China could exert an unprecedented degree of State control. India does not lend itself to that as a society. This makes individual precaution necessary to control the outbreak(PTI)
China could exert an unprecedented degree of State control. India does not lend itself to that as a society. This makes individual precaution necessary to control the outbreak(PTI)

Covid-19: A response now will help mitigate impact | Opinion

It is better to react now, than be unprepared later and risk millions of lives. Individuals must take responsibility
By Ramanan Laxminarayan
UPDATED ON MAR 09, 2020 06:48 PM IST

By now, a number of my friends have asked if we are in panic and overreaction mode to the novel coronavirus outbreak that has spread from China to more than 100 countries. After all, what are 40 cases in a country the size of India where an estimated 22,000 people die each day? Is all the attention that Covid is getting warranted? After all, isn’t the common flu much worse and we don’t pay much attention to it?

Let me clarify. Covid is not like the common flu. The estimates we have of case fatality (proportion of infected people who die) is about 20 times greater than the common flu. Each year, influenza infects roughly 300-500 million people and kills about 300,000 to 500,000 people. Now, imagine if there were a new strain that infected as many people as the flu but killed 20 times as many people. We are then looking at a mortality figure of about six to 10 million people, with about a sixth of this in India. A million additional deaths, even in a country the size of India, is a significant figure.

The 1918 influenza pandemic, which killed about 50 million people worldwide, had a case fatality rate similar to what we are experiencing with Covid-19. Until we have clear evidence that Covid-related mortality is much lower than what we have measured so far, we simply would not want to take a chance of a large number of deaths. For comparison, the excess number of deaths would be twice that of those due to HIV/AIDS, tuberculosis, and malaria combined.

Any disease is easier to stop at an earlier stage when we can prevent its spread through the main approach being used now, which is contact tracing. This method, which was also used widely in India for previous disease control efforts including smallpox, entails talking to infected individuals, ascertaining whom they may have come in contact with, and then tracing those other people to screen them for signs of infection. It is time-consuming and painful but there are people in government who are doing exactly this at this time. They know fully well that contact tracing works only when we are under a few 1,000 cases. Once the number of cases exceeds this, we have no easy means of containing the spread, short of shutting down much of the economy.

People point to China’s declining cases as evidence that the disease burns itself out on its own. It is certainly true that all infections decline after a peak. But we must understand what it took for China to do this — it quarantined large cities the size of Delhi. They had the means to shut down all activity, deliver food to each home every day, create massive makeshift hospitals in stadiums where they were able to take care of patients, and test hundreds of thousands of patients.

These are measures that would be hard to implement in a country such as the United States and nearly impossible in India. It is not that the government is not trying hard enough. It is simply that we, as a society, are not set up for that kind of State control over the people (and for good reason, in the absence of a disease outbreak). Therefore, the main way in which we can contain the outbreak is through our individual actions — social distancing, avoiding unnecessary travel and gatherings, frequent hand-washing, and being mindful of our hygiene, including avoiding touching our faces often, sneezing and coughing into the air, and spitting. Our namastes are certainly helpful but spitting, which is still all too common, is not.

In many ways, it is better to inconvenience ourselves at this stage to stop the epidemic. If we are successful, then there will be armchair critics who will claim that we overreacted. But the containment of the epidemic would itself be a result of our robust reaction. What would they rather we do? Wait and see how bad things get before trying to walk back an epidemic that would have already infected millions of people?

All of this is not to say that we should panic. Panic is counterproductive. Simple measures that have been repeated by public health experts are all that are needed for us to be safe. While I have confidence that the epidemic will be contained, I also think that it will be because we acted responsibly as individuals and collectively as a society. If we are betting on Covid dying out because of the heat or suddenly disappearing, that could happen, but I wouldn’t bet the lives of millions of Indians on it.

Ramanan Laxminarayan is a researcher at the Center for Disease Dynamics, Economics & Policy, a Washington DC-based public health research organisation
The views expressed are personal
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