India Coronavirus Dispatch: Why many Indian Covid-19 trials lack rigour

Tripura's open-air classes, how to avoid super-spreaders, and what sero surveys hide--a roundup of news on how the country is dealing with the pandemic

Tripura’s open-air classes: To aid students who lack access to online lessons, Tripura has now started open air classrooms. The sessions are held in small groups of five in their neighbourhood. The classes — meant for students of grade 3 to 12 from government and government-aided schools — begin with a 10 minute introduction on Covid-19 and precautionary measures necessary to keep the virus at bay. Earlier, a statewide survey had found that 29 per cent of the students did not have access to phones and 44 per cent did not have television. According to the state’s education minister, over 27,500 teachers have so far taught in these classes and more than 100,000 students have turned up at various locations. Read more here.

Indian clinical trials: A UK-based epidemiologist scanned almost 500 Covid-19 clinical trials registered in India and found that a large number of them are just observational studies and not randomised multi-phase trials. Besides, he says many of them are ‘badly designed’. Current Indian trials have very small sample sizes and a biased study design, according to medical experts. For some trials, the sample size was as small as 30 participants. In contrast, UK’s RECOVERY trial has had 12,240 participants. Others caution that drugs are being pushed for treatments without robust evidence. Hence, some Indian hospitals have altogether boycotted the Covid drugs that have caused a buzz elsewhere. Read more here.

What sero surveys hide: Sero surveys tell us about the prevalence of antibodies in those under study. However, as some experts point out, how many of these antibodies are neutralising ones that actually fight against the virus is still not known. Studies on antibodies themselves are yet to take place. In all the surveys till dates, the prevalence of IgG antibodies was determined but not the proportion of those that actually create a protective mechanism. Also, people associated with the Pune sero survey say that one thing the studies have made clear is that the current testing regime is leaving a lot of positive cases undetected. However, the surveys do aid our understanding of which sections of the population are most under risk of being infected. Read more here.

Interview 

Doctor woes: Two hundred and seventy three doctors have died battling Covid-19 on the frontline but government-sponsored benefits are yet to reach intended recipients, says Indian Medical Association (IMA) general secretary. He further pointed out, in the interview, that private doctors are not even eligible for the aid. The doctors’ association had written to the PM a couple of weeks ago but are yet to get a response. He says mortality rate among private doctors is 15 per cent while that among government doctors is 8 per cent. Further, 40 per cent of the doctors who have died are general practitioners. This, he says, is because these doctors are not well-protected since they look after patients before hospitalisation and hence do not wear PPE. Majority of the doctors who have died are above 50 years of age. Read more here.

Comment

Russian vaccine: While news of Russia’s Covid-19 vaccine generated a lot of excitement around the world, this soon devolved into scepticism after closer scrutiny of data. The vaccine, dubbed Sputnik V, did not undergo phase-III trials. The data for phase-I and phase-II are patchy. In phase-III, the vaccine is tested on thousands of volunteers. Many vaccines that seemed promising in the passed failed to pass this critical phase and were subsequently discarded. Besides, the coronavirus is still new and there are glaring gaps in our knowledge about the virus and how it behaves. The columnist says that while we all are waiting for a vaccine with bated breath, we must avoid getting it at the cost of rushing through the critical testing process. Read more here. 

Understanding Covid-19

Super-spreaders and how to avoid them: Super-spreader events are said to occur when single person infects multiple people. Experts say the focus in such situations should not be on the individual but rather on the circumstances that lead to super-spreading. Generally, a gathering in a closed space with poor ventilation and below-normal temperatures is highly likely to lead to super-spreading. An outdoors venue with lots of space can allow for social distancing, they say. Secondly, people with underlying health issues are at greater risk when in close proximity with infected people. Experts say that avoiding crowded places, closed indoor spaces and close proximity is therefore key to protecting oneself. Since super-spreading is believed to be driving the pandemic in many areas, avoiding these circumstance is also crucial for containing the outbreak at large. Read more here.

Aerosol transmissions: Findings from studies around the world show that airborne/aerosol transmission could be a big factor in spreading of the disease. It was previously thought that only ballistic droplets emitted by coughing or sneezing by infected individuals could result in the spread of the virus. Now, it has been found that the virus can linger on in air for hours in the form of aerosols. In July, over 200 scientists wrote a letter to the WHO asking the organisation to recognise the airborne nature of the disease. The columnists recommend improving air circulation systems as the major way of tackling spread. Besides, an important aspect that needs to be looked into are air conditioners. They must be designed to ensure that the same air is not recirculated in the room and must allow for refreshing the air ever 12 hours. Read more here.