A pandemic
IT WAS FORETOLD, BUT WE NEVER BELIEVED THAT A CRUMBLING INFRASTRUCTURE IN THE WEALTHY WORLD WOULD MAKE ALL OF US VICTIMS
THE PLANET is locked in containment. Barring lifestyle diseases, no other disease or infection has ever caught the grip of the globe in contemporary time—176 countries, and over 2,00,000 patients spread in every continent, except the Antarctica. Rich or poor, some 3 billion people are virtually in containment as 112 countries have closed their borders (see map, p 22). We are in the midst of what is called the containment stage in the global protocol to fight a pandemic.
But the invisible foe—COVID-19—has already escaped from our radar. It is spreading faster than anyone had expected. Between the period Down To Earth did its last cover story on coronavirus in February, and now writing this unprecedented second cover closing on March 20, cases outside China–the origin of the pandemic–have increased by 15-fold (see graph: “Tipping point”). Our helplessness to control this first non-flu pandemic of the 21st century has resulted in panic and hysteria. Health experts are no more hopeful of containment because we still don’t know the real number of cases from poor and developing countries that are ill-equipped to screen and count such cases.
We still don’t know how and when it transferred into a human host from an animal. But we know for sure now that it is a prolific jumper from human to human. Taking a clue from the Spanish Flu pandemic of 1918, we, the social animals, have been prescribed with social distancing—measurable to 3 feet—as the best way forward to delay transmission of COVID-19, not to stop it.
Coronavirus is not new to us, but COVID-19 is. It is the third new human coronavirus of the century. And its characteristics are not in line with this family of virus. Coronaviruses were supposed to have evolved in humans just to widen their spread, thus, not to kill but just to sicken us. But that is not happening. COVID-19 has already killed more than the earlier two such infections together—SARS and MERS. When it infects also, the symptoms are not according to observed patterns. They are mild enough not to be noticed and in many cases even absent after being diagnosed.
That is where the spread is unbridled: we don’t treat or contain those who don’t show symptoms. After the outbreak in China, the immediate screening and detection elsewhere were not adequate. In Africa, Chinese workers were allowed immediately after the New Year holiday, and they were not screened. This also makes all of us a potential carrier of the pandemic, and making it simply not containable. Marc Lipsitch, a professor of epidemiology with Harvard University, USA, says, “I think the likely outcome is that it will ultimately not be containable.” After China’s quarantining 100 million people in and around the epicentre, Wuhan, COVID-19 spread to rest of the world much faster. On March 6, we had 100,000 cases which doubled by March 18.
As screening and detection became aggressive across the world, new epicentres or secondary hotspots emerged in hydra-like splits, from Europe, West Asia and Southeast Asia, and now to Africa. This means the world has to mount an even bigger and more expansive containment and surveillance to catch each suspect and then scan all those who were in touch with this individual. The virus has emerged as the powerful demolisher of the globalised world, where we all thought the world is with us for everything. One after another, COVID-19 tested the crumbling health infrastructure in
the developed world. Their weaknesses and failures got globalised as affected people took the virus to other countries. Developing countries are dense in settlement and population. This makes containment and detection less effective. Thus allows transmission in multiple chains, almost like an uncontrolled atomic chain reaction. With over 8,788 deaths by March 20, the fear of fatality leaping seems real now. T Jacob John, a paediatrician who has extensive experience of more than 25 years in microbiology and virology, says, “As much as 60 per cent of the Indian population would be infected in a year’s time because the infection would be seeded well. The reason why I put such a number is the fact that unlike mosquito or waterborne infections, this is a respiratory infection.”
The world is now unable to contain the spread and hopes that it becomes a general community infection, like any other cold and flu. It is argued that in such a scenario the community would develop immunity and thus developing the capacity to fight. But, it also means that the fatality from COVID-19 would be in thousands till we reach this level of infection. “What is important is the timescale: whether it is in a matter of 6-9 months which will completely overwhelm many health systems, or over many years which will allow health systems to cope adequately,” says TEO Yik-Ying, dean, Saw Swee Hock School of Public Health, National University of Singapore. In Italy and Spain we are already witnessing this situation, while it is going to erupt in India and African countries. As the virus spreads, the already-stressed health infrastructure will be under extra pressure. This would be overwhelming and fatalities would be more.
There is almost an acceptance that the world goes through seasons of flu and cold, most of them are infections that erupted as epidemics in different points of time but gradually became seasonal. Are we going to experience the same? If we believe epidemiologists, we would have soon a regular COVID-19 season, and we will have to pay heavily in terms of human costs.