The COVID-19 epidemic has struck the world like a thunderbolt. Though there is widespread fear, it is a challenge we can and will soon overcome.
The Enemy
COVID-19 virus spreads very fast. In the De Gaulle aircraft carrier, within 4 weeks of COVID-19 coming on board, nearly everyone had been exposed. In crowded localities like old city areas, and urban slums, COVID-19 mostly reaches everybody before they begin self protection.
The big unanswered question is what happens if 100 people are exposed to COVID-19. It seems about half do not allow it to get a foothold. When it knocks to come in, the body blocks its entry. Of the other 50, most will remain perfectly well throughout the course of the infection, though the virus is multiplying inside and being passed on to others. After a few weeks, these ‘asymptomatic carriers’ get rid of COVID-19 and become immune. The rest will have mild or moderate symptoms before recovering. The problem is the last 0.5%. They become severely sick and their lungs start to get damaged. They may have loose motions, internal bleeding, strokes, heart trouble, and myriad other problems. About 1 in 1000 cases may be fatal.
Children and healthy young adults can expect to sail through with barely a sneeze. Those who are very old, or have damaged lungs, weak hearts, failed kidneys, immune systems compromised by cancer or chemotherapy are the ones who are most likely to be unlucky; but even among them, a small minority will succumb.
How Indians will fare with COVID-19 remains to be seen. We should know by May. As we are measurably less healthy than people in developed countries, we can expect to be at higher risk than them. However the total deaths will be fewer, because we are a country full of children and young adults who can take COVID-19 into their stride. There are relatively few Indians who are 80+ or undergoing dialysis.
Our Weapons
Our immune system is our only real weapon. Remote islands can arm themselves with an additional weapon, viz. barricade the island completely before the virus enters and continue the barricade till a vaccine becomes available, or till COVID-19 has been eradicated from the rest of the world. India will have to rely on our population’s immune system.
The immune system has 2 components. Innate immunity is present in our skin, mouth, throat, and other surfaces. It is an ever ready, forever on-duty entrance security guard. It successfully blocks out COVID-19 in about 50% of people. Unfortunately, in those who are heavily exposed, like front line health workers, it may get overwhelmed. Our second line of defence is adaptive immunity. Once the virus is inside our body, our lymphocytes size them up and design very specialised killer chemicals that target the germ. For neutralising viruses we have T lymphocytes. B lymphocytes produce antibodies that are mostly for bacteria. They too join the effort, but they mostly just add to the noise, and little to the war effort.
Footage from Battlefields
COVID-19 comes like an avalanche, nobody can be quite ready for it. Suddenly the hospital emergency rooms start getting a steady stream, the hospital beds get filled, makeshift extra beds are unable to meet demand. Health workers are overwhelmed with cases, and with special COVID protocols and uncomfortable self-protection wear. They have never had so much work, never felt so helpless and inadequate, and they keep falling sick themselves. Fresh hands with little training join. There are patients everywhere who keep collapsing and little can be done.
The mortuaries too, are full, and the orderly disposal of dead bodies is no longer possible. Impromptu rules and procedures have to be adopted. The patients’ attendants are distraught and violence is commonplace.
In countries enforcing the lockdowns, the rest of the city becomes ghostly. In the few that have not ordered lockdowns, the crowds are thinner, but the shops, streets, offices, buses and most other places function normally, though one sees masks and hand sanitizers everywhere.
Very fortunately, the COVID blaze is likely to behave like a heap of newspapers catching fire. After about 2 months of mayhem, fresh cases may suddenly dry up, and all the chaos will end. All the young and healthy people who went through these 2 months fearing for their own lives cannot believe their good fortune. They get themselves tested, and are told they and their whole family had COVID and became better without knowing it.
Preparing for war
If we know our strengths and weaknesses, and those of the virus, we can make sensible preparations. Understand that fear mongering will be rampant. Popular and social media thrives on cricket score-like updates. Authorities may not fully clamp down on fear mongering. The more petrified we are of COVID now, the more grateful we will be later towards the authorities for ‘saving our lives’.
There is over 99% chance that each of us will cross this hurdle and come out alive and healthy. About 9 million Indians die every year, approximately 2% of our population. In 2020 as in all other years, the number will again be around 2%, although it will be visibly higher than in previous years.
The very elderly and those with major medical problems must stay away from all avoidable exposure for these months. Public gatherings must be curtailed. People should avoid visiting hospitals, socialising, and cancel avoidable travel. They should try to attend to their work, pursue solitary pastimes, and take extra rest and less sugar. For all flu-like illnesses they should take leave from work till they have fully recovered.
The hospitals will gear up for the extra load. Since the disease has no effective treatment, they should offer oxygen, fever medicines, and be by their patients’ side till he recovers or succumbs. They should avoid giving expensive, unproven remedies. Whatever false hopes these may raise, the costs and potential harm outweigh any possible benefit. The hospitals must strengthen their security as violence will be common; they require extra ‘May I help you’ counters for distraught patients’ attendants, and arrangements to help families keep abreast of their patient’s progress by phone.
The Government must step up reassuring explanations on the nature of the epidemic, prepare the public to accept the unavoidable heartaches and unbearable losses it will bring to many. It will prepare itself for handling a high number of fatalities. It should transfer cash into poor peoples’ accounts, gets ready to provide meals in needy neighbourhoods, arrange transport for emergencies. There should be constant guidance on how to deal with illness at home. Fever tablets, rest, enough food; to seek help by phone when severe breathlessness or other acute symptoms occur; suggestions on when and how to reach hospital.
Businesses and workshops should modify their products. Pharma companies would focus on COVID-time medicines, caterers on the arrangement of public meals, travel agencies on helping stranded people reach home, tailors on self protection wear.
Final days
There are hints from Wuhan, the first battlefield, that this epidemic recedes as quickly as it arrives. So, we can expect a sudden drop in new cases. That will be the time to start getting back to normal life, and to attending to all the collateral damage that the epidemic will surely cause. We should ready ourselves to get going as the fire subsides.
Collateral damage
Offices, workshops, factories, transport services will be short of staff. Insurance companies will have huge backlog of work. Just as a 2-day break for Holi festival leads to a week of disruption, 4 months of lockdowns and epidemic will require six months to normalise. There will be many businesses that may never re-open many homes and families that have changed irreversibly.
Poverty and desperation may lead to breakdown of law and order. Past epidemics have taught us that the existing social fissures widen in troubled times. Mutual distrust, blame games and witch hunts are part and parcel of every large epidemic.
Alternative scenarios
Apart from the one outlined above, there are other possible scenarios. Many specialists believe that this epidemic will behave like others, with a rising number of cases, then a prolonged plateau, and then a gradual down trend punctuated by intermittent flare ups. Large epidemics usually last 1-2 years.
Loss of livelihoods and poverty can lead to waves of malnutrition and secondary epidemics like tuberculosis. Conversely, many hope that a new cure, or an effective vaccine, or some special unknown capability of our culture and genes will shut out the epidemic from India.
There are concerns that immunity may not develop after COVID-19, or it may be short lived. With COVID-19, a new, unknown enemy, anything is possible, but going by our knowledge of immunity to viruses, this is a very remote possibility.
India’s priorities
This epidemic flares rapidly and should last some 2-3 months. Once lockdowns are ordered in the hope of stamping out the virus, it becomes difficult to call them off. Each lockdown phase will end with many more cases than we started with. It will be wisest to claim that the objectives of the shutdown have been fully achieved and relook at our strategy without too much delay. The time to shut the gate was early January. It required curtailment of all international flights and travel. Our horse has already bolted, it is too late to lock the door.
After tiding over COVID-19, we need to introspect on our functioning. Why do we allow our media to make everything into a spectacle, how should we locate real experts to guide us instead of relying on the usual celebrities and international bodies. Presently, the heart specialists and celebrities are doing the talking. It is hard to locate a lucid public health specialist in the cacophony on TV.
Our personal battle
We will all surely be exposed to COVID-19 , or have already encountered it. Whether we brushed it off, or we were its hosts for a few weeks, or have fallen sick, ample rest and good food are our shields for 2 months. We should cut sugar, smoking and alcohol. We should increase intake of health foods like dairy, poultry and nuts. We should segregate our elderly. We can spend time in solitary and indoor pastimes, and avoid strenuous activities that will exhaust the body. No matter how addicted we are to exercise or gym workouts, ample rest is best. We have to protect our mental health and positivity by forgiving our foes and forgetting our grudges. We should open our hearts and provide help and support to all around us who need it. Being well fed, well rested, and happy is the best way to promote our immunity.
Yes, COVID will come, but it will soon depart,
Slow down awhile, and just play your part,
With mirth, nuts, butter and ample rest,
Our immunity will surely perform at its very best,
Come August, we’ll all be rid of this pest.
*MD DM (Cardiology), Consultant Cardiologist, Batra Hospital, New Delhi