Corona Crisis and Some Questions

Sthabir Dasgupta

Crisis teaches us so many lessons, sometimes pleasant, often severe. The Corona crisis also in its own way has started teaching us, albeit punitively. We are learning the grammar of viruses, the methods of containing them and also possibly, how to reap political benefits out of a human crisis. However, while getting absorbed in such learning classes from dawn to midnight, it also seems now that we are being more confused than enlightened, for the continuous stream of propaganda raises more questions than it can answer.   

For instance, it is being told repeatedly that the Novel Corona is an RNA virus. We know that a virus is a parasite that needs a host in order to survive and reproduce. So, most viruses have either DNA or RNA as their genetic materials. These DNA and RNA viruses are not new to us. We had smallpox as we still have chickenpox and herpes, caused by some DNA viruses. We also have common cold, rabies, influenza, hepatitis C and E, SARS, Ebola disease, caused by RNA viruses. However, the RNA viruses have some distinct characteristics.

One of them, as we are being taught, is their very high ‘mutation’ rates which make them so diverse. This diversity is one of the reasons why it is so difficult to make vaccines against them. Therefore, the question is, if waiting for an effective vaccine in the near future against COVID-19 may be a useless luxury what other effective measure(s) may be fruitful? Should we purposefully expose ourselves to COVID-19 so that we acquire ‘herd immunity’, or should we continue maintaining ‘social distances’ for an indefinite period of time? Will viral threat go away in the face of social distancing and cleanliness? Or, will it increase the social distance in its present physical form towardss augmenting the social segmentations in a more cemented way? 

It needs no reiteration to understand that protracted social distancing will jeopardise large parts of our economy. In order to avoid such a huge loss in terms of human beings and money on the other hand, do we afford to allow the virus to spread and then treat only selectively those people who are seriously ill? After all, the evidence gathered so far indicates that around 10% of our people may get infected and a very small number of them would require institutional treatment. It is clear that under the present state of our public health infrastructure, this scenario is unaffordable, indeed.

We have assumed from the media reports that the rate of Novel Corona infection in our country is very low so far, as well as the fatality rate. But is it not due to the very low testing rate? The current testing rate is about 20 per 10 lakhs people, it is said. The fatality rate is also not more than 3 percent. What will happen if the testing rate is increased? Will it result in more death? Does the rate of testing for Corona corelate the rate of death? What if we do not test at all unless it is really needed for the sake of specific treatment?

Does this infection have a specific treatment, unique of its own? So far, it is evident that this kind of infection may need strict isolation and respiratory support in extreme cases. Do these measures require a label of Corona? If Dengue fever does not need a label before certifying the cause of death, why should we require it in this case? It is being said that if we fail to follow the draconian measure like ‘lockdown’, as much as 50 crores of Indians could be infected. A propaganda based on this kind of ‘research’ has resulted is knee-jerk reactions on our part.

However, this kind of mathematical ‘model’ that jumped into such an alarmist conclusion has already being questioned. Knowledgeable quarters have also questioned the methods followed to compute the fatality rate. They said that if we compute the fatality rate as the number of deaths out of the total confirmed cases in our hand, then there will be an error of ‘selection bias’. In order to avoid such biases, one should take into account the actual total number of infections instead of the number of confirmed cases only. That will give us a real picture of fatality out of this disease. 

It is easy to understand that the actual number of infections will be much higher than that of the confirmed cases, but the number of fatalities will not change; and therefore, the fatality rate will also be much lower. After all, COVID-19 is a disease having high infection rate, but mostly producing mild distress. This is not to say that we must invite those symptoms, but the question is, is the paranoia that we are witnessing hold ground? It is true that it will be an unprecedented burden on our medical infrastructure, even to deal with a huge population with mild symptoms, forget about those with severe illness.

Must we therefore, not search for other practical measures to contain the disease? What could be those measures? We do not know, but we can urge the public health experts to think about it rather than periodically raising panic in the public life. We understand that a compulsory quarantine of three weeks or more may reduce the disease threat to some extent; but will it not be a small gain as compared to the huge loss on the other fronts? These are uncomfortable, yet practical questions, since total uncertainty prevails over the extent of threat of this man-made infection. Will the threat be over by six weeks or even six months?

Can anybody vouch for it? On the other hand, what if we intend to think of a different narrative? Instead of becoming panicky, can we not think that many people all over the world die of normal corona virus (not a novel one) everyday all over the world? This narrative surely invites another question: we have already faced menace of various other viruses, and so, pandemic is not new to us; but why living is more dangerous today? Is it not true as a new study published in Nature, on 19th March, 2020 that the coronavirus death rate in Wuhan, China, the ‘epicentre’ of this epidemic may be only 1.4%?

It has also been revealed in Nature, on 26th March, 2020 that among the quarantined passengers in Diamond Princess cruise ship, the case fatality rate was around 1% while almost half of the passengers were infected. Despite being so close to Wuhan, in Vietnam the spread of the Coronavirus was limited, without any fatality worth mentioning. In Kerala, which came into the contact of Corona much earlier and owing to its global connection has substantial number of cases, the death toll so far is only two. It has to be remembered that among the deaths mostly were elderly people. Is it not known to us that the mortality rate in the elderly is always high as compared to the young persons?

The medical community is well aware that the mortality rate in pneumonia in the extreme old age from any cause, is around 20%, worldwide. Then why is such a hue and cry raised over corona-related pneumonia? Any student of today’s politics knows that draconian measures are politically safe, for they cut in both the ways. If they fail to give dividend that one can say, alas, what else could be done, people are stupid, they did not follow the rules. If on the other hand, the measures give you at least some dividend then it becomes creditable, indeed.

This is possibly why our politicians are being courted by the epidemiologists, virologists and almost entire medical community today. They have learned that doing more and more is safer than doing little. However, there was a statesman in the erstwhile days who said, better fewer, but better!

The classical teaching of medicine also is that there are many things that can be done, there are some things that should be done, and there is precious little that must be done! It seems we choose to forget it.

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Apr 6, 2020