We need China’s cooperation to understand covid: former WHO chief scientist

Cooperation from China, including access to sites, data, blood samples, and animal farms in the country, is required to determine the origin of the covid-19 virus, according to former World Health Organization (WHO) chief scientist Soumya Swaminathan. The virus is believed to have originated in Wuhan, China.

In an interview, Swaminathan stated that while the covid-19 pandemic will no longer be considered an emergency, it will continue to have recurrent surges whenever a new strain emerges. She noted increased antimicrobial resistance in India due to the widespread and irrational use of antibiotics during the first and second waves. Swaminathan emphasized the need to address long covid symptoms, particularly among those with high-risk conditions such as hypertension. She also said that there is currently limited evidence to support the need for a fourth vaccine dose. Edited excerpts:

According to the WHO, the global health emergency of covid-19 is over. What does it mean?

We must be careful about the terminology we use. We are used to calling it a pandemic. But if we look at the international health regulations, there is no definition of the pandemic. So, what the WHO director-general (DG) said was that the public health emergency of international concern has ended. DG said it is time to transition, which is no longer a global health emergency but still a global threat. He has warned that it should not be taken as everything is over, and let’s forget about covid. He said that we have enough tools, knowledge and resources to manage covid and need to manage it as a long-term threat and no longer the kind of emergency that it was in 2020 and 2021 and the middle of 2022. This means that the pandemic is not over. For example, TB and HIV are a pandemic, and we are still living with that. For the common people, it is important to understand that we should not lose our guard and follow safety measures as covid is unpredictable, shows unusual patterns and keeps observing the data.

Now that covid is not a health emergency and we have tools to manage it. Why there is no clarity on how the virus originated?

The origin of the covid virus is still not answered yet, and the reason is very simple. We need cooperation from the place where it originated. So, we need cooperation from China, and we need access to the site, data, blood samples, and animal farms. Also, the WHO had a plan to conduct a set of research studies, but it could not be taken forward. Even in the past, it took several years to identify SARS’ intermediate host. Similarly, for HIV, it took many years to find out from where it originated. So, in all those cases, scientists were trying to put the pieces of the puzzle to find clues. But without cooperation from China, this cannot happen.

Reports also suggest that antimicrobial resistance (AMR) is growing.

The reason why AMR rates have gone up in the last 2-3 years is due to the widespread and irrational use of antibiotics. During every covid wave, when people had respiratory symptoms, there was always a tendency to use antibiotics, although we know that viral infections do not work on antibiotics. But I have seen prescriptions from many private hospitals around India where doctors were prescribing not just one but multiple antibiotics along with other drugs which do not work. For an ICU patient with a secondary infection diagnosed by the treating doctor, it may be justified, but for the majority of people who were at home, antibiotics were not needed. People in India self-medicate but antibiotics should be used only if it is indicated, and for viral infections like covid and influenza, it should not be used.

A lot of people have long covid symptoms. What are the long-term effects on our organs due to covid?

Certainly, there are multiple reports on long covid symptoms from across the world. Long covid is defined as people who have covid even after 12 weeks. They continue to have symptoms right from the time they recover. These symptoms can be cardiovascular, palpitation, heart arrhythmia, breathlessness, lack of concentration, brain fog etc. Currently, it is estimated that 6% of the people who have covid will have long covid symptoms. The other observation is that people who recover from covid have no symptoms, but there is an increased rate of cardiovascular events, heart attacks, and diabetes. In India, we need to have some good studies as we have a high underlying burden of hypertension and obesity. We need several good case-control and cohort studies to follow up on people who had covid in different age groups and gender and document everything.

Is there a requirement for a fourth dose?

The coverage of the precaution dose is still low, and WHO recommends that everyone should take the third dose. Most importantly, high-risk and vulnerable groups should receive it, such as the elderly, those with underlying morbidity, immuno-compromised people etc. and even in that category, only 30% of people have taken the third dose. For the fourth dose, I don’t think there is great evidence in the long term. And people in India, almost everyone got contracted by Omicron. At this time, what we need is more research in monitoring immune response as it escapes faster in some people.