chinese New Year celebrations in January 2020 and the frequent air travel in this period converted this endemic disease to a pandemic. In hindsight, we could have prevented this endemic from becoming a pandemic if air travel restrictions from high-risk zones were imposed in early January.

Is social distancing and lockdowns effective as WHO suggests effective case identification and isolation as being crucial?

We all know coronavirus spreads by droplet transmission and simple measures like holding a tissue while coughing or sneezing, washing hands, avoiding touching faces and social distancing are very effective measures that reduce the transmission of the disease.

How is COVID-19 different from other virus epidemics in the past?

COVID-19 has high infectivity, morbidity and mortality, unlike the SARS or swine flu virus. This can cause deadly pneumonia leading to sepsis and multi-organ failure, unlike other viral infections. The infection is now, unfortunately, a pandemic and not limited to China.

What is the way forward?

This pandemic can be compared to the Black Death of the 14th century, which was due to plague caused by a bacteria, Yersinia Pestis. This coronavirus pandemic occurred due to a zoonotic jump from a mammal to human beings via an intermediary in a meat market. This is likely to happen again if we don’t address the hygiene and meat handling of many such markets that exist in China and Southeast Asia.

Early detection by imposing an early air travel ban will contain the spread of the disease. Strict travel bans and air restrictions must be applied as soon as possible. As far as the spread of coronavirus pandemic is concerned, I am optimistic of a vaccine being available to health care workers and the population at risk by the end of the year.

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