Understanding India's COVID Crisis

(English captions & Hindi subtitles available)

About the Speakers:

Gagandeep Kang is Professor of Microbiology, at the Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences at the Christian Medical College (CMC) in Vellore. She received her training in medicine and microbiology at the Christian Medical College, Vellore and post-doctoral training in the UK and US before returning to India to continue her work on enteric infections in children. She has worked on the development and use of vaccines for rotaviruses, cholera and typhoid, conducting large studies to define burden, test vaccines and measure their impact. She also studies the consequences of enteric infections and has shown that infections in early life impact future growth and cognitive development. Professor Kang has built a strong inter-disciplinary research program that uses careful and detailed field epidemiology with molecular tools for characterization of infectious agents and host response to infection to understand and change factors that affect transmission, development and prevention of enteric infections and their sequelae. She is a member of the several advisory committees for the WHO, mainly related to research and use of vaccines. She serves or has served on the scientific advisory or strategic committee of several national and international institutions, including the Wellcome Trust, UK, the DBT-Wellcome Trust India Alliance, the International Vaccine Institute and the International Centers for Genetic Engineering and Biotechnology. Professor Kang has published over 375 papers in international and national journals. She is the first woman working in India to be elected a Fellow of the Royal Society. She is also the first Indian woman to be elected to Fellowship of the American Academy of Microbiology and the only physician-scientist to receive the Infosys Award in Life Sciences.

Bhramar Mukherjee is John D. Kalbfleisch Collegiate Professor and Chair of Biostatistics; Professor of Epidemiology and Global Public Health, University of Michigan (UM) School of Public Health; She also serves as the Associate Director for Quantitative Data Sciences, The University of Michigan Rogel Cancer Center. Her research interests include statistical methods for analysis of electronic health records, studies of gene-environment interaction, Bayesian methods, shrinkage estimation, analysis of high dimensional exposure data. She has co-authored more than 270 articles in statistics, biostatistics, medicine and public health. She is the founding director of the University of Michigan’s summer institute on Big Data. Professor Bhramar is a fellow of the American Statistical Association and the American Association for the Advancement of Science.  She is the recipient of many awards for her scholarship, service and teaching at the University of Michigan and beyond: including the Gertrude Cox Award, from the Washington Statistical Society in 2016, the L. Adrienne Cupples Award, from Boston University in 2020 and most recently the Distinguished Woman Scholar Award, from Purdue University in 2021. Professor Bhramar and her team have been modeling the SARS-CoV-2 virus trajectory in India for the last year, which has been covered by major media outlets like Reuters, BBC, NPR, The New York Times, The Wall Street Journal, Der Spiegel, Australian National Radio, and The Times of India.

FULL TRANSCRIPT:

Tariq Thachil:

Hello and welcome to this special event on Understanding India's COVID Crisis hosted by CASI, the Center for the Advanced Study of India at the University of Pennsylvania. My name is Tariq Thachil, and I'm the director of CASI. And we're pleased to bring you this event in partnership with the Perelman School of Medicine Center for Global Health, Penn Nursing and the South Asia Center.

While it is wonderful to have so many of you join us, your reason for doing so is deeply regrettable. By now, India has crossed 23 million confirmed COVID-19 cases and 250,000 deaths. During this wave, India has also crossed a threshold of 400,000 daily new cases before recent declines and 4,000 daily deaths. Moreover, we know these official figures are dramatic under estimates. Various experts, including one of our panelists today, have estimated the actual number of cases to be between 10 and 20 times the official estimates. Only about 3% of Indians have received two doses of the vaccine, 10% have received a single dose. Just by contrast, it's about 35% of Americans who are fully vaccinated. And worryingly, the seven-day moving average of vaccines administered in India has dropped by roughly 30% since this day, one month ago.

These sobering aggregate statistics are made up of deeply personal tragedies that have affected and ensnared many of us who either live in India or have friends and family there. In my own hometown of New Delhi, harrowing stories of families failing to secure hospital beds for a sick relative circulated alongside desperate pleas from hospitals for oxygen to reduce preventable deaths, and images of mass cremations. Each time we open Twitter or WhatsApp or even answer the phone, we brace ourselves for the worst. And no one that I know has been spared loss of grief. This grief has often turned to anger by a policy response that many public health experts have criticized for its complacency, opacity, and often haphazard nature.

To help us make sense of these truly terrible times, we are exceptionally fortunate to be joined by two of the foremost experts on the subject. Professor Bhramar Mukherjee, who is the John D. Kalbfleisch collegiate professor and chair of biostatistics, and professor of epidemiology and global public health at the University of Michigan, School of Public Health. She also serves as the associate director for quantitative data sciences at the University of Michigan Rogel Cancer Center. Her research interests include statistical methods for analysis of electronic health records, studies of gene environment interaction, Bayesian methods and analysis of high-dimensional exposure data. She's the founding director of the University of Michigan's Summer Institute on big data, and a fellow of the American Statistical Association and the American Association for Advancement of Science. She is the recipient of many awards for her scholarship, service and teaching, including the Gertrude Cox award from the Washington Statistical Society, and the Distinguished Women Scholar award from Purdue University.

During this pandemic, Bhramar and her team have been modeling the virus trajectory in India for the last year, and the analysis has been covered by many major media outlets. I'm sure many of you have seen that.

Our second panelist is Professor Gagandeep Kang, who is professor of microbiology at the Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences at the Christian Medical College in Vellore. She is one of India's foremost vaccine scientists and has done pioneering work on the development and use of vaccines for rotaviruses, cholera and typhoid. She also studies the consequences of enteric infections and has established a strong training program for students and young faculty in Clinical Translational Medicine. She's a member of several advisory committees for national and international institutions, including the WHO, International Vaccine Institute and others. Professor Kang is the first woman working in India to be elected a Fellow of the Royal Society, and the first Indian woman to be elected to the fellowship of the American Academy of Microbiology, as well as the only physician scientist to receive the Infosys award in life sciences. Professors Kang and Mukherjee, thank you so much for joining us during what I know is an incredibly busy and possibly difficult time for both of you, and during a time when you are both understandably in very high demand.

For our panel today, our panelists will speak for the first half of our session together, and then we will open it up for q&a. Please enter any questions you have in the q&a box. We've already received a number of questions in advance from our audience, and we'll try to get to as many as we can. In the interest of time, and to allow us to get to as many as possible, please keep your questions short and to the point and refrain from entering comments which can be distracting. Please mute your mics for the duration of this talk.

Professor Kang, let's turn to you now. And we thought that we would ask you some of these questions that we had directly in a kind of q&a format. So let me begin by asking you to comment, from your perspective, on what Professor Mukherjee also commented on, as what do you see as the key differences between the manifestation of the first and second waves in terms of who is getting infected, how and how fast? What do you see as these differences?

Gagandeep Kang:

I think in the first wave, we saw a lot of infections. So the infection entered into the country with people importing the infection. So it was a class of society that travels overseas. But very rapidly, the infection went into places where people live in very crowded circumstances and essentially blew up there so much so that if you look at what was happening as a society, it was stigmatizing to have COVID. There were people who were locking themselves up, and this was particularly interestingly the relatively wealthy who had brought the infection into the country. They weren't badly affected during the first wave. They are being quite badly affected during the second wave.

And I think while the middle class and upper middle class were able to protect themselves reasonably well, particularly in cities and more remote parts of our country, essentially by the time the second wave came around, we had the problem of more infectious variant, as well as an unexposed population there. And what we've seen in private hospitals filling up much more than last time around, is different strata of society are getting affected. What I don't understand, and would love to hear from Professor Mukherjee about, is what we did that controlled the first wave. Because if I recall behaviors, yes, we locked down early. And then we lifted reasonably early and kept lifting and lifting and lifting and lifting, but we haven't completely lifted when the wave went away. So I don't think I understand why that happened. I do have explanations, which everybody does, on the behaviors of the population as well as completely unnecessary events where people could gather, that have driven the second wave.

So there are very distinct differences between the two. But one thing that I really still cannot get... Well, actually two things I really cannot get, one is why did the first wave die? And the second is, what happened in Delhi, given that Delhi had such a high zero positivity rate, not once but three times?

Tariq Thachil:

Those are good questions and perhaps we can pose them to Professor Mukherjee to open up our q&a once we're finished. So let me just pick up on one of the points you mentioned there. So obviously, one of the key points of interest around the second wave has been about virus mutations. And you have cautioned in prior interviews, that we have very little biological data to confirm how virus mutations in India are behaving. So two questions relating to that. A. What needs to be done to speed up such confirmation, given limited resources, and what evidence do we have on the new mutations? Their role in the current surge, their transmissibility, their responsiveness to existing tests and vaccines.

Gagandeep Kang:

We are, I think, better off than when I made those comments, because now we know a little bit more about the viruses and perhaps because the viruses traveled outside the country. It took us a long time to get our act together, because when the variants started to be described in the UK, a lot of us emphasized, again, what we had been saying for a while, which had unheard. The difference was that in December, the government started to hear the need for additional sequencing data. So they put together a group of 10 laboratories to do sequencing. And in principle, the goals are good. It's been a little difficult to operationalize, but I hope that it is a network that will continue. So hopefully, as they get all this ironed out, we will wind up with more real time sequence data. But in terms of the ability to study the biology of the virus and what it means in terms of people who have been previously infected or vaccinated, is much more of a challenge.

So far, we have one very small study from CCMB in Hyderabad, which has shown us that sera from people who have been previously infected or have received Covishield vaccine can neutralize B1617. There is a similar study from Bharat Biotech and the National Institute of Virology showing that they can neutralize the 117 as well as B1617. And there are data that have come out from Cambridge and from Emory more recently, showing us a few things. One, this virus is more transmissible if we follow the same process that we did for B117, which means that if you examine samples from people who have been infected, it does look like there is a lower CT value and therefore more virus in infected individuals. For B117, we also know that shedding lasts a little bit longer. We don't yet know that for B1617, because we haven't studied it.

So we have the information that potentially, it may be a virus that is easier to transmit because there is more virus. And we have the epidemiological data, which I hope someone is gathering sensitively, which is showing that transmission is very high within families, which would be useful confirmation that this is a much more transmissible agent.

In terms of neutralization, we hope the vaccines will work. We won't know it until we do vaccine effectiveness studies. Fortunately, the other things that you worry about with variants that diagnostic tests won't work, has not played out. We have no drugs, so it doesn't matter whether the variant is escaping drug action. But I can imagine that when and if India has monoclonal antibodies available, then that would be something that we would also want to study in addition to vaccination.

Tariq Thachil:

Okay, thank you. Let's turn to kind of the vaccination plan. And this touches on something that Professor Mukherjee was noting and wanting to ask you. So what is your assessment of the government's initial vaccination strategy? Were its targets suitably ambitious given resources? If not, how should domestic vaccine production and distribution have been ramped up in the past few months? And perhaps most importantly, what do you think should be done now, especially given this worrying trend of falling daily vaccinations?

Gagandeep Kang:

Sometimes I feel like an idiot, right? It happens to all of us and when things are unknown, it happens very frequently. So when the government announced its first plan for vaccination, it was to vaccinate 300 million individuals. They said that they were going to vaccinate all healthcare workers, essential workers, and everybody over 50. So I thought that was too limited a plan. And I went out there and I said, "Oh, this is too small. There needs to be more vaccination." You can't just stop with 300 million people, because that's what the government said they were going to do.

And then when we started the vaccination program, we started with health care workers for about 15 days, then we included other essential workers, which is a range of professions. And then we kind of blew past the 50, and I could accept that. We said we're going to do 60 and above. That's fine. It's a good starting point. But then we said in the next month, "Oh, we're going down to 45." And I didn't quite understand that, because the original plan had been, we would do 50 and above. That seemed reasonable. And then suddenly, we have this announcement that we're going to do 18 to 45 in the next month, when we have not even managed at that time. 7% of the population had received one dose of vaccine, and just over 1% had received two doses of vaccine. It just did not make sense to me to open up to a lower age group without having had a reasonable level of coverage in those who are the most vulnerable to severe disease and death.

Now, we are in a situation where 800 million people are eligible for vaccination. There isn't enough vaccine in the world to immunize them at this time. So I think what's happening is that a lot of time and effort is being wasted unnecessarily, because people are scrambling for vaccination shots. And obviously this because we have an app to do this, is people who can essentially be on a smartphone and keep refreshing so that they can get a booking. So that means that a lot of people who don't have that kind of access are going to be cut out of the immunization program. And if you're going to immunize 18 to 45 year olds, I completely agree that they need the vaccine. But the question is, do they need it now? And that decision-making process is not clear to me.

Tariq Thachil:

So maybe just following on this about vaccine supply, what are your thoughts on the current vaccine procurement policy? It's marked by differential pricing, there's been a lot of commentary on the fact that central and state governments as well as private providers are all buying and administering vaccines. What do you view as the optimal kind of procurement and pricing strategy rules for central, state and local governments within this?

Gagandeep Kang:

So I didn't answer Professor Mukherjee's question about the dropping vaccine coverage, and the answer is simple. There isn't vaccine. So there is a trickle of vaccine that is coming out. And when you're trying to do an adult immunization program across a country that does not have an adult immunization program, and you're doing it by priority groups and not by geographic distribution in a particular population, you are going to wind up with not having optimized logistics, and it's going to lead to low coverage. And that's essentially what is happening now.

The vaccination program is not that complicated. India runs a huge vaccination program. It is the biggest in the world. It is one of the most successful in the world. It works by central procurement. They can [inaudible 00:18:23] the lowest prices in the world. There is no question that central procurement makes sense. Free vaccination for the country makes sense. We just need to do it like that. Differential pricing is nuts. Sorry. But yeah, I think that's what we need. And if people want to go out and get vaccinated, import the Pfizers and the Modernas and the whatever else's you want that are not going to go into the national immunization program. You can pay top dollar for them? Go ahead and get them. That's the way the program has worked before. Chickenpox vaccine, you want it? You can get it in India. But the whole country doesn't get it.

Tariq Thachil:

Speaking from the US, many have been hailing the recent US decision to support the waiver of IP protections on COVID-19 vaccines as critical in enabling greater vaccine access, including in India. But some public health experts have cautioned that this step alone is unlikely to make much difference in vaccine supply for India. What's your view on this, and what else can the US or global community do to aid vaccine access in India?

Gagandeep Kang:

It's a great first step. But it's obviously not the end, because what you need is technology transfer. And the more complex, the newer the technology, the fewer people there are in the world that can help you do that tech transfer. So where are those people, because we need them. We need all the supplies to make the vaccines, as well as the IP. Without all three components, it's not going to make a major difference to supply.

Tariq Thachil:

Let me just end with a kind of question that hints at something that Professor Mukherjee was talking about as well. But do you think it is likely that we will see a third national wave in India? You've already spoken about the fact that we've had third waves at a local or regional level. Do you think it's likely we're going to see a third national wave? And if so, what are the most critical steps we already need to be taking to deal with that possibility? And do you see any evidence of such planning.

Gagandeep Kang:

Again, I'd love to hear Professor Mukherjee's thoughts on this. But my thinking is that we are going to... Just the fact that this virus has come and gone without reasonable explanations, we see this with other respiratory viruses as well. So there must be environmental drivers, in addition to everything else that influences the circulation of this virus. So then that tells me that we're going have third, fourth, fifth, sixth waves for a long time to come. They will, I think, almost definitely be smaller in amplitude, unless we wind up with a variant that is very, very different. Again, with variants, I think I'm a little bit more optimistic than most people are, because I think most variants will adapt to being more transmissible and less virulent. So if that happens, then we will wind up with a second additional flu-like illness in the unvaccinated. And I think actually vaccines are working so well against SARS-CoV-2, that we may not need annual vaccination for this virus.

Tariq Thachil:

So before we open it up for q&a, Professor Mukherjee, I thought maybe if you'd like to respond to the question that Professor Kang asked you both on the third wave, but also what we did to control the first wave. Why did it die, et cetera. Thanks.

Bhramar Mukherjee:

Yeah. Thank you Professor Kang for that discussion. I really learned a lot. Thank you for your insight. So I think that one virtue of science and scientists, is that to say that I don't know. Right? So I think the first wave, my thinking is that definitely the national lockdown helped to certain extent to flatten the curve. And even if not with transmission, I do feel that in terms of scaling up healthcare infrastructure, in terms of isolation center, COVID care, testing, that time really helped us. But again, I think that human behavior was also quite different. People took it much more seriously. You mentioned this fresh population. So in my work, I have called them pristine prey for the virus. People like my family who are taking the utmost caution and washing their hands 10 times when they are indoors, not seeing anybody, did not even wear masks when they are going to weddings in January.

So I think that there was definitely this change in process, as well as, I think, the evolution of the virus as well. These are all contributed. So I think that this pandemic has taught us that everything is possibly a confluence of factors. It's very hard to do a causal pinpointing that this contributed this much, because everything is so coupled together.

About the other question about the third wave, I honestly want to do a very good job with the second wave and build up infrastructure for anyth wave. Because even if that does not come, this investment does not hurt you. Because if it comes, this is such a crushing consequence. If you do unexpected loss calculation, you will err on the side of caution and really not stop your oxygen manufacturing processes or medical supply or vaccination. And vaccines are so important. So I think that I would prepare as if the anyth wave is staring at us.

Tariq Thachil:

Thanks. I'll hand it over now to our postdoc Naveen Bharathi, who is going to run the open q&a. So Naveen, do you want to just pose some of the questions we've been getting from the audience?

Naveen Bharathi:

Yeah. Thanks Professor Mukherjee and Professor Kang. We have a lot of questions. I'm trying to summarize few questions together, so that it makes more sense. So the most of the questions are on lockdown. So there seems to be a difference of opinion among experts about whether lockdown is useful or not. One approach is, lockdown will help protect lives, but other approach is, lockdown would destroy livelihoods and [inaudible 00:25:15]. So what do you think of this? This is a question for both of you. Now that many states have opted for lockdown, what should be the duration of lockdown? Should there be a particular geographic scale of lockdowns, or how early in the virus transmission do you want to see a lockdown? Is there a threshold on lockdown? So these few questions are mostly on lockdown. So this is a question for both of you. So what do you think would be a proper mechanism to implement a lockdown if at all we need a lockdown? Thank you.

Gagandeep Kang:

So who do you want to go first, Naveen?

Naveen Bharathi:

Professor Kang, you can go first and then Professor Mukherjee.

Gagandeep Kang:

I'll leave her to do the quantitative bit, and I'll do the social bit. So I think the one thing we learned about lockdowns, is that doing them at four hours' notice does nobody any good. So if we must lock down, then preparation is key. Give people a couple of days to get their act together, to figure out what needs to happen, especially for essential services. How do you lockdown a hospital or the services that our hospital needs just for people to figure out what is going to be required can be very, very challenging. So, in fact, I'm in lockdown at the moment. I'm still going to work, and it's very organized and reasonable. But it's because we had the weekend to prepare. And that did not happen last year. How long should these last? I think this is something for Professor Mukherjee to tell us.

And the other question is the stringency of lockdowns. Because I think in India, the kinds of activities that lead to crowding, that lead to contact, are very different from what people see in other places. So doing a micro-level assessment to figure out what those more dangerous activities in a way are, is very, very helpful. I think lockdowns require detailed local planning and preparation.

Naveen Bharathi:

Professor Mukherjee, do you want to answer?

Bhramar Mukherjee:

Yeah. I think that last year, we did not know enough. There were not enough studies about the virus and how it transmits and spreads. So we had to go into a hammer, in order to really that massive national lockdown. And again, I completely agree, implementation is key here. But right now, I think that we know much more about risky behavior activities. There have been papers in JAMA and nature ranking the various different common activities in terms of how much risk that confers. So our approach right now could be much more nuanced and targeted. And one thing is about acting early. Right? If we avoid large gatherings, indoor restaurants, indoor dining, gyms, which are high-risk activities earlier on... And again, mask mandate, use of masks, and avoiding large gatherings. If we did this in March, and if we have adherence to sustained measures, then we can avoid such stringent measures. Delhi and Maharashtra went to a point then there were no choices left. Not many choices left.

But even with a lockdown, and my friends tell me that it is much more useful to call them shelter in at home orders, are where things could be much more nuanced and done in a much more humane way, avoiding particularly indoor large gatherings and restricting the number of people that can get together. I think that one important thing is also, Dr. Khan mentioned, this cluster infections are household infections. It seems like in wave two, it has been the contribution of household infections to the total number of infections has been higher. So I think that even if you put these orders together, families are going to get sick. And so you have to make sure that you have plans to address that.

So no country can hide behind the curtains of lockdown or shelter in place orders in perpetuity. But I think that's where you have to intensify and intervene early enough, so that it does not get to a point where you have more choices. That would be my recommendation.

Naveen Bharathi:

Yeah. Thanks, Professor Mukherjee. And we have few questions on herd immunity. Do you think India can achieve herd immunity anytime in the future? You are in the US for that massive high vaccination rate, you experts believe that herd immunity is not attainable in the foreseeable future or even ever. So do you think that India will any day attain herd immunity? Or even few reasons and have some sort of a herd immunity with the number of infections are lower, still containable, still treatable, still the entire sector can bear the impact. So this is a question for both of you again. Do you see any evidence of herd immunity anywhere? Our do you think India can be on the mutants and various other things? Do you think herd immunity is indeed a possibility in India or should we just take this as kind of ongoing struggle for many, many years to come? Thank you.

Gagandeep Kang:

I think from a vaccine performance point of view, I think herd immunity might be possible. Obviously, a lot will depend on how much the variants change. But the fact that the Pfizer and Moderner... Well, the Pfizer vaccine is working very well against all the variants it's encountered, gave me hope that potentially we might be able to get to herd immunity if we have vaccines that perform that well. Obviously, it will require a level of coverage that is very challenging to achieve in an adult population. I think it's theoretically possible. Practically, we'll have to wait and see.

Naveen Bharathi:

Professor Mukherjee, do you want to...

Bhramar Mukherjee:

Yeah. I just want to add that I was never a believer in natural infection induced herd immunity. When the sera surveys were coming out and it was showing that Pune, Mumbai, Delhi have more than one out of two people with antibodies and people thought that we do not really... We have reached that, so we can see that that was a mistake. Right? And we can question the validity of the sera surveys, we can talk about waning immunity, and as well as reinfection processes, but definitely vaccination. And we'll need to study vaccine effectiveness in a rigorous manner, and also vaccine variant interface to learn more. And from various literature I have read, for the foreseeable future even with high degree of vaccination, there could be outbreaks. So we definitely need a surveillance system with sequencing, which can give us that information from breakthrough infections, from reinfections, that what is going on? So I will be on high alert and not rely on this concept of herd immunity right now, because it may be elusive.

Naveen Bharathi:

Thanks, Professor Mukherjee. This is a question for Professor Kang. So do you think that now that we know that the enormity of number of cases with a lot of modeling and other statistics, do you think that... Do we have the enough infrastructure to really deal with this, even kind of number of beds, oxygen? Now that you are on the panel of Supreme Court on oxygen procurement and distribution, so do you think that we have enough infrastructure? Can we ramp up infrastructure at all? Can we at least stop losing lives because of lack of infrastructure like oxygen, beds, intensive care units? Can we expect in the next few months at least that infrastructure will be in place or is that also elusive according to you?

Gagandeep Kang:

Well, I can guarantee that the infrastructure will not be in place. We have years of chronic underfunding our of health system. You cannot protect your population against such a highly transmissible disease. Even though it has a low case fatality rate, it has a low percentage of people who go on to severe disease. But you cannot ramp up infrastructure to provide quality care to all of your people with the situation that we are seeing now. This requires a rethink of how we function.

We've had a situation where we have let the poor get by for schools and for hospitals with something that we ourselves, people who speak English as a classifier, would never use. We don't go to government schools, we don't go to government hospitals, unless it seems. So that's where the bulk of our population goes. Do you think overnight or six months or in a year we can change 70 years of under investment? Not going to happen. I'd like to see a change, but I'd love to see a change. That's why I've been where I've been for all my career. But it's not going to change in a year. And that's sad. Between wave one and wave two, the little infrastructure that we set up, even that started to be withdrawn. And we have to remember that if we look at our budget, other than paying for vaccines, nothing has changed.

Naveen Bharathi:

Yeah. So Professor Kang, given this, what can we do? People who are outside India or even within India, the so called entitled English speaking, have been very less impacted by the larger disastrous pandemic which is happening there. How can we help? So that's a question a lot of people have been asking, because we feel so helpless at times, where we just see it, we can't do anything. So what can be done from our side, from people abroad, people in India? So what should we do?

Gagandeep Kang:

Well, I've gotten to the stage where I'm saying, "Send funding." Send funding to small hospitals in rural areas, to NGOs that you know. Wherever you can get your family to support a group of people, volunteers that are trying to do good, do that. Because right now, that is what is required. Otherwise, I was asking people, if you can get a concentrator, send that. If you're well off, then send us an oxygen generating plant, because everybody needs one. But it's a very difficult time to do anything quickly.

There are doctors that are helping with teaching materials, with being available for telemedicine consults, but even that is hard. Because the medicine you practice in the US is not the medicine that you practice in India. The drugs are different, treatment facilities are different. So it's a difficult time for all of us. But the one thing that I've been impressed with is the commitment that everybody has to help. There's nobody who hasn't been touched by this, and everybody is doing the best they can. Professor Mukherjee had no need to sit and model the pandemic in India, and yet her group has produced what is the most widely used resource for data in the country. It's been a to for everybody that is looking for data. So everybody is doing something. And I know we all feel terrible at this time. So right now, do whatever you can to help out whomever you know. And in the long term, I think we need to think about what we want our society to be. Are we willing to go back to what we had before?

Naveen Bharathi:

Thanks, Professor Kang. Professor Mukherjee, do you want to answer this?

Bhramar Mukherjee:

No. I know Professor Kang has summarized this beautifully. I just think that this is somewhere in the process. I think this pandemic has changed all of us as academics, and I became almost an activist, going to different talk shows and media outlets arching for global collaboration, writing narratives and opinion pieces. I like math, I like equations, and I became a different person. So this process is touching every human being and changing. So I hope it touches the system, because we make the system. So it cannot be all of us are changing and embracing this trauma, internalizing this trauma, and thinking differently. And the system does not change. So I would really like to leave with that contradiction that we are facing and I'm with the hope that if all of us change, the system has to change.

Naveen Bharathi:

Thanks Professor Kang and thanks Professor Mukherjee. I have a lot of questions, but given the paucity of time, we can't take every one of them. Thanks for your time. And I [inaudible 00:40:08] to Tariq to end the session.

Tariq Thachil:

Thank you both. We know your time is valuable, so we don't want to keep you over. Thank you both for spending this time with us and with our audience. I know everybody appreciates it. And it's a time where I think many of us, as Naveen said, feel a lack of hope. But having people like both of you working on and caring about India and from the different perspectives that you do, is one small glimmer of hope at what's been a very dark time for all of us. So thank you for taking the time to help us, to educate us, to teach us about making sense of what is felt like a very sensitive time.

And so, thanks everyone for joining us. Thanks again, Professor Kang and Professor Mukherjee, and thanks to everyone who supported this event. Thanks. Take care and our best wishes to you and your families and friends. And hopefully, we will get through this soon. Thank you.

Bhramar Mukherjee:

Thanks to Tariq, thanks Naveen, thanks to CASI for putting this event together.