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Opinion: India is going to have to live with Covid-19 for a while

Given that the new normal is 450-500 infections a day in India, it is clear that India is going to have to live with Covid-19 for a while. And "live" is the operative word.

15,May
2020

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Given that the new normal is 450-500 infections a day in India, it is clear that India is going to have to live with Covid-19 for a while. And "live" is the operative word. Whether the geometric progression of community spread is in danger of happening or not, the massive damage from the lockdown is not being spoken about in the media anymore (if you've noticed, no more death tolls of migrant workers, which had almost caught up with the Covid toll in India on the sixth lockdown day itself, being tallied, very few of those stories being told anymore). 

But of course, the deliberate veering away from unpleasantness hasn't tempered the alarmism. A couple of days back, television news channels flashed this - "42% of cases in India are between 21-40 age-group" and seemingly educated urbane people were hyperventilating on how notions about age had been debunked, and bizarrely no one contradicted this (it should be obvious that infections are merely a function of which group is being tested currently for whatever reason; the death column is the one to watch and the fatality rate in that age group of people with no serious pre-existing conditions would most likely be zero). 

In India, the litany of "testing, testing, testing" is becoming a bit of a joke now. Know why:

  • Nobody is concerned; we're still testing less than most countries in the world. It doesn't suit political narratives to increase those numbers unless absolutely required (i.e. when a rising death rate cannot justify less testing). 
  • This is a country that so easily and quickly normalises social stigmatisation - there are thousands of people with symptoms terrified of going for testing because of how they will be treated post that (I actually spoke to one of them a couple of days ago); many are convinced their landlords will throw them out (it's an extremely valid fear, going by how many doctors and nurses were being treated in their own housing colonies last week). 
  • The narrative of panic will subside if extensive testing reveals a far lower mortality rate than is being imagined currently, which does not seem to suit people in power or the media. 

Has the whole world grossly overreacted by imposing lockdowns with neither compelling evidence to head in that direction nor a clear plan ahead? The West has anyway been committing cultural and political suicide for a while, most evident from the political expression within many of those countries, but now they've gone ahead and committed economic suicide as well. It completely fits the pattern of a highly polarised world, where only extreme reactions find expression and validity. And extremism can only end badly. 

Going back to the evidence against lockdown: the perfect incubation example for Covid-19 being discussed worldwide is the Diamond Princess cruise liner and its naturally quarantined passengers. The case fatality rate there was 1%, in a densely packed closed, air-conditioned container. Moreover, this was a largely elderly population, in which the death rate from Covid-19 is much higher anyway. So, does this mean that a 1% fatality rate logically should be the worst case scenario? In the early days of the virus, when Germany's first 10,000 infected cases were recorded, only 50-60 were severely ill, and only about 30 died (references in second comment). This, in a country where 2200 people over 65 years of age die everyday, out of which 60-odd are flu cases. 

Similarly, Sweden's progressive attempt at herd immunity (the only country of that size to have not imposed some kind of lockdown till date) leads to these numbers - on average, 53 out of every 10,000 people are infected; people showing symptoms are on average 61 years old and over 60% of the deceased are older than 80 years old. This, in a country where 200-300 die per month in winter seasons from the flu. The idea of herd immunity, where the younger, healthier people are put in the line of fire (as their infections are almost never fatal; those with pre-existing conditions obviously have to be much more careful) so that they develop antibodies and immunity, actually ends up shielding the sick and the frail eventually. 

This is the time-honoured way to fight diseases (given India's average age of 26.8, not an illogical alternative here by any means, despite having a far higher population density than Sweden). As Fredrik Erixon said in The Spectator, "It’s not Sweden that’s conducting a mass experiment. It’s everyone else."  

Meanwhile, there is another argument that is being raised in many quarters - are many normal flu deaths that are being attributed to Covid-19 deaths just because the deceased tested positive for Covid-19 but did not necessarily die from it? Even in India, it may be worthwhile asking why Swine Flu (H1N1 virus) deaths in India till March 1st just tallies to 28, when the monthly average in 2018 and 2019 was in the region of 100 per month. 

This can only be answered across the board by comparing the death tallies from flu in 2020 so far with what the tallies have been in the last 2-3 years in the same months. It is mystifying why this exercise has not been carried out in any context. There are two things known about lockdowns so far:

  • One, they do not reduce cases, just delay the inevitable, which is only useful if the idea is to buy time to test more and ramp up quarantine facilities. Going by all the ostensible focus points and conversations, it is highly debatable that this has happened in India on any meaningful scale. And we now have far more cases than we did when lockdown began; which was highly predictable anyway. 
  • Two, the human cost is huge - obviously in terms of the economy, but also in terms of mental health and disadvantaged people, and also what it does to an already mentally diseased society like India's, filled with irrational prejudices and extreme instincts for self-preservation. Not to speak of vulgar levels of thoughtlessness, outright corruption and of course, sheer stupidity; there are multiple stories of the rich and the powerful flouting lockdown protocols, people bursting crackers and shouting victorious slogans on one hand, desperate crowds congregating to just somehow get home on the other. 

And many mindless administrations imposing curfew, perhaps trying to win brownie points by showing their superdeep allegiance to those who ordered lockdowns. And now, so many administrations are asking for a lockdown, it boggles the mind. Is an irrational fear of the unknown making them shirk their true responsibility and go for the low hanging fruit of lockdown? But since these infection numbers are not going to go on decline for a long time (as testing will only increase, not decrease), perhaps for many weeks, the logic to lift the lockdown will get less and less all this while, unless the paradigm dramatically changes, for which we can't really hold our breath (no pun intended). 

Meanwhile, we haven't even touched upon crime yet, which is an absolute inevitability in such dire circumstances, if this continues for long. It is not just looniness that led to such high gun sales in the US so recently. At a time when so many people around the world are speaking out against the idea of lockdown, in a country like India, it actually makes the least sense compared to anywhere else. So, given the huge amount of ignorance about the virus in India, isn't it time to level with the people here and tell them the score? This question is aimed at not just the political class but the medical community as well, at the higher echelons of which politics seems to be a far more prominent preoccupation than medicine. 

And of course, the media. This has been a worldwide phenomenon though, and it exposes the horrifyingly low levels of leadership in every one of these institutions. And a quality of education that seems to enable an obsession over detail rather than help discern, or perhaps even care about, the big picture. It is very sad that neither the media (which pretty much has the mandate to only focus on this one story currently) nor the academic fraternity can help measure the cost of a lockdown week-by-week, including projecting the number of likely lives lost from that. Nor have they bothered to juxtapose the number of deaths in India from previous years with death tallies from all causes this year (especially influenza), to at least rule out unintended overlaps and to bring a hugely-needed sense of proportion to what is actually unfolding. 

Our societal immune systems to counter chaos have failed us - that is the biggest takeaway from this crisis. Given that, and the realities listed above, in an attempt to regain some sanity, is it time now to move the focus to the people themselves? By making a very conscious shift from being preoccupied about the number of infections to just worrying about the more severe cases? Is it not time to aggressively and single-mindedly inform people about what to expect in case they develop symptoms (even after observing the protocols of social distancing and regular hand-washing as much as possible)? 

That it is not the kiss of death and nothing to be terrified of? That if they develop symptoms, to take a deep breath, relax and self-quarantine themselves to whatever extent possible and NOT go to the hospital? That in 80% cases, just resting with zero medication will self-dissolve the infection within a few days? That in some cases, the discomfort will be more acute (Testimonial A from the US, in the first comment) - lack of taste and smell, listlessness, loose motions, body ache, energy depletion? That if breathlessness occurs, even that is manageable (Testimonial B from the US, in the first comment), even if it seems a bit scary? At what point one needs to get admitted is tricky, thanks to the obstacle courses around getting tested and admitted (Testimony C from Mumbai, in the first comment), but perhaps certain markers can be defined for that clearly by the medical fraternity (if they could just agree)? 

In the 15% cases where there may be breathing difficulty, medical help may be required. But instead of crowding hospitals perhaps there could be multiple telephonic healthlines manned by our array of doctors, who can just guide and reassure patients, and only instruct them to get to the hospital if their case is acute (and may require ventilator). 

They can also guide those (economically disadvantaged or people with elderly at home) people who cannot isolate themselves at home to quarantine centres. Healthcare systems around the world appear to be collapsing primarily because it is not just the critical people rushing there for help (obviously the proportion of non-critical patients is far, far higher). By easing that load, won't things can be much more manageable in hospitals and quarantine centres? This kind of communication focus would also hugely reduce the societal stigma this virus currently carries in India, which could be as big a contribution as critical patients exclusively receiving care. It would temper the alarmism hugely, and eradicate denial. 

The harsher symptoms  will tell people what to expect, working both as deterrent at first, and later as an acceptable worst case scenario. There are many reasons to give the benefit of doubt to India for overcoming this crisis. The young population is a good one (with an eye on herd immunity, as mentioned above), in a country where 94% people are below 65 years of age. Then there's the American study that suggests India's compulsorily enforced BCG vaccination reduces Covid-19 dangers , and the MIT study where the the heat-sensitivity of this virus was shown to not being able to withstand beyond 32 degrees. 

Then, there is a brand new study done by Translational Bioinformatics Group, New Delhi, that suggests a unique mRNA in the Indian genome, that apparently makes Indians more immune to Covid-19. Does the extreme alarmism that justifies the lockdown have any supporting evidence, however tentative, like that? Or is it based on extreme pessimism and the panic instinct of erring on the side of supposed caution? Removing the lockdown doesn't mean other measures can't be taken on an emergency footing (including keeping the lockdown only in some select hotspots, for a short while and ramping up testing, smartly). 

But the shift in mindset to stop being alarmed about infections and focus on protecting those most vulnerable while keeping life as we know it going (even if on a diminished scale), with all sensible precautions like social distancing and frequent hand-washing intact, will infuse some hugely-needed sanity back into proceedings. And will save a lot of lives - that we are criminally not even paying attention to currently.   


Dibyadarshan Das

Author of the Content

Dibyadarshan Das has been a veteran cricket and esports feature writer for some of India's top web portals. You can follow his daily articles on Sportskeeda. He reports, does analysis and a bit of storytelling through his posts.



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