The story of Covid-19 – Human Intelligence or the lack of it

An alien phrase, ‘ Zoonotic Spillover’, as it is called by wildlife epidemiologists or  transmission of a pathogen from a vertebrate animal to a human, will become very popular in the days to come, as it presents a global public health burden. Zoologists and disease experts have claimed that the destruction of natural habitats have enabled diseases that were once locked away in nature to cross into fast moving human beings across the globe. Scientists are unsure where the corona virus generated. It’s difficult to find that as well, as it would mean a live virus is to be isolated in a few suspected species to say with surety from where it generated. But the viruses very similar to the one that causes Covid 19 have been found in Chinese Horseshoe bats.

Zoonotic spillovers, happen because of human activity. We are increasingly transporting animals, for food, medicines or other purposes. When they are shipped or held in markets, there is a possibility that some viruses which are in animal body, get released to other animals or humans. Swineflu, Birdflu, ebola , and Nipah in the past have come because of this phenomenon. We are destroying the natural habitats of the animals, and they are mixing with humans in a weird way. Cutting down a forest for agriculture or habitation, can have far reaching effects on climate, disease emergence, carbon footprint, and floods. Corona gives a very important lesson, that a damage to the planet can also damage humanity more quickly than we think.

Corona Virus has burst out of quarantine in China and has engulfed the world posing a threat of the biggest economic downturn after the Great Depression of 1930. As the number of people infected worldwide, increase on the meter, the stock markets around the world are collapsing. The industries that are worst hit are the ones who are dependent on global supply chains. Apple warned on February 17^th that it would not be able to meet its revenue projections for the first quarter of the year. Carmakers, aviation, transport, energy and hospitality industries across the world are facing a shutdown situation, and the workers working for these industries will be unemployed. The merits of capitalism in the world which is considered flat will be under scrutiny.

In India, the first case of Corona Virus was found on January 30^th 2020. We could contain it till March 5^th when the count rose to 31. We crossed the mark of 150 on March 18^th and it was clear that the inevitable community transmission of Corona will happen in India, the same day the stock market closed 5% lower, Sensex at 28,896 and Nifty at 8,468. The RBI hinted at repo rate cut, as other central banks around the world were cutting interest rates. Governments around the world would be forced to inject huge amount of money in the economy through loose monetary policy.  Economists are predicting that Indian economic rate of growth which stands at 5% today may dip down by 1.5% for the coming financial year. Goldman Sachs warned on 20^th March that US GDP could plummet at the annual rate of 24%, during the second quarter, with unemployment peaking around 9% later this year. The collapse would be worse than the sharpest contraction during the Great Recession, when GDP dropped by a rate of 8.4% in the fourth quarter of 2008. It would also surpass the previous post-World-War-II record of 10% set in early 1958.

Janta curfew has been imposed in India on Sunday. A large part of success of India’s effort to contain Corona, will depend on public awareness. Whether we are able to reduce the rate of community transmission of virus will depend on two factors, self imposed restriction on physical contact with others as much as possible, and the ability of the health system to test and cure those who are infected and sick. Russia developed a better strategy to contain Corona, than the other Europeon countries. Vladimir Putin, the President of Russia said that the country has been able to stop the mass spread of Corona Virus. The number of confirmed Russian Corona Virus cases (253) is relatively low, although Russia shares a lengthy border with China and recorded its first case in January. Russia had shut down its borders with China, in January, and had set up quarantine zones. The Russians conducted large amount of testing of suspected Corona Virus cases standing at 156000, starting from early February, focusing on travellers from Iran, China and South Korea. But they did that for those coming from Italy much later.

India had put travel restrictions and had set up quarantine zones in the beginning of March. The surveillance at the airports began at the same time. The borders were sealed and the visas were cancelled. But, by then the imported virus had already been spilled in the local population. The first evidence of locally transmitted cases came by 18^th of March, and small towns like Bhilwara were locked down. The key strategies for India in the coming days would be to exercise self-isolation and to expedite health system response to the epidemic, by providing testing facilities and cure.

As of March 20, around 14,500 individuals had been tested in India, according to the ICMR data. We have fallen short of many countries in testing, and that will increase the local transmission of disease. India has .9 beds per 1000 population as compared to WHO standard of 5. There is a huge burden of NCDs in India, and a dearth of doctors, nurses and medical practitioners. There is a huge resource constraint. One in every eight Indians aged 50 and above is diabetic, and there is a very high burden of cardio-vascular diseases. Co-morbidities are likely to exist and the death toll is likely to be high.

Scientists at the National Institute of Virology isolated a strain of the novel corona virus. By doing so, India became the fifth country to successfully obtain a pure sample of the virus after China, Japan, Thailand and the US. ICMR said that isolation of the virus will help towards expediting the development of drugs, vaccines and rapid diagnostic kits in the country. The government has banned export of all ventilators, surgical/disposable masks and textile raw material used for making masks in the wake of the corona virus outbreak.

India is a very densely populated country, much more than China or Italy. There are 455 people per sq km, compared with 148 in China, 205 in Italy and 50 in Iran, according to the World Bank. The most powerful strategy of fighting against the virus at an individual level would be to protect oneself from someone who might be infected. A complete isolation done by families in the next 10-15 days will help in containing in virus. If the entire country is isolated in the family space, confined inside a household, it will drastically bring down the reproductive rate of the virus.  That is the reason, why success of Janta Curfew was critical. If the people of the country decide not to come out of the houses, in the next 10-15 days, during lockdown, only then the chances of an epidemic turning into a pandemic will be reduced in India.

Finally, it will be a natural human intelligence which will be able to contain the virus, by doing self isolation and observing restraint, as it was the lack of it that caused the spread of disease in the first place.

Can we prevent corona virus spread in India?

Florida has declared a public health emergency, and Berlin has reported a first case. It is now clear that the corona virus outbreak that happened in China, has now spread to second, third and fourth countries. In India, Kerala has reported three cases, Delhi, Hyderabad and Jaipur, one each.The Corona Virus has spread to 34 more countries in a month. At Mumbai International Airport, passengers arriving from China, Hong Kong, Thailand, Singapore, South Korea, Japan, Nepal, Indonesia, Vietnam, Italy, Iran and Malaysia are being screened. WHO has not yet declared it a pandemic, but that is what it looks like it is. 

The virus gets spread by droplets that are infused into the air, during coughing and sneezing. one way to prevent this virus from spreading is to do 'social distancing', that is shutting any kind of social mingling activities. India is a very densely populated country. If infected cases are found, localities and cities will have to be shut down, to prevent its spread. Schools, colleges, religious places, public transport, metro railway, malls and public parks come under this category. Evidence has shown that crowded emergency rooms of the hospitals are the entry points for the virus too. Front line health workers at a risk. 

Preventing the virus to enter the Indian territory is the best public health response that the country should provide to its citizens. This would mean stopping Visas for the affected nations, and conducting screening at all the international airports, seaports and borders in the country. The virus entering into the country through neighboring countries is also a threat as cases have been found in Nepal and Pakistan. Often the results of the screen tests do not come immediately, and the person could be spreading the virus before his test results arrive. 

Health authorities in many countries are frantically trying to prepare for a possible spread of the virus epidemic. Hospitals run out of testing kits, respirators, oxygen, masks, gown, gloves and drugs when the epidemic spreads and stockpiling by hospitals needs to be done. Doctors will have to be educated to reuse equipment carefully. Isolation wards and units have to be prepared in order to keep patients quarantine. The mortality of the disease is 2%, old and those with weak immunity are at risk. 

The way an epidemic hitchhikes depends upon a variable, the reproductive rate R - the rate at which a new case will give rise to further cases. R is going to be high in countries where public health interventions are less. Physical barriers, good hygiene and reducing various forms of mingle can help in bringing the R down. Well-equipped healthcare facilities, enough supplies and public awareness can provide a better response to the epidemic.

The good thing about Corona is that the fatality of the virus is low. The fatality rate in Hubei, the province of China, where Wuhan is located, is 2.9%. All those who test positive with mild symptoms, are health wise not facing much discomfort, little cough and fever, at the initial stages. If they self-isolate themselves at home, for 14 days and take regular medicines, they will be fine, but they will have to wait for another 14 days before they get back to normal life, so that they do not infect others. An awareness among the people to self-report and self-isolate will definitely help in containing the disease from spreading. A strong messaging system within the country would also be effective

A situation of panic in the case of any epidemic makes things worse. This disease is indeed like any other flu, and can eventually be handled by medicine and care. Just a little bit of extra care taken by an infected person, about not spreading the infection can help in controlling things. A sudden influx of patients in Chinese hospitals, made them overwhelmed. India will not be able to impose as strict restrictions as China, but an aware population, that neither dismisses the risk not panic, and handles the times of crisis with compassion and courage, will put India in good stead. Government will have to take steps to restrict public gatherings, and compensating a loss of job, or wages, to the poor and the vulnerable. A digitized service industry, as is available in parts in the country will help too in containing the spread. Finally, those who panic for losing wealth because of the loss of health, will also have to exercise patience to keep the nation fit, economically and physically.