As Covid-19 spreads, the silver lining | Opinion
It is a problem. But there is now enough know-how to help prevent it, and manage its consequencesUpdated: Jul 27, 2020 18:46 IST
Looking at the rising curve of new cases in India, it may seem premature to talk about what the new normal will look like. However, just as it was important early in the pandemic to look ahead to save lives, it is also important to look ahead now to preserve the social fabric and the economy. The pendulum of fear has swung from one extreme to another with much misinformation. So, it is time to review what we do know.
The Sars-CoV-2 infection has taken a huge toll globally, with over 600,000 deaths so far. The actual number of infections is far greater than the known cases. This is important, because it has led to many misconceptions about the fatality of the disease. For example, in Delhi, antibody data, which tells us about the percentage of the population that has been infected and recovered, points to about two to three million infections. When compared to the 130,000-plus known cases and less than 4,000 deaths, the difference is staggering; fatality is less than 0.2% by antibody data and around 3% by known cases. It is clear that when diagnostic testing is done extensively, as is now happening in the United States (US), more than 99% of diagnosed infections recover uneventfully.
The additional risk of dying of Covid-19 is unlikely to be more than a person’s current one-year risk of death. For example, for a young Indian male, the risk of dying of Covid-19 is not more than the risk of dying in a road accident this year. For a young Indian woman, it is comparable to the risk of dying during pregnancy. A 70-year-old elderly Indian male already has an annual risk of death of 5% or more, to which Covid-19 adds about 1% additional risk.
However, none of this means that the problem is small. Restated in another way, the annual risk of death is being doubled during the pandemic — the additional risk compressed into a few months. Also, this risk is transmissible to those around us. The real problems begin when the disease starts to spread so rapidly that it overwhelms the health care system. Then, deaths start not only because of Covid-19 but also because of other causes that would normally be preventable. The focus of the new normal should be to get on with our lives, while observing reasonable precautions to prevent a catastrophic spread.
At the first semblance of normal life, with schools, universities, and more restaurants and malls opening, there will be a further rise in Covid-19 cases and, consequently, deaths. This cannot be helped until we have new effective treatments or vaccines. The universal use of masks in public spaces will probably be the single-most important intervention to reduce the risks. We don’t require more debate on airborne transmission. It is quite straightforward. Large droplets from sneezes and coughs are more likely to transmit infections but settle down fast from the air. While speaking, we expel very small droplets that are less likely to infect, but remain in the air longer, creating tangible infection risks in closed, crowded and poorly-ventilated spaces. Wearing a mask reduces the droplets we send out and those that we breathe in. Comfortable surgical masks, or almost any mask, do a good job of the former, while N95 respirators are required to effectively do the latter. If everyone is wearing a mask, N95 is not required and people can stay comfortable and protected. This is the simplest strategy to reduce not only the number of infections, but probably also the severity of infection, since it seems that a higher amount of virus exposure may lead to higher chances of severe disease.
The other necessary intervention is to restrict indoor crowding and increase fresh air ventilation. As the summer comes to an end in about a month, it will become possible to bring in fresh air without compromising the temperature control of air-conditioned buildings. However, optimal design of indoor spaces is still a problem that requires thought on the part of architects and engineers, especially for restaurants where masks are not possible. Rapid air exchange with filtration or decontamination is a viable option where fresh air cannot be brought in.
The other critical need is to destigmatise Covid-19. None of us know where it is coming from, but there is no reason for panic beyond rational precautions. Most people can safely self-isolate and recover at home, preferably without any consternation on the part of neighbours. Reverse isolation, in which high-risk people are temporarily isolated, is another option. The large number of infections has a silver lining: When managed well, there will be a large fraction of recovered people with some immunity. Herd immunity is still some distance away as a nation, but local immunity may be sufficient to prevent large outbreaks in such areas. In data collected by others and us, about 20-30% of Delhi and Mumbai residents seem to be in the recovered category based on antibody presence, although these are not neutralising antibodies with definite anti-virus action.
A very positive sign is that there have been no proven re-infections in over six months of global experience, despite poor antibody response and lack of neutralising antibodies in many people. Better immunity tests will allow immunity passports for those who can safely serve at the frontline of critical high-risk services. The size of our problem may yet become the size of our opportunity. It is time, despite the doom and gloom, to start thinking of the new normal.