Expert View: The Pandemic of Panic caused by overwhelming numbers, not lethality of the virus
Politics and commerce may have triumphed over science. India has had a vaccine for Tuberculosis for decades but with zero effectiveness on the Indian population.
The pandemic of panic surrounding the pandemic of the novel coronavirus is reminiscent of the medieval era. Hasty decisions have been taken giving and maintaining an illusion of control. These crude and clumsy measures have fractured society and will have long term economic impact.
How the world arrived at this predicament? As the pandemic originated in Wuhan , China became the pacesetter in this marathon. Being the bête-noire of most nations, whatever drastic measures China implemented was roundly criticised by the Western media and even the WHO. The WHO representative remarked that the lockdown of Hubei district in China, of 56 million people was unprecedented in public health history and certainly not approved by the WHO.
Western media and legal experts had then dubbed China’s actions as “harsh,” “severe,” “extreme” and “controversial,” and as unlikely to control the virus. They stressed on the darker side of lockdown being unscientific and authoritarian. Who would have imagined that China had effectively done its role as pacesetter and nation after nation including western democracies would outdo China in implementing these draconian measures. Concerns about the dark side and authoritarianism of such harsh measures seemed to have been forgotten. The experts advocated this to “flatten the curve” and “break the chain of transmission” -- some of the several jargons thrown up as the pandemic progressed relentlessly.
The lethality of the virus was grossly overestimated in the early days as it was calculated from hospital admitted cases comprising mostly the elderly. The median age of fatal cases in Italy in early days of the pandemic was 80 years. The Lancet in March 2020 suggested that the case fatality rate can be as high as 20%. Subsequent studies including serosurveys refined the infection fatality rate to as low as 0.27% as most infections are asymptomatic and mild cases in the community were only detected by antibody levels during population surveys.
However, first impressions last long. The early impression of high lethality continues to provoke panic among the masses to this day. This is aggravated by reports of lack of hospital beds and oxygen presently being faced by our country in the unprecedented and unexpected second wave. However, according to the third round of national level serosurvey by ICMR the infection fatality rate can be roughly estimated to be 0.05% in our country.
In the second wave we are overwhelmed by numbers and not by the lethality of the virus alone. The pandemic has exposed cracks in our public health infrastructure and inequitable distribution of health services. Corporate model of health system focused in big cities are not geared to face public health emergencies like pandemics. Even in normal times the out of pocket expenditure for health services drives many poor families below the poverty line. So because of this mismatch of supply and demand we do have an acute emergency on our hands but not squarely due to Covid. The common man is facing the grim situation of lack of adequate medical care what the poor and marginalized have been facing all these years.
The scientific community too lost the plot early, sometimes by omission and sometimes, regrettably, by commission. Prediction models based on computer simulation instead of epidemiological surveillance predicted doomsday. These caused shock and awe.
More serious are doubts concerning scientific integrity. An editorial in the British Medical Journal (BMJ) by K. Abbasi, titled, ‘Covid-19, Politicisation, Corruption, and Suppression of Science’, raises concerns about the science, or rather the lack of it during the present pandemic. It puts forth, rather candidly, that science is being suppressed by politicians, and governments ostensibly in the public interest. Making the issue murkier are conflicts of interest of academics, researchers and commercial lobbies.
The scientific debate gave way to polarization with eminent scientists on both sides of the divide on issues of Covid-19 control. The vast majority were and remain silent fearing professional repercussions. Politics and commercial interests replaced science driving policy. The New Indian Express on 20 September 2020 alleged that the ICMR, under political influence, firewalled crucial data of serosurvey conducted to assess the spread of Covid-19 spread. Such reports erode public trust in scientists.
As reported in the BMJ editorial, even in developed countries politics meddled with scientific reports. Political appointees within the US Department of Health demanded to review and revise scientific statements related to Covid-19 published by the Centre of Disease Control and Prevention. In the United Kingdom, government advisers influenced the deliberations of the Scientific Advisory Group for Emergencies.
In this crisis, we have had the worst of communism emulating the repressive measures like lockdowns from China, and the ugly underbelly of capitalism with market forces hijacking the narrative as the pandemic progressed. Opportunist politicians and career scientists piggy-backed en route.
In a global disaster, world leaders, their scientific advisers including career scientists are under tremendous pressure. They have to give the impression of being in control and may resort to authoritarian ways to camouflage their uncertainties. Such tactics deviate from the scientific approach. The present pandemic is full of such uncertainties and therefore a vicious cycle of repression has set in when the authorities and their advisers are faced with rising case numbers.
The tendency is to blame the people for not observing appropriate precautions, most of which like social distancing are difficult in densely populated countries. There is even a joke circulating that if all Indians were to maintain social distancing we will enter our neighbouring countries! And most of these non-pharmacological interventions are based on computer simulations which consider humans as inert units and not as social beings, who cannot live in a bubble insulated from their environment. Attempts to do so cause greater harm to health by way to psychological disorders.
The collateral damage to children who are losing on schooling and social development is also considerable. And of course people have lost livelihoods, which will translate in loss of lives.
The arrival of the vaccine also brings its own sets of dilemmas. The world medical consensus seems to go for a win against corona, i.e. eradication of the disease. This is again unprecedented in public health history. The vaccines have hit the ground running. The effectiveness data on population level is too early to predict.
Going all out for mass vaccination with uncertain input on effectiveness is a big gambit. We have a vaccine against tuberculosis for decades which has zero effectiveness in preventing tuberculosis in the Indian population. Moreover, there are concerns that haphazard and incomplete vaccination of the population can trigger mutant strains. All these concerns, like almost anything concerning the novel coronavirus, need more detailed research.
A scientific temperament should be able to contemplate diverse opinions with detachment and equipoise and subject them to proper scientific enquiry. Unfortunately, such an approach is lacking presently. Any opinion contrary to the consensus is brushed under the carpet if not censored. There is opacity and obfuscation instead of transparency. Moral courage among our scientists in advisory positions to the government to stand up for scientific integrity is the need of the hour.
(The writer is Professor & Head, Community Medicine, Clinical Epidemiologist and Editor in Chief, Medical Journal Dr DY Patil Medical College, Pune. Views are personal)