COVID-19: No cause for panic in India but are we really prepared to cope with an epidemic ? 

While hysteria is unwarranted, the quarantine that we arranged ( see pic) doesn’t inspire confidence about our preparedness. Individuals need to be separated, not put together.

COVID-19: No cause for panic  in India but are we really prepared to cope with an epidemic ? 
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Dr (Major General) VK Sinha (Retired)

I had called a friend over for dinner. He insisted on a vegetarian fare. “Vegetarian? Are you sure?” I asked, having known him as a non-vegetarian. He insisted on having vegetarian food again and cautioned me on the possibility of falling ill by taking non-vegetarian fare.

Over the dinner I asked him if he would like to accompany me on a short trip to Nepal. “Nepal”, he exclaimed and was clearly aghast. “Have you gone mad”, he ranted, “Nepal is so close to China. We should not take this kind of risk at all”.

The world is seized with the pandemic of coronavirus. The fear is palpable. People are moving in closed cars with mask. Others are riding motorcycles with masks but without helmet! Print, visual and social media are constantly bombarding the world with the latest ‘updates’ from China.

Coronavirus is infectious. It is spreading fast. Misinformation and rumours are spreading faster. It is a deadly disease. Deadlier still is the fear. The problem has been compounded by the fact of its origin being a place where secrecy and lies — even in matters concerning global health — are standard tools of statecraft.

Every lie incurs a debt to the truth; repeated lies replace the truth with stories. Today we are in such a state of obfuscation where thousands are being hyphenated with millions or the other way round.

To get the facts straight, certain strains of coronavirus are prevalent in animals. Rarely, it jumps over to humans. But when it does, it is transmitted from one human being to another.

It happened earlier during SARS, avian and swine flu epidemics as it possibly happened this time as well. Flu viruses are known to change its genetic makeup very fast. When a new one is detected it is called novel coronavirus till officially named. This time it has been officially named Covid-19. It is a type of flu and behaves like any other flu, the commonest being seasonal flu.

The death toll in present epidemic stands at 1700 and counting as I am keying it in. It may be of interest to know that seasonal flu (happening every year) infection can range from mild to severe resulting in death in some cases. Those who get the infection may or may not become symptomatic. Those who get symptomatically manifest mostly recover. Such infections result in immunity. Eventually there is development of ‘herd immunity’ in the population with subclinical (and clinical as well) infection.

This is how nature controls (together with other factors like change of season) the epidemic. Hospitalisation and death occur mainly among high risk groups. As per WHO figures, globally, these annual epidemics of seasonal flu are estimated to result in about 3 to 5 million cases of severe illness, and about 2,90,000 to 6,50,000 respiratory deaths. Deaths occur among the elderly or among the very young with compromised immune system due to concurrent illness.

As per a WHO study done on 17,000 cases in the present outbreak of epidemic in china, the facts are reassuring. Of the cases testing positive on serology, only half get clinical illness (sudden onset of fever, cough, headache, muscle and joint pain, severe malaise, sore throat and a nasal watering).

Of those getting symptoms, a majority (83%) develop mild infection; severe infection occurs in 15% with only 3% getting critical. These figures are comparable to seasonal flu. With a mortality of just three per cent, that too mostly in immune compromised people; alarm necessitating abundant precaution is certainly in order but not hysteria.

The crux of management of an epidemic is to control transmission — from an infected person to a healthy one. There is just one method of transmission of Covid-19 infection — through droplets coming out of respiratory tracts of infected people.

The point to keep in mind is that an infected person is infectious even during the incubation period (before clinical illness becomes manifest). Droplets can travel directly from person A to B (up to 2 meters) during sneezing/coughing or indirectly through an object that has come in contact with it (fomites) like clothes, utensils, and furniture.

Droplets on an inanimate object contain live virus for no more than a few hours. A contaminated hand or any other object can infect more than one person in geometric progression. Frequent hand cleaning, therefore, is advocated as one of the most effective tools in the control of transmission.

It is, therefore, imperative that those having respiratory symptoms should not come out in open public places without a mask, more so if they have been in contact with an infected person or visited a place where there is a possibility of a contact.

Since a person is infective even before the onset of symptoms, quarantine is certainly in order but quarantining an entire group together (especially in closed environs) without individual isolation is laughable. It exposes the entire group to the possibility of infection from even one person — as it happened on the cruise ship Diamond Princess quarantined in Japan; more than 350 people on the ship have got infected so far. Since we may not know who is transmitting the virus, it is safe to presume that it could be one and all. Basic precautions need to be observed.

First, not to come too close to anyone. Too close may be up to two meters if the other person sneezes or coughs. Secondly, not to touch mouth, nose or eyes with any object or even own hand (fomites transmission) unless cleaned with soap and water (better) or at least an alcohol-based hand rub.

In times of a grave crisis involving global health, the greatest enemies are misinformation and fear mongering. Development of a vaccine and treatment may not be far off. Hopefully, it will become, in the end, just a footnote in the annals of medicine without a significant human cost — so also, wishfully thinking, in the history of world trade and commerce.

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