Some thoughts on Covid-19

The World Health Organization (WHO) and just about every country’s health department is advising quarantine. This is with good reason. Covid-19 is a very contagious virus and in a very short time it has reached all corners of the world. Naturally the aim of every government in the world is to minimize the fatalities. However, the strategy to save lives through lockdown has put the world economy into a tail spin. IMF report says that the global economy will contract by 3% this year- the steepest downturn since the Great Depression of the 1930s. In the best case scenario the world economy would lose $9 trillion over the next two years. Many countries will now go into economic recession. Andreas Kluth is a member of Bloomberg’s editorial board and in his article titled “This Pandemic Will Lead to Social Revolutions” Mr Kluth presents a very disturbing future projection of the world order which will see rampant social unrest and populist or radical movements.

The question on every body’s mind is for how long does the world remain in lockdown? One thing is for sure that by social isolation, quarantine or large scale testing we are not eradicating the virus. We are simply trying to minimize the collateral damage. From the examples of China and Singapore we can see that lockdown is only able to temporarily flatten the pandemic curve. As soon as normal activities resumed a second wave of infections surfaced. Singapore has once again enforced a lockdown. This means that the virus has not been eradicated in these countries. The wealthier countries may be able to afford the luxury of an extended lockdown but is it a viable proposition for the poor countries? In Bangladesh we are already seeing sporadic cases of anarchy where a truck carrying relief food has been ransacked by hungry people.

As I see it, the health experts’ strategy is to quarantine as many people as possible so that this segment of the population is not infected and thereby the strain on the health services and the number of deaths is reduced. This means that we have to brace ourselves for the massive surge in contamination amongst those who cannot be quarantined or do not have the means of “social isolation”.

If we look back to the 2003 corona virus called SARS which resulted in 8000 cases of infection and 800 deaths, we see that the scenario was quite different then. SARS also originated in China but at that time China was a much smaller economy and the world’s interconnectivity with China was much less than what it is today. Although 256 countries reported the SARS infection, the vast majority of the cases were concentrated in five countries: China, Taiwan, Hong Kong, Singapore and Canada. SARS was eventually contained by means of syndromic surveillance, prompt isolation of patients, strict enforcement of quarantine and in some areas enforcement of community quarantine. By interrupting all human to human transmission, SARS was effectively eradicated. SARS was first identified in Guangdong China in November 2002 and was finally brought under control in July 2003. By contrast the Covid-19 is a lot more contagious and has already spread all over the world with 1.75 million reported cases. Since the asymptomatic cases are unreported we can assume that the actual number of infected cases is much higher. Obviously it is no longer possible to contain this virus. More so because a patient could remain asymptomatic for 2-3 weeks and during this time s(he) could go around transmitting the infection.

R0 is a term defined by epidemiologists as “Basic Reproductive Ratio”. It is the number of people an infected person can infect. If R0 =1 it means that one person will only infect one person and in such cases the contamination graph will remain flat. If one person infects three people then R0 =3. For Covid-19 the Basic Reproductive Ratio is estimated as R3. Meaning one infected person infects three. The other term of relevance in epidemics is “Herd Immunization”. This means that by vaccination or infection if the Basic Reproductive Ratio can be brought to R0 the epidemic will be under control. The formula through which this is determined is (R-1)÷R. So for Covid-19 this would be (3-1)÷3= 2/3. Conclusion-  66% of the population would have to be vaccinated in order to flatten the epidemic curve. It is easy to see that even if a vaccine is found, inoculating 66% of the world’s population is near impossible.

Covid-19 will now run its full course which means that everyone who can be infected will be infected and those who recover from the illness will have developed immunity and will no longer be contagious. The Guardian in its report of 8 April 2020 comments that the lockdown must continue until a Covid-19 vaccine is found. All experts have said that an approved vaccine cannot be brought into the market before the end of the year under any circumstances. By then in all probability the Herd Immunization would have taken place meaning those not following the protocol of quarantine would have been infected and once they recover and are no longer contagious, the world would be safe place.Unfortunately the time frame for this scenario to play out is so long that it is impossible for the world economy to remain in lockdown for the duration of such Herd Immunization.

The Washington Post published a very interesting computer simulation of an epidemic showing the outcome of four different scenarios where in a community 1.Every one moves around without any regard to the epidemic. 2. A Forced quarantine such as the one imposed in Hubei province but where those who move out of the quarantine show no respect for “social distancing” 3. Where a quarter of the population moves around freely and the other three quarter maintains social distancing and 4. Where one of every eight people move around freely and the rest maintain social distancing. Not surprisingly the worst result was with the first scenario of total disregard to the epidemic. However what was unexpected is that the moderate social distancing yielded better results than the forced quarantine and the extensive social distancing yielded the best results. You may be interested to check this out on https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

The Swedish government has steadfastly refused to impose a lockdown. Korea has also not gone for a lockdown. The results of these countries is a lot better than the most other countries. The fact is that an indefinite lockdown is not a viable proposition for any country and least of all for poor countries like ours. Our government has announced a public holiday from March 26^th and in instalments this has now been extended to April 25^th. We have shut down our economy under the pretext of being in quarantine but in reality what percentage of our people are in quarantine? I see hordes of people snuggled together in lines for food; I see hundreds of workers in close proximity to each other blocking roads demanding their wages; I see thousands of people living in slums where it is impossible to maintain social isolation. So how is this type of quarantine and lockdown working for us?  The World Bank has projected our growth rate to come down to 2-3 percent in 2020. Would we be able to withstand the social implications of this recession?

There are many things unknown about this virus. It is possible that it is a seasonal virus which will go away with the warmer weather. It is also possible that it will mutate and become a much less deadly threat. It could also become a seasonal disease like the flu or the common cold which appears every year but the future versions may be less contagious or less fatal. We have to accept that viruses are a part of our earth’s eco system and they will always be here. They will strike us periodically and take a toll on human lives and this has been going on from time immemorial. Mankind has been ravaged by all types of pandemics like the plague, small pox, measles, malaria, Spanish flu, earlier corona viruses like the SARS, MERS, Swine Flu and many more. The world must prepare itself to be ready when the different viruses strike. Every time there will be a loss of human lives. We can only but try to minimize that loss but at the same time we have to be careful not to cause a complete economic and social structure breakdown by shutting down the world economy.

There is a mass hysteria and panic about the Covid-19. News channels showing harrowing scenes of over flowing hospitals and mortuaries in Italy have sent a chill down the spine of people all over the world. But it is also a fact that in Italy more than 99% of the fatalities from Covid-19 occurred among people who had underlying medical conditions.

WHO has put the world wide death rate from Covid-19 at 3.4% but a study in Nature Medicine put it much lower at 1.4%. The fact is that with many cases going unreported and untested, mild and asymptomatic cases may not be included in official Covid-19 infection figures thereby showing a much higher fatality percentage. Internationally renowned Dr. Nageshwar Reddy says that there is difference in the genome sequence of the virus that hit Italy and the one that after mutation has come to India. Dr. Reddy is of the opinion that the Italian corona virus has had three mutations in the spike protein whereas the Indian corona virus has had only one small mutation which makes the attachment to the human cell weak.

Irrespective of the genome sequence of the corona virus in Bangladesh what is universally true is that those who have a strong immune system will be able to overcome the illness if infected. People with a compromised immune system are at a much higher risk of fatality from the Covid-19. Weak immune system is not only due to some underlying medical condition(s). One can also jeopardize his/her immune system due to poor life style. Here are some suggestions to improve the immune system.

*Eat right

*Exercise

*Get enough sleep

*Minimize stress

*Get enough sunshine because it has vitamin D and this is a great booster of our immune system.

*During this pandemic take high dosage of Vitamin C. This is known to fight viral infections.

*Take a Zinc supplement which also works as a prophylactic against viral infections.

Just a few words about Eating right. There are some basic dietary protocols we can follow to improve our immune system. Do not consume sugary foods. These adversely affect our insulin and leptin resistance which weakens the immune system. It is a misconception that sugar is to be avoided only by those suffering from diabetes. Sugar is harmful for everyone.

This scourge will also go away and in sha Allah we will see happy days. It is very important that we maintain a positive mental attitude during this time of distress. Negative thoughts and fear increase our stress levels and make us more susceptible to maladies. Let us use this time to become better. Let us learn something new; let us connect with friends and family who we have not been in touch with due to our busy lives; let us use this time to build our bonds with our near and dear ones; let us try to help those who are in distress to whatever extent that we possibly can.

Let us remember that we humans are the best of the Creator’s creation and the strength and spirit of humanity can overcome every adversity.