Coronavirus infection, pandemic and lockdown

We have been drowned in information, misinformation and propaganda about the current pandemic of Covid-19 (short for COrona VIrus Disease arisen in 2019). World Health Organisation (WHO) declared it as a pandemic because by then the infection had spread across many countries, in many continents. It had not remained restricted to one area in China to qualify as an epidemic.

Many viral infections can lead to epidemics. We had heard of Zika epidemic, Nipah epidemic, SARS epidemic and H1N1 influenza virus epidemic in the past two decades or so. In pre-independence era, plague epidemic – caused by a bacterium and not a virus – had caused havoc in many cities. Residents from old Pune city left their houses and went to live across the river Mutha – an uninhabited place at that time. This 'famous' epidemic, erupted in 1896-97, led to the assassination of Pune Commissioner W. C. Rand by Chapekar brothers and the British rulers notifying 'Epidemic Diseases Act, 1897'. During the current epidemic the same act is invoked to provide a lot of power for the government machinery to operate without resistance from the people!

Why is Covid-19 pandemic peculiar?

Before Covid-19, the World Health Organisation (WHO) had declared swine flu caused by H1N1 influenza virus as a pandemic in 2009. While it spread to many countries, India was not affected too badly by it and hence, we did not see huge media coverage for it. In general, the death rate (calculated based on the number of people dying and number of people getting infected) was much lower for Swine flu than what is predicted currently for the Covid-19.

Fortunately, Ebola virus epidemic did not reach India. Ebola virus infection has a very high death rate. There were a few cases of Nipah virus infection in Kerala and the death rate was very high for it too. However, it was controlled well and did not spread countrywide. SARS (Severe Acute Respiratory Syndrome) virus which belonged to the same family as Covid-19, also did not affect India when it spread to many parts of the world in 2002.

Unlike any of these viruses causing illnesses, Covid-19 has spread like a wildfire in the country and practically every state is reporting presence of Covid-19 patients. There is no real estimate of death rate for Covid-19 because it is an ongoing pandemic. But developed countries such as US, UK, Spain and Italy have reported high death rates indicating this virus may be more dangerous than the earlier ones.

One major difference between any previous pandemic and the current one is the impact of rapid and extensive coverage of every small and large, correct or incorrect piece of information by electronic media and easy access to this information via smartphones and other devices by a large number of people.

What are the possible ways to control the spread of Covid-19?

Many viruses sprea****d by human-to-human contact such as Covid-19 (SARS-Cov-2 is the formal name given to it now). Flu viruses, SARS virus (Formal name SARS-Cov-1) also are transmitted by human-to-human contact. Spread is normally because there is chest infection and coughing, spitting will aid in the spread of the virus easily. In contrast, some other equally dangerous viruses such as Japanese Encephalitis or Dengue are transmitted by mosquito bites to humans. Hence controlling spread of such 'vector-borne' diseases needs different strategies.

Covid-19 spread can be controlled if human-to-human transmission is minimised. That is the logic why this lockdown has been implemented. If crowding is avoided as in markets, public transport, airports, religious gatherings, weddings etc., people will not be coming in close contact with each other and hence transmission will go down. If there is no way of avoiding crowding, as in poor families who have a single room as their house – that too in crowded hutments, this mode of transmission cannot be prevented. Majority of the Indian population lives in crowded conditions and physical distancing (and not social distancing as recommended by the Prime Minister initially) has no meaning in their lives. Hence despite lockdown human-to-human transmission of Covid-19 cannot be prevented effectively.

Covid-19 is a new virus infecting Homo Sapiens for the first time. Hence, every individual is susceptible to infection, unlike the flu viruses. However, every human being infected with Covid-19 does not become ill and does not need hospitalisation. In fact, data from China and South Korea clearly suggest that about 80% of the people who are infected with Covid-19 do not complain of being ill. Thus, infected people may have minor symptoms such as mild fever, or cough or loss of smell etc. and in ordinary circumstances they would not even see a doctor. But once they are infected and recover without illness, they become resistant to further illness caused by Covid-19. This is the protective effect of the infection mediated because the immune system is triggered by infection. This protection can last for some time, quite often for years. But because Covid-19 is a new virus, we do not know how long this protection would last. However, letting many people get infected in a close-knit community so that everyone gets immune to it, is one way of controlling further spread. This is called as ‘herd immunity’ and in a 'herd', immune people provide protection to some non-immune people because the virus cannot reach them to cause infection.

At some point in the future a vaccine may become available for Covid-19. It is possible that vaccination undertaken on a large scale will generate protective response in the population and thereby decrease the impact of illness caused by Covid-19.

What are the potential outcomes of the lockdown measure currently in place?

An ideal and most desirable outcome of the current lockdown will be decreasing human-to-human transmission of Covid-19 to such a low level that the risk of its spread to so-far-uninfected people will be non-existent. But this is utopia. So many of us live in crowded environment, as mentioned above, that this measure in itself will not lead to near stoppage of transmission.

This lockdown period is likely to reduce the frequency of transmission to some extent and hence the number of people who fall ill and need hospitalisation will go down over this period. This period can also provide the opportunity for the government to procure diagnostic kits, proper protection gear, making arrangements for admitting larger than normal number of people who might need admission to hospitals and so on. It is hoped that the people in the government responsible for this planning are actually working towards it.

We are clearly witnessing an unfortunate outcome of a badly planned lockdown. Middle class people who can practise physical distancing are complaining about shortage of daily essentials such as food, vegetables, fruits etc. The less fortunate ones who have hand-to-mouth existence have lost their earning capacity and are starving. If they do not catch Covid-19 they might die of hunger and undernutrition. If they unfortunately catch the infection because of their poor health condition, they will be more susceptible to death.

On the economic front also, the lockdown has disastrous consequences. Sudden demonetisation announced by the Prime Minister in November 2014 had adversely affected poor people a lot more than the relatively well-off people. Many small-scale industries died during this period though bigger industries survived. Similarly, with three-week lockdown poorer people and smaller businesses will suffer immensely. We are already seeing the catastrophic consequences of lack of vision in planning. Circular contradicting earlier notifications are released on consecutive days. There is poor co-ordination between the Centre and the State.  Migration of the migrant population is a clear example of bad planning.

What is the way forward?

No expert can tell us how long this pandemic will last and how many people will suffer because of illness or how many will lose their lives. This is a new virus and it is not easy to make projections with high level of certainty. However, since both South Korea and China have 'recovered' from the peak of the pandemic there is hope for the rest of the world that ‘so will we’. How much will be the economic, social, human damage accrued before that is difficult to say. Scientists, economists are attempting to do modelling based on the data as it is accumulating for predicting the course of pandemic and adverse impact on the growth and economy. Both are likely to go wrong in many ways before getting clearer answers.

India certainly needs to strengthen its healthcare system, not just with ventilators and creating big hospitals, but surveillance system for diseases - something that has been always kept on the backburner. Covid-19 is certainly not the first virus to jump from non-human (birds, animals, bats etc.) sources and will not be the last one. Being alert and watchful with infrastructure support for people's needs is what we need to aim for.

Vineeta Bal

(Vineeta Bal is a trained physician and immunology is her area of expertise. Currently she is associated with IISER, Pune. She can be reached at vineetabal@yahoo.com)