1050:  Round Table Expert Zoom Meeting on “Will COVID-19 surge come back again?”

8th August, 2020, 11am-12noon 

Participants: Dr KK Aggarwal, Prof Mahesh Verma, Dr Suneela Garg, Dr Narottam Puri, Dr Alex Thomas, Dr Atul Kochhar, Dr Ashok Gupta, Dr JA Jayalal, Dr Jayakrishnan Alapet, Dr Anil Kumar, Mrs Upasana Arora, Dr KK Kalra, Ms Ira Gupta, Dr S Sharma

Key points from the discussion 

• With unlock 3.0, the people have relaxed; winter is approaching, when a new wave is expected. We have seen that summer had no effect on the number of cases.
• There are six strains of the coronavirus: L strain (original strain in Wuhan), strains S, V, G, GR, and GH. Strain G and its related strains GR and GH are the most common. In North America, the most widespread strain is GH, while in South America, we find the GR strain more frequently. In Asia, where the Wuhan L strain initially appeared, the spread of strains G, GH and GR is increasing. Globally, strains G, GH and GR are constantly increasing. Strain S can be found in some restricted areas in the US and Spain. The L and V strains are gradually disappearing (Science Daily).
• Up to 30% of additions/substitution can occur in the same strain. If the virus undergoes 70% mutation, it becomes a new virus.
• When we define a surge, we should consider a few points: Is it a new mutation? Is it a new strain? How does a virus behave? Is it a superspreader?
• The surge can be due to a new virus, same virus but mutated and same virus but local spread (superspreader, Dharavi).
• If surge is due to a new strain, the mortality may be different and higher initially. If it is a surge in existing strain, then spread will be high, but mortality will be low.
• Pandemics are won by communities.
• In Delhi and Mumbai, the surge was in downtown, as social distancing and/or face masks were not adhered to.
• RT PCR detects viral antigens (E, S, M, ORF, NS, RDRP); if E antigen is negative, no corona. All labs do not test for all antigens. If the kits test for multiple antigens, the sensitivity of the test is higher. This will reduce the chances of false negative result.
• Cohort pooled Ct value high - this means that the virus is getting attenuated. Ct value cannot be the only basis of the report (ICMR), it has to be combined with clinical interpretation; Ct value can change according to the kit used; it may be operator-dependent. The cut-off value must also be mentioned. It is important for clinicians to know the viral load.
• Family clusters may have varied symptoms. But people are not coming forward.
• Prevention is very important, but it is not 100% preventable; our concern is to also reduce the mortality. All efforts today are towards reducing the infection and less effort in reducing the mortality.
• Western models will not work in India. We should learn from each other about things that are unique to India.
• It is important to identify Day 1. CT scan can become positive on Day 3. If RT PCR report is not available or it may be false positive, then CT becomes important. Don’t wait for Day 5, as complications may set in by this time. One must act on Day 3.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA