Sunday, January 29, 2023

Covidian Conundrums

During the lockdown, few health professionals, policymakers and lawmakers have asked the centre serious questions about the meaning of various data or the effectiveness of numerous measures. By Prof Dinesh Mohan

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Twenty-five years ago, Randolph Ness and George Williams published a book “Why We Get Sick”. They informed us that developing fever during a usual illness is unpleasant but useful. It is an evolutionary adaptation shaped by natural selection specifically to fight infection. In their book, they discuss how many of our ailments, minor and serious, are a part of our evolutionary process which can benefit us or sometimes harm us. One of the important points they make is that one should interfere in the onset of illness and try and reduce or eliminate it only when the expected gain is worth the risk. Serious epidemics result from “exposure to novel factors that were not present in the environment in which we evolved”. This book or other similar texts should be compulsory reading for all doctors to round off their education. However, it is possible that hardly any healthcare professional in India has heard of it.

The news of the spread of the Covid-19 virus has sent billions into a panic not seen in decades. And because of this, governments all over the world have been able to place their citizens under severe restrictions not seen other than in times of war. The lockdown enforced in India is the most severe in the world and that too, without much discussion. The middle and upper classes have accepted these restrictions without as much as a murmur.

History informs us that pandemics can alter the course of nations, societies and the future well-being of millions of people towards deprivation and authoritarianism or a more humane society depending on how they are handled. In such a critical situation, why is it that very few of our senior health professionals, policymakers and lawmakers are asking serious questions of the government?

The whole situation is very confusing. We are told that human beings live in evolutionary competition with microbes, bacteria and viruses. And that new forms of viruses will keep adapting and attacking us from time to time. If this is so, does it mean that since we have “got used” to the lockdown this time, we should be ready for similar action every few years?

We really do not know at present how long the government will want us to maintain “social distance” even after the lockdown is over. Maybe it does not matter. Large sections of our society have been practising it for centuries.

On April 11, 2020, a government spokesperson informed the media that “cases in India would have reached two lakh by now and 8.2 lakh by April 15 if lockdown/containment measures were not taken”. On April 18, it was told that “we have seen an average growth factor of 1.2 since April 1. Between March 15 and March 31, the growth factor was 2.1. This means there is a 40 percent decline in average growth factor”.

What do all these numbers mean when the government is also telling us that it is not doing enough testing? The chief minister of Uttar Pradesh gave a statement that “we are taking care that nobody in the state goes hungry”. Are we expected to believe this when this is not true even in normal times in that state?

Data from around the world is even more confusing. Figure 1 (above) shows the rate of Covid-19 deaths in different countries. For a layperson, it seems obvious that in almost all low- and middle-in­come countries (annual per capita income less than $20,000), the death rates are much lower than in high-income countries. This is in spite of the fact that low-income countries are supposed to have bad health facilities and greater proportions of their populations with existing health problems. Even if we assume that many deaths are not reported, isn’t it surprising that in state capitals of poor countries major hospitals are not reporting very high rates of Covid-19 deaths?

For a layperson, the differences are too large between rich and poor countries to be explained just by lack of reporting issues. Why haven’t our experts spent more time in explaining these differences?

Yet, The New York Times in its editorial opines: “In some places in the United States and other developed countries hit hard by COVID-19, the question is when might it become possible to start getting back to work. For much of the rest of the world, the nightmare is yet to start. And part of the horror is that many poorer countries won’t have the means to do much about it.” Why are they trying to frighten us?

Other international data also confuse laypersons. Figure 2 (above) shows the proportion of population tested for Covid-19 in different countries. This graph suggests that the number tested is partly dependent on how rich a nation is.

In Figure 3 (above), we plot the proportion of people tested in each country against the proportion dying due to Covid-19. This figure suggests that there is almost no correlation between the number dying and the number being tested. If we believe these numbers, then why are poor societies being told that testing is so important when we know that it is not possible for them to test huge numbers in any scientific manner? And if the relationship between testing numbers and deaths is so weak, why are we told that testing is so important? Yes, our “experts” will tell us that these statistics are full of flaws. They probably are, but then how are we expected to believe what they say with any degree of confidence?

For a layperson like me, these data certainly suggest that Indian experts along with their international gurus should have been engaging in a serious dialogue, given these uncertainties, about whether there are enough reasons to suspect that infections in countries like India might not be following rich countries’ patterns.

Given that we cannot do zillions of tests and we do not have the same medical facilities as rich nations, were there different policies that could have been implemented instead of a life-destroying lockdown? And given that this virus is not going to go away, was it necessary to spread this extreme level of paranoia?

The lockdown is here and we will certainly have to pay a heavy price for it. The “we” actually does not include me because my income is not affected. Even if the pandemic gets me, I am old, and will not lose many years of my life. So I am in a position to ask some more questions.

  • Why are people not being allowed to go for walks in the open air? Most countries allow it.
  • Why have we been told that only two persons can ride in a car (one in front and one in the back) and only one on a two-wheeler? Does that mean that no one can make love at home?
  • Why are people being doused with disinfectants and made to walk through sanitisation tunnels when medical experts tell us that these tunnels “give a false sense of security and may have adverse health effects”?
  • Why are we thinking of leaving alternate seats empty in planes, buses and trains? The air circulation will not keep viruses away from you anyway. Do the policymakers have any evidence of the effectiveness of such measures?
  • Why have the authorities made such strict regulations about the care of the dead? They have made it impossible for us to leave this world in peace and dignity. After all, the dead don’t cough, sneeze and spray while talking and laughing and don’t spread infection easily.
  • Why are political leaders and workers not condemning extreme forms of distancing, communal propaganda and stigmatisation of different communities and Covid-19 victims?

No matter what happens in the next few weeks, the government will be able to claim that it saved lives because the official dead will be much less than what the modellers have predicted. However, we will never know how many lives, relationships and families are going to be destroyed as a fallout of the lockdown.

After this lockdown is over, I hope I can resume my “normal” life. I hope I am able to live the rest of my years hugging, touching, kissing, sitting close to and shaking hands with people as long as they also want it. This is how we humans live our lives of love and affection. I also look forward to joining crowds to listen to famous people, singers and performers and those protesting unfair policies of rulers.

—The writer is Professor Emeritus at IIT, Delhi. He is not an expert in medicine, virology or computational epidemiology. He does research on road safety

Lead Picture: PIB; Lead Caption: Joint Secretary, Ministry of Health & Family Welfare, Lav Agarwal (second from left), addressing a press conference on “COVID-19: Preparedness and Actions Taken” in New Delhi, accompanied by other senior government officials

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