Covid-19: How to contain the contagion before it is too late

Viruses are extremely tiny (80-300 nanometers) non-living inert beings. Almost a speck. They come into existence only when inside the cell of a carrier — animal or human. Here, they hijack the host’s cellular machinery to reproduce millions of their copies. Once they have reproduced and their mission accomplished, these viruses break free by killing the host cell to infect neighbouring cells and repeat the cycle. This is unlike the bacteria, which can divide by themselves. And come to think of it, the viruses have brought the planet to a grinding halt and caused the unthinkable today.

Coronaviruses are a group of viruses that can cause respiratory tract infections. The current variant strain (SARS-Cov-2), is a relative of SARS virus (SARS-CoV) which caused the epidemic in 2002. The SARS-CoV-2 virus causes the Covid-19 infection — the name given to denote the epidemic breakout in the year 2019. Each time I follow up on the live tickers to see the statistics, the numbers make me numb and uncertain of our collective future. On March 17, 2020, Italy registered 349 coronavirus fatalities in a single day and 2,158 total deaths so far. Globally, nearly 8,000 people have died because of the virus as of March 19, 2020.

According to research, the fatality is way higher than the numbers given by the World Health Organization. As per the statistical analysis by Tomas Pueyo, if France claims 1,400 cases, the numbers on the ground could range between 24,000 to 1,40,000. And this makes the case as to why countries should proactively take up extreme measures to contain the contagion.

Countries responding to the pandemic

As in case of any new animal to human transition of virus (zoonotic disease), it is difficult for doctors to determine if they are observing a novel strain of the virus. If reports are to be believed, the 55-year-old Hubei resident, who contracted coronavirus on November 17, 2019, could have been the 'Patient Zero'. The whistle-blower doctor Li Wenliang, who wrote on social media about the possibility of an outbreak, was summoned and admonished by Wuhan police for "making false comments on the Internet". He later died after contracting the Covid-19 infection. Although China was criticised initially for its slow response, the country soon resorted to extreme measures to minimise the spread.

Italy seems to be ground zero for the coronavirus spread in Europe. Italian hospitals are running at 200 per cent capacity, and are already reporting lack of beds and ICUs. This is affecting the routine functioning of hospitals and clinics, which cannot deal with patients coming in to be treated for other ailments. Another ethical issue that the doctors are facing is to choose between patients to provide intensive care and ventilation facilities. This is based on the chances of survival — implying that a younger patient will have a higher chance of getting intensive treatment. When the first time my Italian friends told me this as speculation, it was hard to imagine. Barely two days later, this was reality.

In Italy, the entire country is under lockdown and only one person from each family can visit stores to buy groceries. Aerial footage with deserted roads appears surreal and straight out of apocalypse movies. Italy’s coronavirus victims face death alone, and the local priest in the village of Zogno has decided to ring the death knell just once a day, to keep from ringing it all day long. An Italian newspaper printed 10 pages of obituaries, as the death rates do not die down.

The situation in many countries only seems to be aggravating.

According to Public Health England (PHE) briefing, as many as 80 per cent of the population is expected to be infected with Covid-19 in the next 12 months, and up to 15 per cent (7.9 million people) may require hospitalisation. UK’s response has been surprisingly callous, where they were counting on ‘herd immunity’. This is a strategy that counts on letting a large number of people (60 per cent of the population) catch the disease and hence develop immunity to it, to stop the virus spreading. This will soon prove to be disastrous. Though, geographically separate from Europe, the UK is fairly connected owing to many Europeans living in the country. Also, dense cohabitation in many parts like London can spread the contagion. Despite these real risks, it was only on March 16, 2020, that the UK decided to implement a lockdown until March 31 akin to Italy.

Due to their history with the SARS epidemic, Hong Kong and Singapore defied initial WHO orders and upped travel restrictions as early as February 1, 2020. These countries are setting examples of epidemic preparedness for other nations.

Due to its proximity to Europe, Israel has been proactively taking measures to contain the infection. Banks, pharmacies, supermarkets and public transportation remains operative so far,  as compared to the complete lockdown in Italy and Spain, but the restrictions might get tighter. My friend who flew from Switzerland has been under two-weeks home quarantine as a precautionary measure. The same is the case with over a lakh people who flew back to Israel from various countries. Israel has developed mobile apps to track Covid-19 positive patients to minimise the spread. A few days ago, a person who defied quarantine was arrested in Tel Aviv by Israeli Police.

India in stage I/II

India’s response to the situation has been commendable from the start, in terms of containment. When reports of a high incidence of pneumonia from China came through, surveillance at airports was intensified, especially for those returning from China. The first case was reported on January 30, 2020, in Kerala. Just to give a comparative outlook, Ohio in the USA got the test kits on March 5, 2020. The three cases in Kasargode, Thrissur and Allepey were put into quarantine and all the patients subsequently recovered.

The second wave of positive cases came to light on March 5 with a group of Italian tourists. The tourists and people who came in contact with them have since been receiving treatments and are under quarantine. Indian government airlifted 645 Indians as early as January 31 and February 1, 2020, from the worst-affected Wuhan Province in China and placed them in quarantine in Delhi before releasing them. India has been sending medical staff to the worst-affected countries including Italy and Iran in recent times. Here in Israel, we are continuously been updated on emails and WhatsApp groups by the Indian Embassy on the continuously changing situation.

Media has been abuzz on India testing very few people per million population, as compared to other countries. And these concerns are genuine too. To understand it better, the current testing is limited to people with travel history (Stage I) and people who came in contact with those (Stage II). Mass gatherings are cancelled and there is awareness being spread among the people. The problem is only the symptomatic carriers are being checked due to current limitations of being able to conduct only 6,000 tests per day. However, more test kits are being procured.

The potent virus

No one is spared by the virus, irrespective of gender, geography, caste or economic class. From American actor Tom Hanks and his wife Rita Wilson to Canadian President Justin Trudeau’s wife Sophie Trudeau, all have tested positive for the virus. And the virus seems very resilient too.

Recent research established that the virus can stay as aerosol (droplets in the air) for hours and on surfaces for days. Another recent study showed that the virus tested positive in stool samples of 10 patients, even though the nasopharyngeal tests were negative. This demonstrates the potential of faecal transmission of the virus beyond it spreading through contact and transmission through the air. Face masks should be worn by everyone. Regular detergents and hand sanitisers are good enough to break/dissolve the virus structure. Expensive detergents with antibiotics will not do anything different from their basic counterparts. Antibiotics kill bacteria and not viruses. As for sanitisers, at least 60 per cent alcohol content is necessary to break the virus apart. DIY sanitisers that are made at home should be disregarded. The same applies to the media channels/ organisations spreading such news and risking the health of millions.

Mild symptoms following the viral infection include dry cough, fever with shortness of breath and diarrhoea. Roughly two to five per cent cases are fatal, which progress from pneumonia-like symptoms to multiorgan failure. At risk are those with compromised immune systems including the elderly, or those with co-morbidities such as cardiovascular disease, diabetes, cancer or hypertension. There were times when our parents asked us to be home on time when we were growing up. Now, the tables have reversed and we should request our parents and grandparents to quarantine themselves as much as possible to safeguard their health from the viral threat.

Asymptomatic carriers

On average it takes two to 14 days for the symptoms to appear. During this stage, the person is an asymptomatic carrier — that is, the person is not showing full-blown symptoms but is transmitting the virus nonetheless. It is almost like the 2011 movie Contagion is playing out in the real world. It is trending on Netflix and can be a good reference to understand the transmissions globally. Malayalam movie Virus can also be enlightening. After all, Kerala braved Nipah virus which has a fatality rate of 40-75 per cent against two to four per cent for Covid-19 infection. While South Korea is testing everyone, Italy is testing only the people with symptoms. The scary part is that the age group of 20 to 29 years do not show any symptoms and appear fine. However, they are transmitting the disease in large numbers. Hence social distancing for two weeks can help contain the spread to a large extent. 

Governments are doing their best, but personal responsibility and sensibility is the need of the hour.

The case of ‘Patient 31’ from South Korea gives a deeper understanding, makes one realise the gravity of the situation and the need for social distancing. The patient travelled to crowded places in capital Seoul, met with an accident on February 6, 2020, in Daegu, admitted herself to Saeronan Hospital, attended the Shincheonji Church services on February 9, 2020, and February 16, 2020.

Despite being advised by doctors to test herself for Covid-19, the woman went for a buffet with a friend in a hotel on February 15, and it was only by February 17 when her symptoms worsened that she got herself tested. The results were positive and she was identified as ‘Patient 31’ on February 18, 2020.

In just a few days, there were hundreds of people from the hospital (119 cases), Shincheonji Church (2,418 cases), and the hotel who were tested positive. The woman became responsible for 80 per cent of the total cases in South Korea.

No vaccine and no cure

Currently, there are no vaccines for prevention nor FDA-approved drugs for treatment.

The first vaccine trial began on March 16, 2020, based on Moderna’s messenger RNA vaccine — 70 days after the genetic makeup of the coronavirus was released. Another antiviral drug developed by Gilead Science is soon going to trials on infected patients with severe infection. This is a great scientific leap compared to how pandemics like the plague or Spanish flu panned out just a century ago. 

In the meantime, people working from home or under isolation have become creative. Be it workouts at home, or like my friend in quarantine who is taking his singing skills seriously. Remember, Isaac Newton also worked from home during a pandemic and ended up discovering gravity.

Let us not be South Korea’s Patient 31. Let us help contain the contagion.

Also read: How PM Modi scored with COVIDiplomacy