Maybe its just a calling of the times. But, as they say, you need to hold the bull by it’s horns. We don’t want to become matadors against this deadly pandemic. This morning, the number of deaths (on record) by the deadly Coronavirus have surpassed a million, globally.
And even if you want to hold the bull by its horns, you have ensure it’s legs are tied securely. And that means, we need to find new definitions for the term “resilience” in these difficult times. As Bill Gates suggested, millions will perhaps die before this pandemic is over.
I am being morbid with my expressions, but this is reality and we must embrace it. Times are being tough on everyone. India is one of the few countries that created leadership in fighting the coronavirus, with an unprecedented lockdown that has been lauded by many critics. Shutting down a country with a population of this size, meant that selfless leaders have to put their political careers on the line, in the wake of suffering economic losses, and social upheaval.
However, the days of the lockdown, and the subsequent opening up of internal borders should teach us a few things.
1. Numbers are largely suppressed.
We frequently find updates coming from local leaders that if we test more, we find more cases. Rapid tests were organised in some regions – but then, people who were staying isolated never volunteered to expose themselves to test kits. They still remain isolated and voiceless. I am representing here, the group of senior citizens, people who are actually scared of the pandemic and refusing to open the doors and windows, even to shine their faces outside of the cuckoo clock.
It is absolutely wrong to say that cases are increasing because tests are increasing. It only means that we have not tested enough, and there is a greater spread with a stronger under current, than what has been observed.
2. Opening up the economy doesn’t mean the fight is over.
Many have taken “the lockdown” as the problem and ignored the pandemic. Just because it hasn’t hit your family yet, doesn’t mean the virus is not close to you. In fact, by now, most people must have known families that have been infected. And the battle hasn’t been easy for all.
The leaders are supporting the economy to be opened up. This is to enable essential services to function properly, and necessities to reach us through alternate means, such as home delivery and e-commerce.
Even to develop the medical system, so as to provide assistance to the ailing – there’s an entire section of society that needs to brave the frontline, and lead a life that ignores the realities of the pandemic. I salute such warriors. For me, the warrior is not just the doctor who has neglected she has elderly parents at home to look after, while she goes to look after patients from Dharavi. It is also the delivery boy who brings packaged food, milk and bread to the doorstep, and maintains his social distance while transacting.
No, the fight is just not over. There are days when I believe, this is just the beginning. It doesn’t feel nice to say this, but I am only thinking more about what “resilience” could be.
3. (Take for granted) The economy will suffer, a new normal will have to emerge.
Numbers are rising. What the lockdown could give us, is a preview of extremely tough times, when we are all socially withdrawn from the fear of exigencies arising as a result of such a pandemic. The world has seen great economic depressions before, and some of them, were because of deadly diseases that brought people down.
In this age, what is different from older days, is knowledge and communication systems that keep us informed and connected with reality. If we must learn from past experiences that mankind has seen, we must learn to embrace change faster.
It is surprising for me to observe that company CEOs and leaders, who are most often the “change champions” in modern times, are the first ones to resist the impending change. Many organisations have evolved, and CIOs are embracing the challenges of work from home environments. But this battle is still a long way to go.
Until, the time when not covid numbers, but death tolls reducing to the normal levels, we can’t say it’s over.
4. Not all deaths during this time, will be attributable to Coronavirus.
As Bill Gates said, 90% of the deaths during the pandemic would be unrelated to the corona virus. Sadly, I have observed this among my close friends and family. Many people had to delay their treatments, or were unable to receive proper medical attention during the pandemic. I would love to believe, these associations would still be around, had they received the medical care they would receive during normal times.
The restrictions imposed by the pandemic continue to keep people from receiving proper medical care for underlying comorbidities, a word that many of us wouldn’t even have known before such calamity.
At some point, I would like to retrace a forwarded message from the month of May, that I received through a friend. Much of it has been true, and I don’t know right now, what the person believes about the future, but I do agree with his conclusion, that we cannot be complacent.
Allow me to state a few elementary facts. Community transmission of COVID is properly underway and the epidemic is just about taking off in Delhi. The numbers are rapidly increasing and it’s expected to peak in July, which means that on its downturn, the curve is likely to drag on till September. And there will possibly be a second wave in the winter. At some point in early July (if not earlier), we’re likely to observe a complete breakdown of our healthcare infrastructure, which in simple terms would mean that hospitals in NCR will have run out of beds to treat COVID, even if we recruit every last hospital bed available to us (to the exclusion of treating all other ailments). I sincerely hope that it doesn’t come to that, but I don’t believe in divine intercession or any theory that accords inherent innate immunity to Indians. And more importantly because, as doctors, we’re in the thick of this and can see (in real time) the vector and the trajectory of these infections. I urge you to read the following with a great deal of responsibility and disseminate as widely as possible.
1. We’re not getting a vaccine till next year, possibly not even for a year and a half. There is no evidence whatsoever that any medicine or therapeutic intervention can prevent or treat COVID infection. What can definitely and very effectively prevent COVID infections are non-pharmacological interventions that you’re all already aware of. But more of that in a bit.
2. In the absence of a drug or a vaccine, most of us are going to get infected over the next few weeks / months. To believe that we can dodge this would be a form of self-deception. That said, COVID isn’t the plague or Ebola. In about 80% cases this infection would be completely harmless. Even in the elderly, getting COVID isn’t the equivalent of getting a death sentence. There are scores of people in Delhi above the age of 65/70 who have been infected and have been asymptomatic or have had very mild symptoms and have fully recovered. But, of course, the elderly and those with co-morbid conditions are the most vulnerable and have to be protected. It’s usually the young, the restless and the earning members who acquire the virus from their daily excursions and come back and give it to the home-bound elderly.
It’s entirely possible and probable that a few people in Gulmohar Park have had a previous unsolicited encounter with the virus. It’s possible that a few of us are currently asymptomatic carriers, without having any knowledge of it. There’s no way of finding out unless we start extensive testing for antibodies, and that’s not going to happen for a while. The trouble with all these statistics is that it gives you no information about whether you or your loved ones will be safe. It’s fundamentally a roulette. There’s no way of predicting who is going to fall. There have been instances of healthy, young people ending up in ICUs and even dying from COVID pneumonia and its sequelae.
3. The only way forward is to ride the storm. COVID isn’t going to magically disappear. About 70% of us will have to get infected for the community to acquire herd immunity.
4. Herd immunity isn’t real immunity acquired by osmosis: it’s a form of statistical immunity where the uninfected are protected by the previously infected (and cured) individuals around them. This really is the key to understanding how this is going to end. As a crude example, consider all the people in Gulmohar Park as a community. Imagine a time in September when about 70% of us have had COVID one way or the other and have acquired immunity against it. 30% of us are still preserved and uninfected. The virus, remember, needs a human host to survive; it can’t survive outside humans for very long. When a new, uninfected individual now gets infected, the virus wants to move on, wants to jump to a fresh host. This individual in Gulmohar Park is now surrounded mostly by previously infected (and now immune) individuals. There is also a minority of uninfected individuals, but the statistical probability of the virus encountering an an immune individual (70%) is much higher. It cannot infect (and thrive in) these immune individuals in its immediate milieu and withers way. The uninfected minority in a community is therefore protected by a shield made up of a herd of the previously infected. The infected gentleman in B block is the first member of this shield. Remember this.
5. Now, some actionable things: no matter who you are and how old you are, do not step out without a mask. A simple mask is good enough, an N95 is even better, but please do not use N95 masks or Vogmasks with exhaust valves. The valve provides “breathability” when you exhale by releasing your breath and its contagion carrying respiratory droplets. These masks protect no-one. For the duration of the pandemic, these masks should be banned. If you’re using a cotton or a fabric mask, make sure it’s not sieve-like or honeycombed. This leaks air and respiratory droplets. Make sure the mask covers your nose and mouth. It’s instructive to note that even if you’re in the presence of a COVID infected individual and they’re masked and not coughing and you are yourself masked, the probability of you getting the infection is minuscule. The virus doesn’t fly out into your lungs.
6. Learn optimal mask hygiene. Consider the outer surface of your mask contaminated and carrying the virus if you’ve been in close proximity of other people. Do not touch the outer surface of the mask. Remove the mask by disengaging the earloops without touching the outer surface and discard it (if disposable) or wash it immediately on return.
7. Treat every individual you meet as an asymptomatic COVID carrier. Treat every surface you touch as potentially contaminated. That is the meaning of community transmission. Carry a sanitiser on your person. Frequently sanitise your hands after touching surfaces or objects. As we go about our lives, try your best not to get infected. Remember, easing the lockdown doesn’t diminish the virulence or the transmissibility of the virus. On the contrary, it increases it. Your chance of getting infected today is fifteen times more than what it was in the beginning of May. It will be a hundred times more by June-end. Avoid stepping out, as much as possible, particularly for non-essential activities. Give Delhi’s healthcare apparatus a fighting chance. We all have to avoid falling sick at the same time. We’ll all be scampering for hospital beds at the same time. No-one will get it. “Living with the virus” is not the same thing as socialising in the middle of a pandemic. For all our sakes, behaviourally, assume that the lockdown persists unabated. Please do not be complacent.This is from my friend’s friend; doctor and writer Dr. Ambarish Satwik
What is the solution?
It is hard to tell if vaccines and medication will be successful in resurrecting the old normal. Experts suggest that even if a vaccine is 70% successful, administering it to the world population may not be feasible for a long time to come. If one looks at the precedence in development of vaccines and cures for diseases, we are still a long way from the development of vaccines for HIV or absolute cure for cancer.
However, against these ailments, we have learnt to practice care, early detection and meticulous redressal. And, the old saying goes rather well – prevention is better than cure. And I repeat, all the steps we take, are still not “assurances” but only “preventives” that can aid in mitigating certain risk.
For example, a mask not worn properly, or one with a valve, or contamination, will not serve any purpose. It is thus, most imperative that we remain indoors, as much as possible, and interact with the least number of people. If it means, we must socially withdraw, or neglect associations, to save ourselves and our family, we should consider so.
Many of us will not have jobs, and businesses can and will shut down. An optimistic approach will be, to introspect on skills, invest in personal development, skill development and infrastructure development, so we can network and socialise in new ways, possibly digitally. And create a new future, where we work more closely with one another, given such constraints.
I pray to people, to consider contributing towards flattening of the curve. If we could motivate others to think the same, perhaps it will be sooner that we will come out on the other side of this pandemic, with lesser damage to society. If we take upon ourselves, the task of “Each One, Save One”, by motivating them to stay inside, we would probably progress towards flattening the curve very fast.