COVID 19: Musings of a Spectator

India with around 5 million positive cases is the 2nd largest country after USA, in numbers tested positive. With around 1,00,000 new cases per day and the sub optimal testing it could be a gross under estimation.  It may be worthwhile recapitulating the sequence of events of how all of us together, unwittingly are responsible for the enormous rise in numbers.

It started on 30th of January this year, with one case in Kerala who had come from Wuhan.  It was taken note of by Kerala Health Ministry who took stringent measures, while rest of India ignored it. The month of February passed by, with a historic visit by the US president Trump and his much-publicized Ahmedabad rally towards the end of February. The 125,000-strong crowd, who had gathered clapping and dancing to welcome, “Namaste Trump” on his first visit to India alongside Mr Modi. It was one month after WHO had issued a global warning, declaring it a Pandemic. The first COVID related death was reported in an elderly man who had travelled from Saudi Arabia on 12th March.

First outbreak through a Sikh preacher, a “super spreader” returning from Europe attending a congregation in Anandpur Sahib around the same time in March led to a quarantine of 20 villages in Panjab. This news did not generate sufficient interest for the media. However, a few weeks later a Tablighi Jamaat religious congregation event in Delhi, emerged as a  super national news provoking untiring discussions with religious overtones which were highlighted in the print and TV media for weeks together.

In order to prepare countrymen for a lockdown, a 14 hour Janata curfew was announced for 22nd March by the PM, in which he also directed public to show solidarity with the COVID warriors. They were asked to come on balconies and terraces for 5 minutes at 5 pm to clap and ring the utensils. People in most parts, however, came down on streets dancing, clapping, without masks, for hours together. This event was followed by an appeal to 1.3 billion countrymen to light candles, diyas (oil lamp made from clay) or torches after putting off all home and street lights for 9 minutes at 9 pm on Sunday the 5th April. This was to show that the strength of “Prakasha” (divine light) can defeat Corona. Public made it into a Deepawali. Power storage operations corporation (POSCO) had to work untiringly to maintain the stability of the grid during that period and prevent a collapse during an abrupt fall in consumption.

The country was put under a lockdown from 25th March with increasing number of cases, it, however, kept on getting extended essentially up 31st of May in 4 phases. The lockdown restrictions were important for containing the spread and building necessary healthcare infrastructure. Observers stated that the lockdown had slowed the rate of increase of the Pandemic. The WHO appreciated India’s comprehensive response .

The disastrous economic consequences, millions of migrant laborers had to deal with the loss of income, food shortage and uncertainty about their future, and thousands of them started walking towards their native places with more than 300 migrant workers dying due to the lockdown, with reasons like starvation, suicides, exhaustion, road and rail accidents, police brutality and denial of timely medical care. The added burden of millions of non-resident Indians returning because of loss of jobs further complicated the problem of unemployment. The Governments at centre and state level did realize it but quite late and took some feeble measures.

In the meantime, the authorities in collaboration with National Institute of Virology, Pune increased testing facilities, which have now been augmented to more than 1200 centres. The hospital services were improved and ventilators procured in large numbers within the limitations of our poorly budgeted health services. The much publicized hydroxy-chloroquine, trumpeted by US President was shown to be a complete failure. A number of drugs came up to give hope for patients showing low oxygen content in the blood. Some of them like Remdesivir and Tocilizumab are being used currently with some benefit but not improving survival in sick patients. Likewise, infusion of convalescent plasma seems to be of some promise but no conclusive data. Very sick patients needing oxygen under high pressure or on ventilators are recommended high doses of steroids with modest benefits.

Vaccination to prevent infection by increasing immune response are in big news and some countries like Russia have abbreviated the phases leading to hopes of an early breakthrough. However, it needs to be understood that virus is not going to disappear but virulence may be reduced. Current trials are focussing on safety and demonstration of antibodies in blood. Real efficacy means showing lowering of infection rates with improved survival which can only be demonstrated by a long term follow up.

Immunity boosting by modifications in diet, additional supplements like Vitamins D, C, zinc, magnesium etc., are having a heyday with claims of success and a big market. This also includes Baba Ram Devjee’s controversial “COVID Kadha”.  Persons who were thriving on the travel and hotel industry are shifting to newer ventures like making personal protection equipment’s (PPE), masks and sanitizers to make a living. Only assured business is for grocery, vegetable and fruit vendors.

In spite of continuing research and development on beating the virus, still the best way to prevent the spread is the observation of preventive measures. To apply them for the long term is challenging. It needs the cooperation of public. The majority of our population living in slums and ghettos, traveling long distances for work, large families with poor sanitation and huge cuts in wages are some of the vital issues for the non-implementation.

In order to achieve the Herculean task of preventing the spread we need a unified approach, stopping the blame game. We are all together responsible for the present state of affairs. Side tracking it by remaining in a denial mode and focussing on Bollywood, drug scams and avoiding answering various health care issues at different forums is not going to achieve our goal of containing the Pandemic.

It finally comes to time tested preventive measures. Practicality of these is, however, challenging.  Large percentage of our population living in slums and ghettos, having to travel long distances, inadequate transport systems, large families, poor sanitation with huge cut in wages are the issues.

We are facing a Herculean task of containing the virus, which seems to be getting out of control with ever increasing numbers. It is time for a unified approach and stop the blame game. We are all together responsible for the present state of affairs. Side tracking it by the media focussing on Bollywood, drug scams and avoiding answering questions on health care issues, does not help in achieving our goals.

Author is a Cardiologist, Past President of Cardiological Society India, and SAARC Cardiac Society. Recipient of Dr B C Roy Award and Padma Shri.