Our readers will recall that Dr. Sunil Gunness, cardiologist and head of the Cardiac Centre, was one of the first doctors to give us an interview about the coronavirus while it was still an alien disease restricted to China. During the lockdown, he carried on informing us about the virus through a series of videos. In this week’s interview, Dr. Gunness clears up a lot of misunderstandings – in his usual very diplomatic way – and gives some totally unexpected hope.
When the coronavirus first hit Wuhan, you were the first health professional to publicly talk about that virus which we knew very little about then. Eight months later, how much more do we know about the virus and how many things did we get wrong in relation to what you told me at the time?
We know a lot more about the virus today than we did eight months ago. But most of the things I told you in that interview still stand true. What are these things? First the way the virus is transmitted. It is transmitted through the eyes, the nose and the mouth. That has not changed. There is no other mode of transmission. Secondly, surfaces can also be contaminated. That too is still true.
Does the virus survive on the surfaces as long as we were told? Several hours, even days?
Yes, that too is true.
Has the question about whether the virus is air-borne or not been resolved?
Yes. In a confined space, the virus is airborne, particularly in places where there is high humidity. It can still in the air and be transmitted. Outside, the virus is not as dangerous. This is all old information.
And what is new?
What is new is the R-factor – the rate of transmission. At the beginning, it was as high as six or seven. Today, in the US, it is 1.3, 1.4. What this means is that previously, when someone was infected, s/he transmitted the virus to six to seven people. Today, the infected person can contaminate hardly more than one.
“I am particularly interested in Astrazeneca vaccine being tested in oxford and Moderna being developed in the US. I have been reading that the latter is very good, is working very well and that the scientific community is very optimistic about it.”
So why is the virus out of control in France?
There, people were not taking precautions so the R-value went up and this has led to the lockdown to bring the transmission rate back to one. People don’t want to take precautions. It’s very simple. The precautions are the same: wash your hands, wear a mask and observe social distancing. That hasn’t changed. You will agree with me that in countries like China, South Korea and Hong Kong, the R-factor has remained around one or less than one. The reason is that in those countries, people take the precautions we discussed. In the US, on the other hand, people were holding protests against wearing masks and keeping social distancing. They saw these as a threat to their liberties…so the R shot up.
There is now also talk of the viral load. Can you simplify that for us?
Yes, it’s very important to understand that. The viral load is the amount of virus one emits when speaking, coughing, breathing out etc. Now when we don’t wear a mask and observe social distancing, the virus particles are higher.
What you are saying is that if we opened up tomorrow and the virus took hold of the country, all we have to do is observe the discipline we observed during the lockdown? Be disciplined that is?
Yes. We must educate the population.
Aren’t we educated enough?
I think unfortunately, in my humble opinion, we should have kept the momentum we had during the lockdown and after we came out of confinement.
“Fourteen days in quarantine is definitely severe and tough. Maybe a halfway approach with a seven-day quarantine and seven days of selfisolation can be practised now that we know the virus better and that we are well equipped to diagnose it.”
If we are sitting here and talking without a mask, it’s because there is no virus out there or so we are told. So why should we wear masks if there is no virus?
I think the world is changing and we have to adjust to that. This is not the only pandemic we are likely to have. We will have to educate ourselves and change our habits. We have to get used to wearing a mask and stop shaking hands. Why do we have to shake hands? There are several ways to greet one another. What I am sure about is that there will be more and stronger pandemics in the future. So we have to change our habits.
Isn’t that sad?
We have to choose what we want. Unfortunately, whether we like it or not, this is going to be a new trend.
When we last talked, we were terrified of the virus. We are less scared today. Why?
We are less scared because this virus has remained more or less stable over the months. It hasn’t mutated a lot. There have been very minor mutations. And this is why a vaccine is possible.
How optimistic are you about a vaccine being rolled out anytime soon? I am very optimistic because there are about 10 vaccines which have reached phase 3, which is the final phase. I am particularly interested in AstraZeneca vaccine being tested in Oxford and Moderna being developed in the US. I have been reading that the latter is very good, is working very well and that the scientific community is very optimistic about it. Donald Trump even wanted to use it for his campaign but I am happy that the scientific body decided otherwise. The vaccine will come when it comes, they said, which is very good. They won’t allow politicians to decide when the vaccine should be rolled out.
When do you think one or the other will be ready?
At the end of this month or the beginning of December, according to me. And scientists are so sure that these two vaccines will work that they have already started producing them on a large scale.
How effective would this vaccine be? Would we need just one shot and be fully protected or would we need to renew the experience after some time?
Preliminary results show a very effective vaccine as good as convalescent plasma which is considered the gold standard at present. It’s difficult to know today for how long the vaccine will remain effective. If after some time the protection wears off, a booster might be needed. Only time will tell whether this booster will be every year or more often. But, in any case, even if the protection in an individual wears off with time and this person has contact with the virus again, the disease will be milder as his immune system will already recognise the virus. Today, some people get a severe form of the disease because their immune system is in contact with the virus for the first time. In some parts of the world (North East of France, for example) the disease is very mild as many people contracted the virus in March/April.
Would you be comfortable yourself trying the vaccine so early in the process?
Yes, because when the FDA or any other scientific body gives its greenlight, it must be absolutely safe. The greenlight is not given lightly. Yes, vaccines have always been a problem. Some people don’t like vaccines. This is human nature. You can’t do much about it. But if the Food and Drug Administration or another scientific body clears the vaccine, I will feel confident enough to use it myself. Of course the vaccine will improve with time but it will be safe as soon as it has been greenlighted. Never in the history of medicine have so many top scientists been working together on a vaccine. And nothing else will save the world from this pandemic. If people refuse to have the vaccine, then the epidemic will stay with us for a long time. Otherwise, the vaccine will act like an immediate herd immunity.
What about real herd immunity?
We are far from herd immunity. For herd immunity to be achieved, 60 to 70% of the population must contract the virus. Even the mil- lions you hear about in some parts of the world represent only 2 to 3% of the population. So forget about herd immunity. The vaccine is the only thing that will create the herd immunity.
You will appreciate that many people will have apprehensions and may not be as willing as you to take the jab… They are wrong. The only risk with the first generation vaccine is that you might not get the amount of antibodies required for immunity but it will definitely not kill you. What will kill you is the virus. Nothing is perfect or without risk. When you take an aspirin or a paracetamol tablet, you are ta- king a risk. We have to weigh that up against the benefits.
Let me ask you again: are you sure by the end of this month, people will get inoculated and start travelling again freely?
Yes! Or by the beginning of December. Other vaccines will be ready by the beginning of next year. It’s very important that there are so many different vaccines in different parts of the world to cover the whole population. We are talking of saving the world.
How about medication?
I am also happy that some medications – like Remdesivir – are working. Anti-coagulation, corticosteroids etc. are also working. These are used when the disease is quite advanced. Otherwise symptomatic medication is used. We have also learnt about the symptoms and how to interpret chest x-rays, ultrasound of the lungs, scanner etc. and we can also have a score of the severity of the case right from the beginning.
As things stand, there are many more cases as more people are being tested but far fewer deaths, aren’t there? The aggressiveness of the virus around the world seems to have gone down with time. Today, the fatality rate is around1% or less compared to 5 to 6% at the beginning. In the north of Italy, it was even more. Today, it is only a bit higher than the common flu. The problem is that when the R-factor increases, a lot of people get infected and a lot of people die even if the fatality rate is low. I was looking at the figures before you came. In China, where it all started, there are only 45,000 positive cases – or at least that’s what they say – with 4,000 death. Compare that to Europe!
How do you explain that?
For me, it’s very clear. Culture. In China, people wear masks, observe social distancing... And notice that there, life is practically back to normal as if the virus had never visited them.
Yes, the reaction to the virus has been very different from one country to the other. Here, we lock visitors up for 14 days. Doesn’t the virus declare itself in the first seven days?
Yes, most cases declare themselves in the first seven days.
By most, do you mean over 90%?
Now in Mauritius, quarantine means 14 full days locked up in a room. I am not asking you to commend or cri- ticise that. But as a doctor, do you think that is necessary or is it too cautious?
Fourteen days in quarantine is definitely severe and tough. Maybe a halfway approach with a seven-day quarantine and seven days of self-isolation can be practised now that we know the virus better and that we are well equipped to diagnose it. Also, people have to wear masks. Even home-made face masks have been scientifically proven to be very effective. When two people are wearing masks and on top of that they keep a social distance, the viral load is negligible.
So are we not putting caution too far?
We have to find a middle way. I also hope that there is new rapid and reliable tests. The PCR is too sensitive. When the R factor is very small, the PCR is positive.
Which brings me to my next question about the asymptomatic people who were sent to the ENT hospital and locked up there for more than 20 days. I know of a poor Indian national who has been there for 22 days so far and counting. Is that necessary?
(Laughs) I don’t have the answer.
As a doctor, would you rate the people I have described as dangerous for us?
I haven’t followed these patients…
Would you lock these people up for 20 days?
(Laughs) I hope it’s not 20 days. I don’t know the answer…