The mindless slaughter of man and his business in North East Delhi is rapidly becoming old news, thanks to the Covid-19 virus that seems to have taken over the consciousness of the planet; reminding us on an hourly basis that these are not the best of times. Supply chains lie disrupted and global growth is anticipated to dip below 1.5%. Its never been so bad since thew 2008 crisis. Baselworld the biggest luxury watch event stands cancelled, it began in 1917 and has been held non stop every year; even through World War II. The Tokyo Olympics too is staring at postponement. The Japanese prime minister has been compelled to declare a state of emergency after a state of shock when Japanese bureaucracy badly mishandled the “floating petri dish” cruise ship crisis off its shores. No one wants the Olympic village to become a floating land petri dish. Despite the Feds lowering interest rates American stocks continue to stumble, and this certainly is not good news for the American president in an election year. Trump’s initial glee at Chinese manufacturing dip could leave him disheartened in the weeks to come. The simple reason being almost half of the world goods are made in China, and the Americans are in no position to hire Caucasians to sit in assembly lines making blue jeans or even iPhones. India imports around 60% of electronic components from China. There could be serious interruption impacting an already stuttering Indian economy. Elsewhere airlines stare at $113 billion losses because of aborted flights and this is considered unprecedented.
Conspiracy theories are swirling around. One that somehow the Chinese accidentally released the Covid-19 virus due to poor safe guard mechanisms. One of their biggest viral research centre is barely 300 metres away from the infamous wild animal market in Wuhan. After all the current hypothesis is that Covid-19 jumped from bats to an exotic wild animal and made a small step into mankind. China’s biosafety record is not exactly the best. Another conspiracy theory doing the rounds is that American soldiers competing in the Wuhan 2019 Military Games played some mischief, in the sea food market. Both conspiracy theories undermine international cooperation in combating the virus. Why is Covid-19 such a threat? Firstly because it is new and secondly we have very little data on its behaviour. We know it affects the elderly, people with chronic disease or impaired immunity. Mercifully children are less affected, why so we don’t know. It is still unclear as to how susceptible or how infective a school child is. Closure of schools therefore is based more on prudence than on science. Chinese men seem more susceptible than women, possibly because more of them smoke. Covid-19 has a taste for human lungs. Almost all scientists agree that Covid-19 has originated in wild life. They have the genome to prove their theory.
Almost 90,000 people have become infected and more than 3000 patients have died in China. That seems a big number but compare it to the seasonal flu. Flu has infected more than 3 crore people this season in the US alone. More than 300,000 have been hospitalised and around 18000 people have died. Fatality due to flu across the globe ranges from 300,000 to 600,000 in a single year; the fatality rate (percentage of people dying because of disease) is a mere 0.1%, but millions get infected by the seasonal flu virus. Seasonal flu unlike Covid-19 attacks children too. But the true fatality rate of Covid-19 is still elusive. There is absolutely no information available on the number of people infected but have no symptoms; also mildly symptomatic people will just not report themselves. Hence an authentic fatality number will take some time to be established. The current New England Journal of Medicine carries a paper with the largest Covid-19 patients studied. Of 1099 confirmed patients with Covid-19, 5% patients were admitted in ICU, 2.3% patients needed mechanical ventilation, while 1.4% died. Importantly only 1.9% had history of direct contact with wild life.Median age of patients was 47 years, and 58% were male. The most common symptoms were fever (89%) and cough (68%). Lymphocytes were reduced in 83% and ground glass opacity was the most common finding on CT chest (56%). Around 18% of non severe patients had no XRay or CT abnormality, and 3% of patients with severe disease. Crucially, if we keep in mind patients with minimal or no symptoms the mortality rate should be less than 1%, but when large numbers (in the thousands ) get infected the absolute number of deaths can be formidable. The case fatality rate with SARS is 9% and MERS is 36%. European leaders have been horrified by the lockdown of 11 towns in Northern Italy accompanied by orders of imprisonment if any one disobeyed orders. Another large Chinese study has reported that 80% of patients had mild disease defined as no significant infection of the lung, and about 15% had severe symptoms such as shortness of breath or low oxygen in the blood. Five percent of patients were critical requiring mechanical ventilation because of respiratory failure, septic shock or multi-organ failure. The WHO estimate of mortality so far is 3.4%, but this surely is an overestimate as it number derived from confirmed cases. The virus can be picked up from hard surface such as a seat in the metro, the virus probably lasts for 48 to 72 hours on a hard surface, but no is sure of the duration. The trick therefore is to wash hands frequently; wash your hands before you enter office or your home, and of course in between.
The Chinese Centre for Disease Control and Prevention (JAMA February 24,2020) reported that in more than 44000 confirmed cases mortality was 0% in children less than 9 years, but as high as 15% in those more than 80 years, and 8% in those patients in their seventies. Overall case fatality was 2.3%. Fatality was as high as 49% among critical cases.Most cases were mild (81% had no pneumonia or mild pneumonia) but 14% had severe disease ( breathlessness, respiratory rate >30/min, blood oxygen saturation 93%). 5% patients were critical (respiratory failure, septic shock, multiple organ dysfunction or failure).
Currently there is no specific drug against Covid-19.Trials are being conducted with remdesavir and Kaletra (an anti HIV medication) which is a combination of ritonavir and lopinavir. Ritonvir increases or boosts levels of lopanavir, helping lopinavir work better. Some researchers are of the opinion that remdesavir, which failed against Ebola, may prove effective against Covid-19. Preliminary results should be in by April. Remdesavir is a nucleotide analogue, which means it stops an invading virus from multiplying within the cell. Chinese doctors are experimenting with chloroquine hoping that because it is cheap it may be very useful in low income countries.
The reproduction (R) rate or the number of people a patient infects with COVID-19 seems to be about 2.2, in other words one COVID-19 patient is infecting 2 persons. The pandemic will go down when this number is pulled to 1 or less. The reproduction number for seasonal flu is 1.3.The race to develop an effective vaccine has begun but a commercially available vaccine will easily take more than a year to develop. The seasonal flue vaccine is effective in 40% to 60%n people. Till then the best preventive measure is cleaning ones hands with soap and water as much as possible. Sanitisers are sold out and masks are being sold at US $99 by some brands. The worth of a mask whilst walking on the road or driving ones car is of little value . Health personnel of course need to wear a mask especially if treating a patient with fever and cough. Unlike seasonal flu, Covid-19 does not cause a running nose, it has a fancy for the lungs.Mr Trump has gone on record that Covid-19 will retreat as the weather warms up. That may be true for the flu but we really do not know if the same will be the case with Covid-19.
Getting raw ingredients for common antibiotics and vitamins from China has become a problem, many factories over there are under lockdown. This has resulted in a struggle to manufacture these drugs by Indian companies. The government has urged or rather ordered the Indian drug industry to halt exporting 26 drugs and ingredients without its permission. India happens to export 20% of generic drugs to the planet. The government wants to ensure that enough drugs are available for the local population.
It is imperative that the scientific community ensures there is no panic in the general population. Clear information on Covid-19 must be disseminated in simple and lucid language. A brand new germ with the ability to kill people in the thousands is bound to install fear in the bravest. Something that cannot be seen or heard but can you are told lethally attack you is a frighting prospect. The message therefore should be repeated again and again that Covid-19 is a new virus, capable of infecting adults, a few seriously, but the death rate is bound to be less than 1%. The best that you can do is not to touch your face, and wash your hands. This virus has 2 strains, the L type that is considered more aggressive (found in 70% of patients) and the S type (30%) that is milder and the ancestral variety, but even this data is preliminary. The government of India and other governments need to invest more in health care, India’s budget contribution to health is a dismal 1.28% of the GDP (2018). It was a mere 1% in 2015.. Japan on the other hand spends 10.9% of its GDP in health care. The health care allocation in the 2020 budget is only 69,000 crore Rupees, which is 1% of the GDP. India is obviously ill prepared for a Covid-19 pandemic. Yet again the burden will be substantially shared by the private sector. Also claims that cow urine and dung is “helpful” against Covid-19 is patently false. Exercise, consuming a healthy diet, staying hydrated and having adequate sleep should keep ones immune system perked up. The best and only way to prevent spread of this virus is good personal hygiene. One cannot emphasise enough the importance of washing hands several times in a day, avoid touching mouth and face and keeping some distance from an obviously ill individual. Sneeze or cough into a tissue or the crook of your elbow, throw the tissue straight away into a bin.The Centers for Disease Control and Prevention (CDC) recommends self quarantine if you have mild symptoms, including mild fever and cough. But in case of high fever with shortness of breath consult a doctor. Do not believe that the virus is a hoax or not serious enough to isolate yourself. Do not fall for alternative treatment recipes. You have to alter your life style because Covid-19 will do what it has been designed to do regardless of your wealth, colour, caste or religion. It is not pseudo secular but actually very secular.It can however be contained by common sense and paying attention to health professionals rather than Whatsapp messages. YouTube videos on Covid-19 carry a link to the World Health Organisation; ‘Get the latest information from the World Health Organisation about coronavirus.” Instead of bashing heads in North East Delhi we have to beat Covid-19. Tuberculosis ,also spread by droplets, kills more than 15 lakh patients in a year, but TB is largely confined to middle and low income countries, hence the lack of appropriate reaction both from the Western and Indian media. TB affects 10 million or 1 crore people every year, so far 100,000 people have become infected with Covid-19. The latest New England Journal of Medicine has published a new drug regimen (of bedaquiline, pretomanid and linezolid) with 90% success rate in highly resistant lung TB, but there is not a whisper by the international media. Treatment success has never been better than 50% in severe drug resistant TB.
Instead of cracking skulls in North East Delhi, we have to beat Covid-19. This will not be possible by aborting conferences nor by closing down schools and universities, notwithstanding the fact that Covid-19 can kill. Crucially, when a vaccine or a proven anti viral drug does become available , it must be affordable for the general public and as Bill Gates has written not “sold to the highest bidder.”