by Dr Rajiv Bajaj
The Covid19 epidemic has struck the world like a thunderbolt. Though there is widespread fear, it is a challenge we can and will soon overcome.
Covid19 is a virus. Viruses are smaller than bacteria. Unlike bacteria they are incomplete life forms. They come to life only when inside another body. Once inside, they multiply by reprogramming our cells to become virus factories.
Like other nose and throat viruses, Covid 19 can spread very fast. On the aircraft carrier Charles de Gaulle, within 4 weeks of the first infection, nearly 60% were infected. In densely populated localities like old city areas and urban slums, Covid19 can spread rapidly from person to person. After exposure to the virus, many different outcomes are possible. Some people will remain perfectly healthy while others will get very sick.
The 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 the virus attacks, the body blocks its entry. Of the other 50, most will remain asymptomatic and perfectly well throughout the course of the infection, though the virus is multiplying inside them and being passed on to others. After a few weeks, these ‘asymptomatic carriers’ get rid of Covid 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 system compromised by cancer or chemotherapy are the ones who are going to be adversely impacted.
How Indians will fare with Covid19 remains to be seen. We should know this by May end. However, the total deaths will be fewer when compared to developed nations, because we are a country full of children and young adults who can take Covid19 in their stride. There are relatively few Indians who are 80+ or undergoing dialysis, thus even if some of them get infected the overall infected percentage will be low.
Our immune system is our only real weapon. Whilst remote islands can arm themselves with an additional weapon, viz. barricade the island completely before the virus enters and continue the barricading till a vaccine becomes available or till Covid19 has been eradicated from the rest of the world. India cannot do this and will have to rely on our population’s immune system.
The immune system has two components. Innate immunity is present in our skin, mouth, throat, and other surfaces. It is an ever ready, forever on duty counter-force. It successfully blocks out Covid19 from entering our body in about 50% of people. Our second line of defence is adaptive immunity. Once the virus is inside our body, our lymphocytes size it up and design very specialized killer chemicals that recognize and target it. When viruses attack, T cell lymphocytes do this job. B cell lymphocytes join the effort and make antibodies. In viral infections, antibodies do very little work, they mostly just add to the ruckus.
Footage from Battlefields
Covid19 has come like an avalanche and nobody could have been quite ready for it. In Europe and elsewhere, suddenly the hospital emergency rooms started getting an increasing stream of patients, hospital beds got occupied and makeshift extra beds are unable to meet the demand. Health workers are overwhelmed with patients as well as the 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.
Very fortunately, the Covid storm is likely to behave like a heap of newspapers catching fire. After about two months of mayhem, fresh cases may suddenly dry up, and all the chaos will end. All the young and healthy people who are going through these two months, fearing for their own lives will not believe their good fortune. They will get themselves tested, and will be told they and their whole family had Covid and became better without even 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 authorities for ‘saving our lives’.
There is over 99% chance that each one of us will cross this hurdle and come out alive and healthy. About 9 million Indians die every year, approximately 0,75% of our population. In 2020 as in all other years, the number will still be the same and if higher it will only be marginally so.
The very elderly must stay away from all avoidable exposure for these two months. So too those with major medical problems like severely damaged lungs, kidneys, heart or immune systems. Public gatherings must be curtailed. People should avoid visiting hospitals, socializing and cancel avoidable travel. They should try to attend to their work, pursue solitary pastimes, and take extra rest and reduce sugar intake. For all flu-like illnesses they should take leave from work till they have fully recovered.
Hospitals should gear up for the extra load. Since the disease has no effective treatment, they should offer oxygen and fever medicines. They should avoid giving expensive, unproven remedies. Whatever false hopes these may raise, the costs and potential harm outweigh any possible benefit. 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.
The government must step up reassuring explanations of the nature of the epidemic and prepare the public for a period of hardship.
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 cause. We should ready ourselves to get going as the fire subsides.
Offices, workshops, factories, transport services will be short of staff. Insurance companies will have huge backlog of work. Just as a two day break for a festival leads to a week of disruption, four months of lockdowns and epidemic will require six to eight months to normalize.
Poverty and desperation can lead to break down of law and order. Past epidemics have taught us that internal social divisions flare up in troubled times. Mutual distrust, blame games and witch hunts are part and parcel of every large epidemic.
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 finally a gradual down trend punctuated by intermittent flare ups. Usually large epidemics last 1-2 years.
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.
This epidemic flares rapidly and should last some two- three months. Once lockdowns are ordered in the hope of stamping out the fire, it becomes difficult to call them off. Each review date will show many more cases at the end of lockdown period than at the start. It will be wisest to claim that the objectives of shut down have been fully achieved and revise our strategy without too much delay. Flattening the curve will help if reasonable infrastructure is in place to handle the load. If the expected demand hugely exceeds supply, flattening the curve will not solve man problems.
After we have waded through the Covid river, we will need to introspect on our functioning. Why do we allow our media make everything into a spectacle, how should we locate real experts to guide us instead of relying on assorted celebrities and international bodies. Presently heart specialists, bureaucrats and celebrities are doing the talking. It is hard to locate a lucid public health specialist in the cacophony on TV.
Our personal battle
Most of us will surely be exposed to Covid19 or have already encountered it. Whether we brushed it off or we were its hosts for a few weeks, or have fallen sick, rest and good food are our shields for the next two 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 those we consider enemies, forsake antipathy and hatred we have nursed. We should open our hearts and provide help and support to all around us who need it. When our heart glows our immune system will knock out the bug.
Dr Rajiv Bajaj is a senior cardiologist at Batra Hospital, Delhi
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