[ Dr Rima Taipodia ]
In the last week of February, 175 senior managers from around the world, including two from Italy, attended a conference held by Biogen, a Boston (USA)-based biotech company. Within a week, 70 of them were infected with Covid-19, making it the single largest outbreak in Massachusetts. Many students, studying are now stuck because Massachusetts has declared a state of emergency, and all educational institutions are closed.
It is important to remember lessons from past pandemics. During 1918, when America experienced the Spanish flu, St Louis had half the death rate of Philadelphia, because on one hand, Philadelphia held massive rallies to support World War-I, while on the other hand, St Louis closed all schools, churches and factories, and banned public gatherings. Early actions have proven to save thousands of lives.
One can compare this with the spread of the coronavirus outside China. The most exposed to China are countries such as Singapore, Taiwan, Hong Kong, Thailand and Japan, but none of them experienced an exponential growth in infections. This is because all of them were hit by SARS in 2003, so they learnt how quickly viral infections can spread, and they took a preemptive containment measure called ‘social distancing’.
Countries like Iran, France, Germany and Spain took too long to contain the infection, and their numbers have exceeded that of East Asia. Fortunately, even if it was against the wishes of partner countries, India clamped down on overseas visitors very early.
Most people may look at a mortality rate of 3 percent and think that it’s a very low number. However, India is a huge country and Covid-19 is the most transmissible disease we have ever encountered. Every coronavirus patient who is contagious for two weeks infects three other people. India has 107 confirmed cases. Around 5 percent of those cases will need admission into an ICU and 1 percent of the cases will be serious enough to require ventilator support for breathing.
The vulnerable groups are people with preexisting conditions like high blood pressure, immune suppression, or cancer, and if they are over 70 years of age. With medical emergencies and H1N1, most hospital ICUs are already full. We’re already in a pandemic, and the only thing we can do now is reduce infections as much as possible, so that our hospitals have breathing room to manage severe cases.
Let us not simply assume that India’s heat will save us, or that Indians have a special immunity to viral diseases. What if we are like anybody else? Every country had a trickle of positive patients which was followed by a flood. Because of the density of population, the exponential spread of the coronavirus in India may hit like a blast. Noted epidemiologists as well as world leaders like Angela Merkel have said that 20-60 percent of us may be hit by the coronavirus.
Adopting social distancing is a small window of opportunity that we Indians have to limit the spread of the virus. Unlike China, we may not be able to enact complete lockdowns, but there are many common-sense measures that we can and should take:
1. Avoid all travel, international or domestic, air, bus or train. Long-distance travel is the biggest contributor to the spread of the disease.
2. Avoid all places that have a large number of people concentrated in a small area. It may be schools, gyms, malls, open-air markets, pubs, theatres, temples, other places of worship, swimming pools, etc.
3. If possible, work from home. Whether you work in an office or a factory, you are at risk of infecting or getting infected by your colleagues.
4. Keep a distance of six feet from your colleagues, avoid the canteen, and postpone all meetings with outsiders if you must go for work. Don’t meet in groups of more than 10.
5. Avoid situations that present the highest chance of an outbreak occurring, such as conferences, sports events, melas, rallies, and cricket matches.
We must congratulate the Karnataka government for already announcing these measures, and we must encourage other states to follow the same.
The state governments must assume that 10 percent of the population could get infected with Covid-19. Hence, a state like Arunachal would require a large number of critical care beds, along with oxygen.
Covid-19 patients should not be treated in the general hospitals of the states, since they can infect other patients. Every state government needs to convert non-commissioned hospitals or defunct institutes/colleges/hospitals into Covid-19 hospitals for inpatient and outpatient services. In Karnataka, private hospitals have offered the services of their doctors and nurses, along with proper equipment.
Since infected patients with mild symptoms didn’t know they had the infection and kept on spreading it, Italy went from 300 cases to 10,000 cases within a few weeks. Since the purpose of testing is mainly for isolation, all NABL accredited laboratories (2500+ in number) should conduct the test for free. While the epidemic started in South Korea and Italy at the same time, South Korea tested virtually everyone and chased the carriers with dramatic results, whereas Italy restricted testing with disastrous results.
The global shortage of protective gear for medical personnel is a serious concern. Most countries have imposed export restrictions. Indian manufacturers must be incentivized to produce N95 masks. The situation can get worse if medical personnel start falling sick.
There are over 50,000 young Indian doctors trained at overseas medical colleges waiting for licence to practice in India. All of them should be given temporary licences to work under a senior doctor in critical care units of public and private hospitals. In two weeks, they would be an important asset to overcome the crisis, if it happens. (Dr Rima Taipodia is the director of Hope Arunachal, based in Liru village, in Lower Siang district.)
