COVID-19 has highlighted resilience of Indian public health ecosystem Prof Sanjay Zodpey By Kartik Lokhande : WHEN one speaks to a scientist of the eminence of Prof Sanjay Zodpey obviously one seeks to get explanation to technical terms for the benefit of general public. In the prevailing situation several scientific terms viz. R value secondary attack rate (SAR) protocols are being discussed widely with specific reference to COVID-19. Prof Sanjay Zodpey Vice-President Public Health Foundation of India (PHFI) New Delhi and also Director at Indian Institute of Public Health Delhi responded to the questions posed by The Hitavada in this regard and also shed light on what he called resilience of Indian public health ecosystem. Here are excerpts: Q. Of late R Value is being considered to get a picture of transmission of COVID-19 infection. Can you please elaborate on what is R Value and how is it interpreted? A. R0 is the basic reproduction number of a disease and indicates the average number of people an infectious person can directly infect in a population. It is a fundamental determinant of the dynamics of infection at the population level. An epidemic can only occur if the reproduction number R is greater than one. Hence it is useful to measure it as it provides important information about the potential for disease transmission and the impact of disease control measures taken. It depends upon three core parameters -- contacts per unit time (between infected and susceptible individual) probability of successful contact (whether the transmission has occurred) and duration of infectiousness. As you can see population mixing drives the disease transmission whereas physical distancing avoiding closed spaces and crowded places use of masks and early testing and treatment prevents the disease spread. Q. What is the R Value for Nagpur city as well as Nagpur rural and how does it compare with the value for Maharashtra and India? A. The R number is dynamic in nature and keeps on changing. It increases with increase in disease transmission because of population mixing and vice versa which is reflected in detection of new COVID-19 positive cases which you know is dependent on both individuals willingness to get tested when he/she develops symptoms as well as on test sensitivity/specificity and testing capacity. All disease prevention and control measures are directed to prevent the new cases to keep R number below 1. Hence I think our focus should be more on generating awareness about the disease among the citizens and proper implementation of measures to prevent disease transmission such as using masks avoiding closed spaces and crowded places physical distancing maintaining proper ventilation in places of work and early testing and isolation of cases and quarantine of contacts rather than on R number. Q. Is R Value the most effective means of gauging transmission rate? If there are other methods too please shed light on them in brief. A. R number is one of the measures to estimate disease transmission and is very comprehensive measure but requires assumptions of random/homogenous population mixing and average transmissibility (no super spreaders events). Another method to measure disease transmission is secondary attack rate (SAR) which is defined as the proportion of susceptible individuals who have had contact with the primary case and go on to develop the disease as a consequence of this contact. But this is rarely used outside the research purposes because of several assumptions (such as all persons should be equally susceptible; and all cases should be symptomatic) and consequently have limitations. Q. What do you think is the most significant impact of COVID-19 on research and surveillance in public health in India? A. One of the most important dimensions that COVID-19 has really brought into the focus is resilience of Indian public health ecosystem. We have seen timely execution of several collaborative research projects on COVID-19 especially around development of diagnostics and their large scale implementation across the country which is clearly reflected in testing capacities. In addition the whole work around pan India and state and district specific sero-surveillance studies which are providing critical information on trend and pattern of disease transmission to guide disease prevention and control measures. Additionally we have also conducted some critical clinical trials to guide decision around treatment protocols. Also you are aware about the vaccine development efforts that are currently happening in the country. Overall our research and public health ecosystem has fared well under these unprecedented circumstances. Q. The protocols set in the initial stages have evolved over the months. In your opinion how can these protocols be improved further?

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