25 - 11 - 2020

Should we be so scared of coronavirus

Despite scientific and empirical data pointing to the opposite, continuation of lockdown is a possibility because of a misplaced appreciation of the spread and severity of Covid-19 and lack of confidence in lifting the lockdown. This article is to give facts and data to mute the scaremongering so common today.

Covid-19 is caused by a new strain which belongs to the coronavirus family. SARS, MERS are caused by other strains. Coronavirus transmits easily, spreads very quickly and is highly infectious. Thankfully, it doesn’t spread through air, but can survive on droplets suspended in air released by an infected person and the virus can enter through mouth, nose or eyes. Hence, washing hands, wearing masks and maintaining social distance slows down the transmission.

The WHO has declared Covid-19 a pandemic because of the high rate of transmission but not due to lethality, which is much less compared to MERS and SARS. Incidentally, there are nearly three times more deaths from the flu in the US compared to Covid-19. But people are familiar with deaths due to flu which don’t scare them.

Nearly 80 per cent of the people infected by this virus show mild symptoms and recover in 7-21 days, with or without medical help. A person’s own immune system and medicines like paracetamol suppress the symptoms. The rest 20 per cent have to visit health facilities because of the severity of the illness. As much as 75 per cent of this 20 per cent (15 per cent of the total) have been found to recover with hospitalisation and sometimes with support to the respiratory system. About 5 per cent of the total reaches acute respiratory illness when they require intensive care and critical support. And, 50 per cent of these acute cases generally require a ventilator’s support. Of the 5 per cent acute cases, recovery is expected at 2.5 per cent to 3 per cent, depending on the proportion of immune-compromised cases in the subset. Elderly people above the age of 70 are more vulnerable. In Italy, the average age of the deceased is 78 against an average lifespan of 82.

It is not the biological age but the physical age which is critical. In India, with a high incidence of diabetes and hypertension, persons above 60 have been found to be vulnerable. Death cases reported so far show that 80 per cent are cases of co-morbidity of diabetes, hypertension and heart-related morbidity. Figures show 45 per cent deaths with one morbidity, 35 per cent with two and 20 per cent with more than two co-morbidities. It is one thing to die of Covid-19 but quite another for a person to die when he has Covid-19.

The disease is not spreading as fast in India as in the first world countries. This is shown by the number of cases per million of the population. In India, it is 6-7 per million while it is upward of 1,200 for the US, 2,400 for Italy and 3,200 for Spain. Lower spread and mortality rate is thought to be because of the mutation in the virus found in the Indian subcontinent, which has been found to be sticking weakly to human cells compared to the variant in the West. Another plausible reason seems to be the BCG vaccination (for tuberculosis) administered at birth in the subcontinent. This has been supported by a study conducted at MD Anderson Cancer Centre in Houston, Texas, US. The study has found 10 times lower incidence and mortality from Covid-19 in the subcontinent compared to the places where it is not administered universally. This could be providing some kind of herd immunity in India.

Further, the hydroxychloroquine-azithromycin (HCQ-AZ) combination has been found to be effective in the treatment of Covid-19 cases. A study conducted at IHU, Méditerranée Infection, Marseille, France, also supports the said treatment. A good clinical outcome and virological cure was obtained in 92 per cent cases studied at IHU with a mortality rate of 0.5 per cent, in elderly patients. This treatment has been accepted by the ICMR and is being given to patients of Covid-19 in India. The mortality rates in India are expectedly lower, despite poorer health facilities than its peers among the middle income countries. ‘Convalescent plasma therapy’, which involves collecting antibodies from the blood of recovered patients, and successfully used in India, holds promise. With this as an available option, even a curative regime is available in India without vaccine.

Despite limited testing, which willy-nilly forced the health professionals to test only serious cases, only 3 per cent positive cases emerged, which is the lowest in the world. In the ICMR’s sentinel surveillance of all SARI (Severe Acute Respiratory Infection) cases from February 15 to April beginning in all hospital ICUs across India, only 104 Covid-positive cases in a sample of 6,000 emerged. During the lockdown, when all clinics and healthcare centres were closed, all complicated cases came to the hospitals. Still, the number remained modest. Maybe, the supposedly missing cases — which many allege — are not there. Coronavirus is also proving to be not a pandemic in India. Covid-19’s toll on the elderly is more and younger persons, who though are carriers, suffer milder infection.

We need a fast and easily done test of a larger population to get a handle on the width of the spread. Evidence shows the concentration of cases is mostly in 20-25 bigger cities, making isolation, identification and treatment to become easier. India is lucky to not have many cases where the health infrastructure is either minimal or missing. A study by virologists at Heinsberg, the German town where the infection and deaths were reported, establishes non-transmission from restaurants, shopping malls and hair dressing salons. Transmission took place when a congregation or carnival took place. Resumption of normal life may be faster than expected.

Mathematical modelling could have given a grim prognosis. But modellings are not everything. They depend on parameters and assumptions which are often not corrected for age, pre-existing conditions changing virulence and the factors of environment. Believing modelling, India might have probably overreacted.

The evidence on hand does not make Covid-19 as scary a proposition. Even, it has made no change to the normal death rate for worse. Of course, in the short run, people will have to take care of some precautions, like wearing masks, maintaining physical distance, washing hands and avoiding congregation. While being cautious, we need not panic and be stricken by fear. This also shall pass. 

Satya Mohanty & Vinod Agarwal

Former Secretaries, Govt of India