The grim situation facing us, with the dreaded novel coronavirus infecting more and more people daily, should urgently remind us of former US president J F Kennedy’s famous line: “Ask not what the country can do for you; ask what you can do for your country!”
Measures have been spelled out by the state health department and the Union Ministry of Health and Family Welfare to avert the worsening of the outbreak into a full-blown epidemic. But, apart from the government measures, the onus, importantly, also lies on the general public to ensure that the disease (COVID-19) does not explode to unmanageable proportions within the community. More so, because the disease has so far no cure.
The density of population -- especially in urban areas -- is a factor that needs to be looked at. Isaac Asimov says in his 1979 book Choice of Catastrophes: The Disasters That Threaten Our World, “Civilisation has meant development and growth of cities and crowding of people into close quarters. Just as fire can spread much more rapidly from tree to tree in a dense forest than in isolated stands, infectious diseases can spread more quickly in crowded quarters than in sparse settlements.”
The grimness of the situation lies in the fact that in less than two months, India has already accounted for 341 positive cases, including five deaths. There have been 20 positive cases in Karnataka alone, of which five have recovered and one died. Five of the positive cases were reported in one day -- Saturday.
However, although 23 patients have recovered all over the country, the threat of a further spread of the virus looms large.
So far, the spread has largely been restricted to those bringing the infection from affected countries and infecting people here. It means that the spread has remained in the local transmission stage or stage-II of the outbreak.
However, Karnataka’s Medical Education Minister Dr K Sudhakar has warned that there are signs of the situation getting into early Stage-III of the outbreak – community transmission – in which individuals catch the Covid-19 infection without coming in contact with those having a travel history to infected countries.
In such a scenario, the number of cases would multiply with the infection rapidly passed on from one to another within the population – a situation witnessed in China.
A new study published in the New England Journal of Medicine has found that the coronavirus is much more resilient than known. It has been found that the virus, scientifically known as SARS-CoV-2, can survive for several hours in air particles and for days on surfaces. It is detectable for upto three hours in aerosols, four hours on copper and 24 hours on cardboard. It can last upto three days on plastic and stainless steel. These are common materials we come in contact with and which we touch regularly. It means our exposure to the virus is very high if we are in affected areas where the already infected people leave their cough/sneeze droplets, exposing the uninfected people to infection.
At least two cases have been reported in India where patients contracted the virus without having any links with infected foreign travellers. Experts say India at present is staring up the barrel of the gun and if the outbreak reaches the Stage III, it would be extremely difficult to prevent the situation from going up to the Stage IV, a full-blown epidemic.
Testing concerns
Dr Sudhakar has voiced concerns about inadequate testing for Covid-19. This is a problem not just in Karnataka, but across India, which, as of March 20, has tested 12,426 people -- a mere 9.2 tests per 10 lakh people. In contrast, South Korea has tested 2.95 lakh people, which is 5,729.6 people per 10 lakh population. Italy tested 1.65 lakh people, which is 2,740.75 tests per 10 lakh population. Even the United Kingdom, which came under heavy criticism for its handling of the epidemic through mitigation rather than suppression has been testing 1,500 cases daily, which is 846.7 per 10 lakh people. It is now planning to raise the number to about 10,000.
Currently, the Karnataka government is in talks with the Indian Council of Medical Research (ICMR) and the National Institute of Virology (NIV) to rope in private laboratories accredited by the National Accreditation Board for Testing and Calibration Laboratories to conduct testing.
The state government has requisitioned testing reagents and kits. According to health officials privy to the matter, once ICMR validates test kits from manufacturing companies, private players can carry out random tests, which would include tests on people outside the current protocol -- those without travel history to affected countries or who may not have come in contact with infected individuals.
There are also plans to test the health workers showing symptoms while attending to Covid-19 patients. They are currently not part of the protocol. Also, the government is working out the cost with the private sector. While it’s free for patients at government hospitals, it costs about Rs 6,000-6,500 in private hospitals, while it could be higher in private diagnostic laboratories.
Big challenge
The lockdown across Karnataka and the rest of the country has seen many services withdrawn, establishments closed down and people asked to work from home. Those coming in contact with Covid-19-positive persons are expected to report to health officials and undergo self-quarantine.Largely, it is up to the people to support the government’s initiatives of trying to ensure the outbreak does not get into Stage III.
Larry Brilliant, an epidemiologist who had helped eradicate smallpox had in a TED talk in 2006, sounded an alarm on what could happen if a pandemic spread out in modern times. He had foreseen at least a billion getting sick and about 165 million deaths. Worse, he predicted a global recession and depression which could be irreparable. It is up to the government and each individual to ensure the situation does not reach a point where Dr Brilliant’s predictions 14 years ago actually come true.
How the virus affects lungs
When people with COVID-19 develop cough and fever, it means the infection has reached the air passages in the lungs
The worsening of the condition can lead to the viral colonies penetrating the lungs airway linings and entering the gas exchange units at the end of the air passages of the lungs
The virus forms colonies along the air passage, injuring the tissues. The membranes lining the airways and air sacs of the lungs become so sensitive that even a speck of dust can cause violent bouts of cough
When infection reaches this stage, the gas exchange units respond to the virus’ onslaught by pouring out fluid and inflammatory material, which get hardened due to the action of the viral colonies on them. This blocks safe passage of oxygen, preventing the process of getting rid of carbon dioxide
Can you spread the virus without being sick?
People are thought to be most contagious when they are at their symptomatic peak. But even if one does not show the symptoms while carrying the virus, one can be highly infectious if respiratory droplets are spread
The way it spreads
It spreads through respiratory droplets when an infected person coughs or sneezes
These droplets can land in the mouths or noses of people nearby or they can possibly be inhaled into
the lungs
Contact with contaminated surfaces or objects can also spread infection. One can get COVID-19 by touching a surface or an object that has the virus on it and then touching one’s own mouth, nose, or eyes
The virus is thought to spread mainly from one person to another, especially among people in close contact with one another (within about 6 feet)
Stage-I
Imported transmission
This is when the virus enters the country through infected people coming from the virus-affected nations
Stage-II
Local transmission
This is the stage India is said to be in with regard to the novel coronavirus. In this stage, local people are infected by individuals entering the country
Stage-III
Community transmission
Locals catch the infection without coming in contact with the infected people from abroad. The transmission is among local people, with the disease spreading rapidly
Stage-IV
Epidemic
After the virus enters the community, there will be an exponential growth in the number of infected people, resulting deaths too. China and Italy witnessed this stage and reported over 3,000
Epidemics in the past
430 BC: Athenian plague
It broke out during a war between Athens and Sparta in Greece when Athenians were holed up in the walled city of Athens. It killed 20 per cent of the population, including their leader Pericles. The epidemic played the most crucial part in the defeat of Athens
166: Antonine plague
The Roman empire was hit by an epidemic, believed to be smallpox. Roman philosopher-king Marcus Aurelius’ soldiers were hit by the disease and many of the survivors brought it back with them. The disease spread throughout the empire with the city of Rome witnessing up to 2,000 deaths every day. The total number of dead is estimated at 5 million
1347: Black death
The bubonic plague entered Europe through the Italian seaport of Genoa. A Genoese trading ship had returned from Kaffa in the Crimean peninsula of the Black Sea from where the disease entered Genoa. It claimed 25 million lives as the epidemic raged on for two years. It infamously came to be known as the ‘Black Death’ as the disease presented haemorrhagic spots on the skin which turned black
541 AD: Justinian plague
It first appeared in Egypt and then spread through Palestine and the Byzantine empire, before spreading in the Mediterranean region. Repeated outbreaks of the plague over the next two centuries claimed 50 million lives. The 541 outbreak is believed to be the first of the bubonic plague
1817: First cholera pandemic
One million people died in Russia in the first cholera pandemic originating in that country. The disease passed on to British soldiers who in turn brought it to India, where it keeps breaking out even till date. It also spread to Africa, Spain, China, Indonesia, Italy, Japan and the Americas. The epidemic keeps erupting around the world
1918-19 Spanish influenza
The 1918 Spanish influenza pandemic – the most severe pandemic in recent history – claimed upto 50 million lives globally. It was caused by an H1N1 virus with genes of avian origin, but there is no consensus on the origin of the virus. The United States alone accounted for 6.75 lakh deaths. The disease was first identified among military personnel in 1918 when World War I was on. The pandemic infected about 500 million people (or one-third of the world’s population)