Book on Covid We thought it was important to explain firsthand how we all sort

of got together, pulled our socks up, and fought our way through the pandemic,”
Guleria told The Indian Express. The book focuses on three principal issues
regardingthestill evolvingpandemic:whyCovid-19 isnot just another respiratory
disease; the public health response and stories from the frontlines; and the future
roadmap for the public, policymakers and physiciansgiven thelongroadaheadto
vaccines. The book also deals with the after-effects of the infection, termed
Long Covid, which could bethenext crisis inthepandemic. “When we started,
our main aim was to ensure caseswerelow and toprevent deaths. Nowwehavea
situation where we are realising that unlikeinthecaseof a viralinfection, in a
large number of peoplewhohaverecovered,Covid-19 does leadtosomedegreeof
residual post-Covid sequela. In many this is very mild and they recover within a
few weeks but in some, this can cause significant damage toorgans like
thelungsandheart, necessitating long-term rehabilitation and increased care. We
need to move into the next phase ofbeingabletoprovidelong-term care,” Guleria
said. He said they also dealt with challengesonthe vaccine front in the book.
“There isalot of hope that we will have vaccines early next year. However, a lot
of changes will happen as we go along.Wehavemany vaccinecandidates and the
first one may not be the best and we may have more
immunogenicandsafervaccines subsequently... Therefore... how do we decide if
we will have one vaccine or multiple vaccines or will different groups receive
differentvaccination, andhow do we distribute them to the entire population.
These issues are addressed to some extent." On when the country will hit
thepeak, the authors saythey expect multiple peaks. “However, it cannot be said
how many and when...Whether thosewere peak or not and how many peaks
happened,thatcanbeanswered(only at) theend of thepandemic.”They also state
that it's not necessary that the places where cases and deaths have gonedownare
those which have already reached the peak. Onpre-symptomaticpatients, the
book raises a red flag, saying evidencefromIndiasuggests they can be as
infectious. “Asmallproportion, maybe around one in every 10 cases, would be
presymptomaticor (havea)milddisease. The key point is people can infectothers
(when)pre-symptomatic, when they themselves do not show anysignof disease.
This wouldbearoundtwo days before the first sign of disease appears... There is
also evidence thatarecovered person canshed thevirus from the upper respiratory
tract for up to three months after the illness.” On re-infection, the authors say,
“Till now it is being inferred that even if a person is infected a second time, he
or she is unlikely todevelopseriousdiseasein(the) second infection." The book
says that in such cases they had seen that the immune system responded
quickly,andthis showed it won't affect vaccine development and efficacy. On
why men and people with co-morbiditiesare atahigher risk, theexperts state,
“Thereasonsare not fullyunderstood...Researchers have found that in Covid-19,
the immune response of men is mostly through cytokines and chemokine. In
women, the immune response against Covid-19 is considered to be driven by
Tcells... The T-cell dependent response is more balanced and
nuanced."Oncomorbidities too,the book talks about T-cells, saying that in many
patients with such conditions, these are not fully functional. "The people with
comorbidities also produceaspecific typeof protein,which acts as a brake on the
immune system and makes them prone to severe diseases,” the experts state.