Dr A Velumani, Promoter, Chairman, Managing Director and Chief Executive Officer, Thyrocare Technologies explains to Viveka Roychowdhury why he thinks that by March 2021, 40 per cent of Indians will have COVID-19 antibody levels high enough for the SARS-CoV-2 virus to find it difficult to step up the deaths. He points out that the optimistic way of looking at this scenario is that Indians may not truly need a vaccine if it comes too late or if it is too costly
What is the significance of the Thyrocare National Covid Antibody Index?
Thyrocare has completed 1 lakh COVID-19 antibody tests, on globally approved test kits. The test results show that 18 per cent Indians already have some level of immunity due to the presence of Immunoglobulin G antibodies post COVID-19 infection. The Thyrocare National Covid Antibody Index covers 364 cities.
But the statistics do have a sampling bias?
It is a study, with no other aim than to assess who has antibodies or not, as a clinical test. All tested have paid for it themselves, which means that the poor were not part of the study. This is a potential bias.
It includes all major cities in the country, from the most to the least affected. It is also 80 per cent employer driven or paid population, with 15 per cent from housing societies. The full data would be with ICMR.
The significance is that antibody prevalence is high and this high level of antibodies could be the reason why we have low deaths per million in India.
For instance, as per data from www.worldometer.com, ‘rich cousin’ countries, which have 10 times more per capita income of that of India, have higher cumulative deaths per 1 million population. For example, Belgium has 846 cumulative deaths per million population and the UK has 670 cumulative deaths per million population. ‘Poor cousin’ countries like Afghanistan have 31 cumulative deaths per million population while India has 22 cumulative deaths per million population
For how long are the antibodies detected and therefore for how long can an individual be considered to have this protection from SARS-CoV-2?
This immunisation is done by virus itself, free of cost and in many cases free of any pain for asymptomatics. These antibodies will be (effective for) as long as vaccine induced antibodies remain in circulation. It is not that antibodies will remain for years but the memory of this will remain in lymphocytes which will mount faster antibody levels the next time they come into contact with the virus.
If it takes 20 days post initial exposure (to the SARS-CoV-2 virus) to get enough antibodies, subsequent exposures can result in a surge (of antibody levels) in just three to five days. This is the basis of immunology which all infections follow and is also the science behind the making of vaccines.
Given that the COVID-19 pandemic is an evolving public and economic crisis, new research from global sources are changing our understanding of the situation each day. Is relatively high antibody levels a reliable early indication of herd immunity? What additional data and analysis is required?
It is an unprecedented pandemic and all research has to be carried out under acute global lockdown and that too with a lot of precautions of infection at home, on the road, and in the office and laboratory.
We are learning fast about its pattern of spread, ineffectiveness of existing drugs, time needed for new drug, need for vaccines and challenges in making them. We are also learning about what can prevent its spread and how to minimise hospital costs, bed costs and avoid death.
Having said that, if antibody levels are high, it means that there is an end to it. In my personal opinion, by March 2021, 40 per cent of Indians will have antibody levels and the virus will find it difficult to step up the deaths. It (the number of deaths due to COVID-19) would come down slowly. The optimistic way of looking at this is that Indians may not truly need a vaccine if it comes too late or if it is too costly.
How are other countries using COVID-19 antibody prevalence data?
Other countries do not find antibody levels encouraging because only 2-3 per cent of the populations are positive for antibodies. The antibody testing kits are from global manufacturers and India’s higher antibody positive pattern is a shock for them. They initially commented that India is not testing enough and not reporting right numbers of deaths. Now they are wondering if it is due to the high immunity that Asians have. If yes, we need to conduct intense research to determine what it is that gives that edge to low per-capita GDP countries.
Are you now satisfied with the levels of testing in the country or are you concerned, especially about the lack of access to testing facilities in the smaller metros and villages, which are now registering more cases?
PCR tests, which are the golden standard for proving positive for COVID-19 are under-used. This is largely due to the very high costs involved. Though the test today costs around Rs. 2500, it is not an affordable test for a middle class Indian. The Government is not spending (on testing) for all, again due to the high costs.
Secondly, the test is reliable but not useful in clinical management, in the absence of specific drugs for deciding the course of treatment. Thirdly, many positives are asymptomatic (due to high immunity).
However, antibody tests have sold well due to their affordability. Psychologically, PCR positive creates huge stress and people avoid it.
An antibody test positive is happy news and people chase it. If I extrapolate the trend, in the long run, 2 per cent Indians would have done a PCR test and 20 per cent would have done an antibody test.
How has the COVID-19 pandemic changed the business model of diagnostics chains like Thyrocare? Are your investors supportive of your philosophy? What are you doing differently today than before Thyrocare went public?
Investors are not against or supporting all decisions. If everything done is for the good of the common man, everyone will appreciate it. If there are profits after doing good for society, they would celebrate.
Things are very different today, especially when COVID-19 is still imposing lockdowns. Some pains in the non-COVID-19 business and some pleasures in COVID-19 business are balancing each other out.
The good old days are gone and will not be back. But there will be new challenges in the new normal as well.
Going public has not changed my drive as much as increasing competition has. But, if the COVID-19 pandemic helps one industry the highest, it would be healthcare. All in healthcare must enjoy it responsibly.
In many ways the COVID-19 pandemic is now a “perfect storm” of long pending public health and socio-economic issues. What are your suggestions for the long term, to balance people, profits and public health and find a sustainable equilibrium?
The government was spending a pittance for healthcare. And so was the common man. Insurance penetration was painful and pathetic. We need huge infrastructure (HR also) for managing 1.4 billion population and I am sure the government will spend more for (CAPEX) for building infrastructure. Common man will spend more for improving his wellness. Insurance will make sure that it helps the common man to share the risks with society. In my opinion, if healthcare was growing X per cent in the last 10 years, it will grow 2X per cent in the next 10 years.
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viveka.roy3@gmail.com
That government investment on health care is low is perhaps not borne out by facts. India probably has produced the largest numbers of doctors and nurses. Does it come cheap? Dies it come without public and private investment? Where has all this resource gone? Who has benefited from this? I don’t need to answer this. Everyone knows that the developed countries of the world have benefited most by this resource pool created at great cost, while our country doesn’t benefit greatly by this resource. India is today an open economy. Private individuals can set up hospitals. There are no constraints on doing so. But investors want to set up only premium hospital chains in metros and none that are affordable for tier 2 cities, the rural and semi urban areas. Any further investment in health care should come only from the private sector and should lead to affordable health care in smaller cities and rural areas.