At the time of writing, there had been around 4.8 million cases of the novel coronavirus around the world, and more than 320,000 deaths. In India, over 96,000 cases and 3,000 deaths have been reported thus far. The first case in the country was reported on January 29, in Kerala. But 15 weeks and over 2.2 million tests later, we are still not sure whether we’ve managed to flatten the curve, when the peak will come and, ultimately, when life will return to ‘normal’.
We don’t know how to treat COVID-19, aside from treating its symptoms. Researchers and doctors have tried a cocktail of drugs and therapeutic regimes, including non-allopathic medications, but an effective, universally accepted therapy is yet to take shape. The virus is also mutating but we don’t know if a mutated strain will have different characteristics and virulence. We also don’t know if, once we’ve recovered from a COVID-19 infection, we become immune to future infections and for how long.
Two recent studies have shown that T-cell-mediated immunity is also involved, apart from antibodies, in beating the disease. The researchers who conducted these studies also found that a prior infection by a different coronavirus could produce T-cells that also fight the new coronavirus. However, we don’t know for sure if these immune responses could entirely protect against COVID-19. And while we know now that dogs and cats can become infected by the new coronavirus from a human, we don’t know if dogs and cats can infect humans.
Finally, we don’t know for sure if we can develop an effective vaccine against the new virus despite the breakneck speed and intensity with which many research groups are trying. So in many ways, we’re still groping in the dark.
Thankfully, there are some things we know for sure. For example, we know that the disease is spreading via respiratory droplets. We know males and elderly with comorbid conditions are more at risk of dying. We know children aren’t immune to a COVID-19 infection but are far more unlikely to die of it. We know the virus attacks those organs that express the ACE2 enzyme more.
We also know that the COVID-19 epidemic in India hasn’t been as lethal as it has in many other countries, especially in Europe and the US. The death rate in India is 2 per million people versus 275 in the US; 511 in the UK 511; 528 in Italy; 591 in Spain; 431 in France; and 781 in Belgium. Even the case fatality rate (total deaths per 100 cases reported) is quite low: 6.6% v. 3.2% around the world. An overwhelming majority of those infected in India are mildly symptomatic or asymptomatic; only 15% need hospitalisation and 5% need intensive care.
Considered in context
The current outbreak is following the same trajectory as the last pandemic, of the A/H1N1 influenza in 2008-2009. Both diseases share the common presentation and geographical spread.
|Onset||December 2019, winter||
March 2009, spring
|India onset||January 2020, Kerala||
May 2009, Hyderabad
|Cause||SARS-CoV-2 (RNA virus)||
Influenza A,H1N1(RNA virus)
|Incubation||2-14 days||1-4 days|
|Case count (global)||4,804,011 (till May 18, 2020)||
|Case count (India)||95,698 (till May 18, 2020)||
|Mode of transmission||Respiratory, droplets||
> 75% urban dwellers
|Most affected||21-40 years||20-39 years|
|Presentation||Mainly respiratory system (URI and LRI); multisystem involvement in few||
Mainly respiratory system (URI and LRI)
|Treatment||Empirical, symptomatic, no specific medicine||
Anti-flu antivirals (Oseltamivir: questionable efficacy)
|Post-infectious immunity||Partial immune protection/
Partial (owing to previous H1N1 pandemic)
|Total deaths (Global)||316,703 (till May 18, 2020)||
|Total deaths (India)||3,025 (till May 18, 2020)||
|Highest mortality (India)||Elderly and those with co-morbidities||
Elderly and young children (0-5 yrs)
|Post-pandemic surges||In pandemic stage as of now||
Yes, from August 2010-2015, became part of seasonal flu
|Case fatality rate (%) Global||6.6 % (40.6 deaths per million) *||1.13%|
|Case fatality rate (%) India||3.2 % (2.0 deaths per million) *||6.04%|
|States having highest number of cases||MH, GJ, TN, DEL, RJ, & MP||
DEL, MH, KAR, RJ, TN, & KL
|States having highest number of deaths||MH, GJ, MP, RJ, DL, & WB||
MH, GJ, RJ, KR, DL, & MP
|Cessation of pandemic||Not over yet (Still going on)||
August 2010 (first major phase)
* Exact calculation of CFR is not possible as pandemic is ongoing: 55,878 cases (out of 95,698 ) in India are still active, under treatment.
When the A/H1N1 pandemic ended, WHO said the virus’s outbreak had fallen back to its original, seasonal pattern. This time round as well, a senior WHO official said the novel coronavirus won’t be eradicated but will live with us, probably for the next few years. And we will have to learn to live with it.
This being the case, we must ask ourselves why we’re getting working up looking at the numbers every day. Thus far, around 100-150 people are dying every day due to COVID-19 – and over 18,600 people are dying every day due to other diseases. Tuberculosis alone accounts for 1,232 of them. Many of these non-COVID-19 deaths are either not reported or are ignored because we’re distracted by the pandemic.
Second, India is conducting almost one lakh RT-PCR tests every day, and the associated expenses amount to Rs 45 crore per day and Rs 1,350 crore per month. Many of the tests’ results are false positives or false negatives, and most of those being tested are asymptomatic or mildly symptomatic. Four months is enough time to learn of the nature of the pandemic, so when we don’t have enough answers, it’s time to ask if our testing strategy was justified.
Indeed, since we also expect the virus to become endemic, like many other infectious diseases, such a great expense seems almost superfluous. It would be better to economise the testing strategy and divert a portion of the spared funds to improve our poor primary health infrastructure.
More broadly, the need of the hour is to shed our obsession with the numbers, stop performing unnecessary tests and create a scare in the community, stop needless quarantines and sealing off entire localities and health establishments. Instead, we should focus on the sick and the susceptible. We should treat this disease as yet another infectious disease, treat the critically ill and test only those displaying symptoms and those at greater risk of getting the virus. Only symptomatic patients should be followed up, and thoroughly so.
Almost all Indians will likely be infected over the next few years. COVID-19 is not as fatal as the infections caused by the Nipah or Ebola viruses, nor the plague. So let us act based on what we know – instead of what we think we know – and open the economy, protect the more vulnerable among us, and follow non-pharmacological protocols like wearing masks, washing our hands, and maintaining physical distancing. These measures will take care of this disease as well as many other respiratory infectious diseases like it.
Dr Vipin Vashishtha is a former national convener of the Indian Academy of Paediatrics Committee on Immunisation and is a pediatric generalist and neonatologist at the Mangla Hospital and Research Centre, Bijnor.