Dr. Nikhil Tandon, is Professor in the Department of Endocrinology and Metabolism at the All India Institute of Medical Sciences, and Head of Capacity Building at the Centre for Chronic Disease Control in New Delhi.
His research interests include autoimmune thyroid disease which includes thyroid epidemiology, diabetes and metabolic bone disease, and the impact of early life events in adult chronic disease.
In an interview to Swimmi Shrivastava, Dr Tandon talks about precautions everyone, especially people with diabetes and other comorbidities, should take to avoid a surge in the Covid-19 cases during the upcoming festival season.
Q. Recently, the COVID cases in Kerala increased considerably. There is a concern that the upcoming festival season may lead to a spike the Coronavirus cases countrywide. What is your take?
A. Earlier this year also, we had a devastating second wave. It perhaps was a consequence of a variant, which was more contagious, more infective, more transmissible, and more likely to impact immunity.
This second wave had a higher mortality rate, and put a huge pressure on the health system. And when it spread, it also affected people in regions where there was no obvious reason for its an increase in the number of cases. So, even in the absence of any obvious reason for spread, we have to be watchful of subsequent waves, because viral infections such as COVID-19 often have multiple peaks and waves which may be of different severity, may be of different intensity, may be of different durations.
We cannot assume that there will not be another wave even under routine circumstances. Look at countries like Australia or New Zealand, which were quite particular about who will enter the country and who won’t, and had stringent measures in place to prevent congregations. But despite that, there have been waves out there.
So, the first important message is that waves can happen till at least a substantial proportion of our population has been suitably made immune.
Second, anything which increases the likelihood of transmissibility, will increase the chances of a surge of infections. Given that this is an airborne infection, crowding will increase the likelihood of its transmission. So, why should we indulge in any activity where an environment conducive to spread is created?
Q. Festivals in India are often associated with feast. What advice would you like to give to diabetics, who are more prone to developing a severe disease?
A. Though we don’t know if a person with diabetes has a higher chance of getting infected, certainly if a person with diabetes gets COVID-19, he/she has a much higher chance of poorer outcomes. Even within a group of people with diabetes, those with poor blood glucose control (people with an elevated HbA1c) have worse outcomes.
Further, people with diabetes or other comorbidities or vascular complications of diabetes also have poorer outcomes than those with with good metabolic control.
It is important to emphasise that nearly 50 per cent of people with diabetes may be unaware of their condition. Out of 50 per cent who are aware, only half seek medical attention, and further half of these, which is 12-15 percent of all people with diabetes, keep their blood sugar levels under control.
So, we need to have strategies for all three scenarios. First, people should periodically get themselves screened for diabetes, so that we can make an early diagnosis and initiate prompt treatment.
Second, if you know you have diabetes, it is critical that you do everything within your power to control your sugar levels as near normal as possible. So, consult your doctor, and adjust your medicines, if needed, and comply with dietary advice and regular physical activity.
No extra eating, particularly sweets,is advisable especially in view of the current pandemic. We all like to meet and celebrate festivals with friends; we all like to enjoy the food items which are associated with these events, but in the current circumstances, it would be negligence on the part of individuals with diabetes to succumb to the temptation of doing so.
Q. It has already been 18 months, there is a sort of COVID-fatigue settling in among the people. Can the country afford complacency at this juncture?
A. What you have raised is a fair and valid point. Human beings are born social, they like to go out and meet people. But haven’t we changed or adapted new ways of interacting with people? For example, instead of meeting a doctor physically, we have exercised the option of using telemedicine and other digital platforms.
Similarly, students have transitioned from attending classes in-person, to online education. So, thanks to technology, there are alternative ways of social interaction. I agree that it may not be as satisfying as sitting and chatting with friends, but at least it is an option which should be considered.
I strongly feel that one should exercise these alternatives as much as possible. But if you feel compelled to go out and meet people, I suggest that the events have to still be limited in number, because, if there are fewer people, the chances of somebody carrying an infection reduces. And also if there is one person who’s infected the likelihood of transmitting infection to a large number also reduces. Second, if possible, meeting outdoors, where the risk of transmission reduces, is more advisable. Not forsaking masks at any point in that interaction is also strongly advisable.
And if there is a feast, then disperse as much as possible while eating, so that for the time the mask is down, adequate distance is maintained. Remember, while there’s been an exceptional ongoing campaign for immunisation, a significant proportion of our population is yet to receive both vaccines.
Also,we must understand that the vaccines don’t give 100 per cent protection and there is still the risk of catching the infection.