Life is, definitely, an adventure with its fair share of ups and downs. What makes us understand and appreciate our own lives better, is looking into a fellow human being’s life experience with its numerous turns, roundabouts and hairpin bends that make every morning worth waking up to. Let’s take a quick peek at a Day in the Life of Dr Anoop Sinha, MD – Registrar Microbiologist in Brisbane, Australia – and find out what makes his day an unexpected blend of unbelievable moments.
In the world of science and the greater good of mankind, what is the role of a Microbiologist?
As a microbiologist, we are involved in the diagnosis of infectious diseases that are caused by bacteria, viruses, fungi, parasites and so on. We are also involved in determining the antibiotic susceptibility of bacterial pathogens that we isolate so that patients may be given the right antibiotic.
How would a typical day be for you here?
In India, I was mostly into medical academics. However, here in Australia I am a registrar working under supervision until I get a full medical registration for my specialty. On a typical day, I start my day by taking a look at the positive blood cultures of patients and then call up the doctors who are treating these patients. I make a note of the health complaints of each patient as well as the antibiotics they are on at that point of time. Wherever appropriate, I do offer advice if the antibiotics patients are on should be discontinued or not.
So, what was it that triggered your interest in Microbiology? Why did you choose Microbiology or did the subject choose you?
When I chose Microbiology, I was the only male in my batch simply because around twenty years ago it was very rare for young men to join this stream of science.
Clinical microbiology is a subsection of pathology. I always enjoyed both microbiology and pathology. So, while I was doing my MBBS, I chose pathology as my first option and microbiology as a distant second. As far as MBBS students are concerned, microbiology is just a list of bugs that we memorise and spew up on the answer sheet.
Since there were no seats available in pathology initially, I joined the microbiology batch and started my training for six months. That was when I fell in love with a subject that was only my second choice. Later I decided not to choose pathology but continue to be madly in love with microbiology. As a microbiologist, I love the fact that we have a chance to cure a person of disease caused by bacteria.
Our current COVID situation has been very challenging and scary on a global scale. During your career, have you come face to face with a similar infectious disease?
Never seen anything like this before. The closest thing is the great flu pandemic of 1918-1919 or the cholera or even the plague pandemics. Something like COVID in the modern era is pretty much unprecedented. But of course, it is not something that we humans cannot tackle.
Tackling the COVID pandemic is difficult.
When we talk about infectious diseases, there are those that spread very quickly but are mostly harmless such as the common cold. At the other end, you have diseases that are slightly more dangerous, such as the flu, which is controllable under normal circumstances unless there is a new strain like the Spanish flu or Bird flu. Then again, the mortality rate of a seasonal flu is less than 0.1 per cent and we can easily come up with vaccines as well as anti-viral drugs. At the extreme end, we have the Ebola but the challenge is less since it does not spread like the Corona. There are no mild or asymptomatic cases to spread the disease.
Coming over to the Covid-19 pandemic, the challenge is specifically the SARS COVI-2 virus that spreads almost as rapidly as flu. There is also a very high incidence of asymptotic or mild cases which can potentially spread the disease in the community without anyone even realizing it. And to top it all, you have a mortality rate of 10 to 20 times more than what you would expect from seasonal flu. This is what makes the Covid-19 a dangerous pandemic that is difficult, but not impossible, to control. Just when you think you have it under control, there emerges a second outbreak like the one we are currently witnessing in Victoria, Australia.
We are in the middle of this pandemic with everyone trying to find an effective vaccine. What is the way out?
There are three ways out of this pandemic, of which one or two may be practical. Obviously, getting hold of a vaccine that works, is the most practical way out. Once everyone gets vaccinated, the Corona becomes less worrisome than a slightly dangerous version of the flu. The second way out is a strict global lockdown which may not be practical in many parts of the world. We may put a global lockdown into effect for a short period but in the longer run, I do not think it is practical due to the resulting socio- economic impact. Finally, comes the worst-case scenario. Assuming we do not find a proper vaccine soon, every single person on the planet would become infected and while some might succumb to the virus, others would develop a natural immunity to it. The death rate would be very high but whoever survives develops immunity. Anyway, we certainly will not be wiped off from the face of the earth. If we look at the statistics in a very cold-hearted manner, the mortality rate is only 2%, which means 98% of the global population who contract the Corona are going to survive. But then, 2% of a global population is still a mind-boggling number.
Around 150 countries are now trying to get the Corona Virus vaccine into the market. Do you think it is too soon?
It is risky to use a new vaccine without having proper trials. A properly tested vaccine is safe but if we cut corners in vaccine research you are bound to have problems. I shall share an example here. A few years ago, there was a vaccine against dengue called the Dengue Vaccine. Initial studies were really promising. But long-term studies proved that if people with no previous history of dengue were being vaccinated, they would end up with a severe form of the disease in case they become infected at a later stage. In fact, I would say India is going in the right direction by doing Phase III trials so you know what to expect and a basic safety has been established.
Is there any difference in vaccines being developed in India or Russia and other parts of the world? Some countries advise that we get vaccinated twice while others say once is enough.
This just reflects the protocols each nation uses for testing the vaccine. Single dose vaccines are usually live-attenuated vaccine that use a weakened (or attenuated) form of the germ that cause the disease. For most live-attenuated vaccines, we use two doses and smaller doses. I shall give you an example here. For the MMR (measles, mumps and rubella) vaccine, we usually use two doses. On the other hand, we administer five or six doses to a child for the DPT (diphtheria, pertussis and tetanus) vaccine which is a killed or inactivated vaccine. In the case of Corona Virus vaccine, it is possible that the first dose might give only 75% of protection and an additional second dose is required to boost it to 95%, speaking arbitrarily, of course. All this depends on what we find out during the vaccine trials.
In your opinion, which country is taking the best and worst approach in terms of the Covid pandemic?
I have no idea about the worst approach.
However, I would say one of the best approaches has been taken by the New Zealand government. They did have a second outbreak but they had it controlled remarkably well.
Of course, I can proudly say our Kerala government has been pretty effective in dealing with the Covid-19 situation. During the second wave, things did get out of hand especially since a lot of people were returning to their home country. New Zealand has the advantage of a smaller population as well as the fact that it is an island, making it easier to implement regulations. However, Kerala is no island and there are plenty of people crossing the borders, making extremely difficult to regulate or control. In spite of everything, Kerala’s approach to containing the pandemic has been commendable.
What do you consider as your major achievement?
Well, my biggest achievement was when one of my MMBS students decided to take up Microbiology simply because my classes inspired an interest in her for the subject. Being able to be a role model for someone is a great honor and achievement for me.
On the career front, my tenure at Aster DM Health care Centre in Qatar has been a very fruitful period. I was asked to set up a new microbiology lab and get it accredited by QCHP Qatar Council for Health care Practitioners.
I was also given the opportunity to implement an infection control program and formulate the antibiotic stewardship program for the hospital.
For this initiative, Aster DM had given an award for medical excellence, which I feel is another of my cherished achievements.
What is the role of a microbiologist in patient care?
In general, microbiologists help diagnose the infectious disease and decide on the treatment based on the diagnosis. With respect to bacterial diseases, we also look at the antibiotic susceptibility. We observe whether the bacterium affecting a specific patient is resistant to any drugs and it is after this observation, we provide appropriate advice on the right drug to be administered. In short, we play a great role in the diagnosis as well as choosing the right antibiotic for treatment.
After this Covid-19 episode, do you think our lives will be back to normal?
Well, certain things are definitely not going to change. Now that we have become aware of the potential of what a pandemic can do, the present generation who have come face to face with a pandemic for the first time in their lives will certainly be cautious of a lot of things. It will be a second nature for us to follow hand hygiene and cover our noses while we sneeze.
Are there any new initiatives you foresee in terms of innovations in microbiology?
A game changer that I have seen in the last few years is a device called MALDI-TOF (Matrix-assisted laser desorption/ionization) that is routinely being used in many laboratories around the world to identify microorganisms for medical diagnosis.
Around ten years ago we used to do biochemical tests to identify microorganisms which was time-consuming and more approximate than accurate. With the arrival of the MALDI-TOF, we can identify a bacterium with greater accuracy in less than 30 seconds or less.
What I hope to see in the future is a device that can identify bacterial, viral or infectious diseases by detecting the genetic material and also identify markers for antibiotic resistance as well as bacteria. It is just my wish and I hope we get to use such a device in the future.
We often hear about individuals who are Corona positive yet asymptomatic. Why is that so? Are these individuals resilient or have acquired immunity on the go?
Compared to other viruses we know of, the Corona is not a very virulent one, which is why you don’t always get to see symptoms like you do in the case of a Chicken Pox or Measles attack. In most cases, the symptoms of a Corona virus infection are mild and asymptomatic. It just a pattern of the organism.
The constitution of an individual also plays a great role here. You may have noticed that serious infection and higher death rate is more common in people who are diabetic, elderly and/or have underlying conditions such as respiratory and cardiac diseases. Asymptomatic cases tend to be among the younger population who do not have any underlying medical history.
You do have interesting interests in photography and music though you are madly in love with microbiology. Who instilled that interest in you?
My Dad taught me photography when I was a kid. He bought me my first SLR when I was in medical college doing my MBBS. For the past 25 years, I have been experimenting with cameras and photographing everything around me. I also play the guitar, thanks to an unplanned move in college to be part of a musical band.