On our 74th Independence Day, 62,512 Indians tested positive for COVID-19. It was the highest daily count thus far. With that, we won the dubious distinction of heading the global figures for the pandemic by pipping the United States at the post.
Eight months is a long time. UNICEF reckons 392,000 babies were born on new year’s day. Of these, 67,385 were born in India. These babies, and the many more that followed, inherit a benumbed and panicked world. This landscape of desolation will be their norm. I write this appeal for them, and for their parents.
This ‘norm’ we have maintained for eight months hasn’t worked. We adhere to it because COVID-19 is the central event in our lives. Everything revolves around it. Its ambit extends beyond disease, its reach beyond death, into lives that are yet to unfold. COVID-19 calls the shots, and unquestioningly, we obey.
It is high time we questioned our terror, and our terror of the consequences of refusing that terror.
The norm is diktat. We know this because we have seen the political turn deeply personal. This pandemic has been used, time and time again in these eight months, as both smokescreen and exculpation for abhorrent acts of cruelty and injustice. All around the world, the crumbling façade – for a façade it has long been – of humanitarian governance exposes the true extent of impoverishment and helplessness.
The norm is a paternalistic trope: it’s for your own good; it hurts me more than it hurts you. It is menacingly, chillingly, inescapably fascist. We are expected to believe that if this norm is maintained, we will be free of the pandemic.
That’s the credo.
Mask, scrub, isolate, and all will be well.
But it isn’t, is it?
Yes, we do need to mask, scrub, isolate. But it is no longer enough. That was only the standard knee-jerk response to an unknown contagion. It has worn the honourable badge of failure since it was instituted in 1348 in Ragusa (today’s Dubrovnik) as a measure against the Black Death.
Pundits push encouraging figures like bankers peddling stock-market abstractions, but our experiential is deeply discouraging. COVID-19 is everywhere, and the norm has neither contained, nor controlled, nor cured it.
Gagged, blinkered, incarcerated, we are still infected. We still infect. We still suffer. And we die. And past a short post-recovery phase, we do not sustain an immune response.
I hear everywhere the question – What else can one do?
When the first cases of what is now COVID-19 were reported from Wuhan, every doctor recognised a few simple truths about this disease. I did, too. Anybody who has treated respiratory illnesses is familiar with the frightening complication of pneumonia, called acute respiratory distress syndrome (ARDS). We are aware of the broad spectrum of diverse illnesses that can terminate in this disaster. We know its mechanics, its disordered chemistry. It was all old hat. And this was a new virus playing to an old script. That was the scary bit.
Most of the other illnesses that ended up in ARDS were noncommunicable. This one was very quickly communicable.
Another problem soon popped up: you could catch infection from people who showed no trace of sickness. This placed everyone under suspicion. A harsh and punitive lockdown was clamped. And a wonderful thing happened. The outbreak stopped. Everyone cheered.
In the rush to claim credit for the lockdown, most people ignored a parallel happening.
Wuhan had changed within a week of the lockdown. I had monitored this change with great curiosity, watched the air quality go from ‘dismal’ to ‘healthy’ as the smog lifted. Over the next fortnight, Wuhan had blue skies. To me, there was a clear correlation between the end of the outbreak and improved air quality. The reason should be obvious to anybody with even a cursory knowledge of the impact of particulates on the lung.
The changes within the lung have all the implausible drama of Elizabethan tragedy, Webster for choice. It seemed to me that the first step to contain this epidemic should be to improve air quality. My opinion had no takers.
Equally clear by February was the profile of COVID-19. It would not, could not, confine itself to the lung because it was essentially not about the virus, but about us. It was an uncontrolled, and uncontrollable, inflammation set up by a disordered immune response. It was obvious that COVID-19 would claim the greatest casualties among those whose bodies were already in the grip of chronic inflammatory diseases. These illnesses usually carry a misleading euphemism that is almost aspirational: lifestyle illnesses. These non-communicable illnesses are the world’s leading killers.
Cardiovascular disease: hypertension, heart disease, stroke.
They have a common denominator: the silent killer, obesity.
Kidney disease, arthritis, autoimmune diseases, the list of chronic inflammatory illnesses could fill this page.
There was also the vexed question of age: the aging body is in an enhanced state of inflammation, a condition rather rudely called ‘inflammaging’. COVID-19, it seemed to me, would target all these vulnerables. Again, the idea had no takers.
Because of my interest in zoonoses, I didn’t buy into the ‘wet market’ story. There are bats everywhere, and they are among the most vagile creatures known. The logic of transmission could never be as linear as the pundits had us believing. This virus, like most others, is autochthonous, and multiple spillovers were likely. This thought too had no takers.
As journal after journal slammed its doors on me, I gladly got down to what I usually do. I wrote a book as the pandemic unfolded. By the time it was done, there was growing evidence, at least, of the vulnerable groups. With a data cut-off at the end of June, my book has been waiting a long time to see print. During this waiting period, many of the thoughts in the book have gained an international blessing as ‘new research’. I hope this will prompt the necessary U-turn in our strategy against COVID-19.
The battles for health are not fought in the corridors of power nor in cyberspace, but at the bedside. These past months have been a litany of horrific disasters as the dying are refused care at hospitals, rejected by their families, who in turn are barricaded out of the community. The humiliation continues past death: corpses pile up unclaimed in hospital corridors and morgues. Nobody, it seems, will have anything to do with a COVID-19 patient, alive or dead.
Even the worst excesses of historic plagues pale before the barbarities of our enlightened times.
We seem to have resigned ourselves to the mechanical response of carrying out instructions with ritualistic fervour.
COVID-19 may well be the beginning of a new religion, so abject is our surrender to its diktat. And like all religions do, COVID-19 has fragmented the holon of humanity.
What we need is ubuntu. The Bantu word translates roughly as ‘I cannot exist without you’. Its philosophy can cement the cracks and get us moving again as a society to protect and cherish each other. The time for that understanding is now.
Now that science is making this U-turn, where do we stand with COVID-19?
The term ‘co-morbidities’ has eased its way into common parlance. It is a stupid label, really, because it doesn’t convey the message ‘this is me’. Breaking up the term into its component diseases will do that.
We now know that one out of every five people with COVID-19 will land up with serious complications because of one, or more, underlying disease. These are all diseases of chronic inflammation. Think of that. Out of the global population, one-fifth is doomed if they catch the virus. That is, roughly, the population of India. I don’t give a damn about statistics, so I’ll translate that down to your household, to ask:
How many members in your family have an illness of chronic inflammation? High blood pressure? Diabetes? Obesity? Arthritis?
Are they being treated for these illnesses?
Are they being protected from worsening by the right decisions about nutrition, activity and sleep?
By addressing these questions, you would have moved your loved ones a little further out of the high-risk zone for COVID-19.
It is as simple as that.
There is no drug, there is no vaccine, but we still have ourselves and basic medical care. That structure has wobbled these past months as all other illnesses have gone underground – but it can be steadied and strengthened.
If you’ve followed the spread of this pandemic, you’ll know now that the concept of linear transmission is a fairytale. If you wisely refuse to look at animated informatics, your surroundings, no matter where you live, will provide anecdotes of people who turned up positive for COVID-19 without having crossed paths with infected people. Some of them were even carefully isolated at home, avoiding all human contact.
It is time we assumed that we are all breathing in this virus, and we will not necessarily be sick.
Let’s get real about this.
It is common knowledge that we inhale and exhale trillions of bacteria and viruses every day, and maintain perfect health. The average doctor in any general hospital is a walking example.
The truth is: we can’t avoid the virus. It is, by now, everywhere. Its iterations are too numerous to be counted, and yet, not necessarily growing in virulence.
Why then do we fall sick?
Today, there is enough literature to support what most doctors knew for certain when COVID-19 showed up in Wuhan. This is an illness that kills by altering the immune response. The initial cases had ARDS, a familiar manifestation in many fatal respiratory conditions. It was not the virus but the body’s inflammatory response that set off the final disaster.
Inflammation is a very complicated and finely balanced body process. Knocked off balance, it causes uncontrolled and uncontrollable tissue destruction. This is what COVID-19 is all about.
Eight months on, we are no longer myopic enough to imagine that the tissue destruction in COVID-19 will be limited to the lungs. Every body system can be targeted.
Can we limit the ravages of this disease?
We do have a handful of molecules that can serve as biomarkers to monitor the progress of the disordered immune process in this disease. As yet there is little consensus on how these signposts can be addressed. And rightly so, for the doctor’s decision is based on the individual patient, not on some protocol devised outside the exigency.
What do we know about immunity against COVID-19?
In one word: nothing.
Research piles up conflicting reports, as we scan them for glimmers of practical guidance. Humoral immunity – the production of antibodies by immune cells – is disappointingly unreliable.
‘Neutralising antibodies’ are molecules produced by the B-cells, which bind with cell-free viruses and prevent them from infecting other cells. They can block the action of the virus in a number of ways, all of which are being scrutinised to design possible therapies or vaccines.
Asymptomatic, mild or moderately affected patients don’t always produce satisfactory neutralising antibodies. Antibody response in COVID-19 is iffy. The other arm of defence – cellular immunity – might prove a little stronger, it now appears.
Patients convalescing from COVID-19 have been tested for T-cell responses against the two principal SARS-CoV-2 antigens. Strong T-cell responses were elicited in people recovering from severe infections; weaker responses were noted in the mildly affected and in asymptomatic caregivers.
Robust T-cell responses were seen in people with no neutralising antibodies. Seroprevalence may not be an adequate indicator of ‘herd immunity’.
Natural exposure, or infection, may prevent recurrent episodes of severe COVID-19. Mild and asymptomatic infections are much more common.
There is also cross-reactivity between T-cells responding to common cold coronaviruses and those specific to SARS-CoV-2. Which means we could have immunity against COVID-19 without ever having met its virus.
Just one pixel more in the growing portrait of this complex disease.
The word ‘immunity’ is yoked to the word ‘vaccine’. A simple faith in this duality powers our hope. Here, then, is the state of affairs.
The genome of SARS-CoV-2 was announced on January 11. From then on, numerous efforts have strained at developing a vaccine. The first of these vaccines was tried on a human volunteer on March 16.
That is probably the quickest ever in science.
Many different vaccine ‘platforms’ are under investigation. Some of these have never been explored before, and it is exciting to see how diverse they are.
Will the vaccine act? And on everybody? Should there be different vaccines sorted by patient groups or geography? How long will immunity last?
This last question has prompted comparisons with influenza vaccines, but that may not be an accurate parallel. The mutation rate of SARS-CoV-2 is relatively slow for a RNA virus. And natural immunity against SARS-CoV-1 is pretty long term, so this may be the more logical comparison.
Introducing a vaccine amidst the asymptomatic prevalence of a disease that wreaks hell on the immune process should come with a great deal of caution. Which means with no shortcuts – or the damage can be unimaginable.
We cannot, rather should not, expect a safe vaccine before the early months of 2021. And then there will be questions of manufacture, supply and, most importantly, reach.
All said, the vaccine, one that’s safe and effective, is nearly a year away.
What do we do until then?
This question, and the glaring fact that we have no therapies, has prompted the U-turn. Yes, we have drugs we can turn to as complications crop up one after another, but we have nothing that can stave off each potentially fatal complication. The answer is clear: if policy won’t change, we must.
Our body is not state property. It is our individual responsibility. Let’s protect it from illness, from disaster, from manipulation.
If we remain enslaved to policy, we aren’t taking this responsibility seriously.
Atithi devo bhavah is often misread as ‘revere the guest’. The literal meaning of ‘atithi’ is ‘unexpected’. The aphorism translates more correctly as ‘revere the stranger’. This tradition is desecrated in today’s xenophobic India where every other person is contagion. The truth is none of us can exist without the next person. Physical isolation is a safety measure. Social isolation, or shunning, is self-destructive.
Meanwhile, the reality of COVID-19 is the torture of anxiety, physical suffering and the anguish of loss. And for those who are spared all this, there still is the dread of penury and starvation.
In India, particularly, the loss of livelihood has ruined millions of families. The worst affected are India’s invisibles – children. They have been robbed of tomorrow, and they are all the future we have. We are a nation primed to self-destruct.
Our inability to assume responsibility comes from fear. Fear, not just of contagion and suffering, but a fear much more menacing. The fear of rejection. In a fragmented society that is based on exclusion, this the deepest of all human terrors.
To many, even before lockdown and social isolation became the norm, the smartphone screen was the chosen interface with the external world. Now, of course, the phone is a lifeline. We are already at a stage where reality requires a virtual presence for comprehension, perception, acceptance.
In the real world, acceptance and rejection inform and determine life decisions. But these decisions are private, as are the joys and sorrows that compel them. On social media, worth is measured by likes, friends, followers. It is always open season for comment and insult. It is all too easy to feel unloved and isolated on social media – and who wants that? The need for approval informs every digital decision. It is a shaming quality in the real world, but in the cyberverse, it is ambition.
This makes the response near-Pavlovian in its predictability. Indeed, Ivan Pavlov’s famous experiments on dogs should be enshrined as Internet Apocrypha. And the infamous Cupertino effect, the autocorrect gibberish which now is a texting norm, may well become the future of human thought. We may even be, right now, doing that happening thing. Transitioning.
Transitioning from Homo sapiens to Homo stultus.
On July 11, 1564 , John Bretchgirdle, vicar of the Holy Trinity Church, Stratford-upon-Avon, inaugurated the plague with the words hic incipit pestis. That epidemic would go on to claim 80,000 lives in England. An infant, baptised by Bretchgirdle on April 26, 1564, would survive that plague. His gift of reason would outlive him. It has delighted and inspired humanity ever since.
William Shakespeare’s brief lifetime (1564-1616) was repeatedly circumstanced by bubonic plague, especially the outbreaks of 1578-9, 1582, 1592-3 and 1603. The cornucopia of his talents may have been nurtured by the plague, but it did not merit notice in his writing. It hardly ever appeared on stage, but it lurked in the wings with the prompt book. When all else failed, accidents, misunderstanding, treachery and tragedy could be blamed on the plague.
If it is an exposition of the plague you’re looking for, you won’t find it in Shakespeare. For that, Thomas Dekker, indefatigable pamphleteer and sometime playwright, is your man. The Wonderfull Yeare documents the plague of 1603 in harrowing detail. Dekker’s picaresque tabloidism, since forgotten, perhaps even in his time, was no more than that – a chronicle of passing picayunes, today’s reality show.
They were both writers born into plague years, and acknowledging their obvious intellectual disparity, their views of the plague were distinctive. To Shakespeare the plague was circumstance, to Dekker the plague was event. To Shakespeare it was an interesting variable, only when all other variables failed, and never the demoralising force it was for Dekker. Shakespeare allowed human nature to express itself despite the plague.
I think of that contrast today, in our own plague year.
In 1603, with a London population of 100,000, on a good day, Dekker’s pamphlet might acquire a readership of a few hundred. They lapped up his stories of sick London, its victims and profiteers.
In 2020, Dekker seems a rollicking picaresque raconteur. In 1603, he was a reporter, and his readers relied on his veracity.
Compare Dekker’s readership with the reach of our social media. India has 280 million Facebook users. (The recent Wall Street Journal exposé detailing political manipulation of content merely confirmed an open secret.) Most social media users feel compelled to read their messages. Many forward them. Some respond. All think of this process as ‘communication’, a word that has somehow got confused with ‘truth’. The constant cerebral bombardment with such ‘communication’ is an effective tool of control. Over the past months, it has held us paralysed, catatonic in terror.
Somebody has to say it, and I will. This virus, like innumerable viruses in nature, will soon be a part of our ambience. It will erupt now and then as outbreaks. But most of the time it will grumble on as a chronic and troublesome infection.
Forget making a vaccine at warp speed. As if the truth of science can be hurried by the stupid exigencies of politics! Ronald Reagan spent one term of his presidency denying AIDS and the second promising a vaccine against it. Forty years down the line, we have adjusted to AIDS as a chronic illness and there is still no vaccine.
COVID-19 is here to stay. Statistical modelling and predictions are meaningless. It will prove more intelligent to look at environmental disturbances that induce spillovers, and cause zoonoses to emerge. Cutting down a tree during a pandemic may spell a death sentence on the surrounding population.
Above all, playing possum won’t help. Open your eyes, the predator is still among us. We need to regroup and re-strategise. Identify vulnerable groups, and make certain they have the necessary resources to access treatment.
The only way we lose our fear of contagion is to step out and engage the afflicted. This will take away the stress of concealment and the dread of punishment from those suffering the illness.
COVID-19 may be our last chance to regain humanity. We can’t do it in a clench of dread. Can we risk it? I think the moment we step forward and grasp life, this pandemic will be over.
Shakespeare and Dekker made different choices as they wrote through plague after plague. The drill in their time was very like our COVID-19 rules, except that masks were restricted to health care workers.
To Shakespeare, the plague never was.
To Dekker, nothing else was.
We too can choose. We can choose to continue in the fear psychosis of Mask-Scrub-Isolate-and-All Will Be Well, stockpile drugs that don’t work, adorn fingertips with oximeters, cram the kitchen with oxygen cylinders, divide our attention between WhatsApp and YouTube, vacillate between TikTok and Twitter, bribe or threaten for hospital beds at first sniffle, barricade or imprison sick neighbours, bang thalis, light candles, throw our dead relatives on dungheaps, and wait for a vaccine which may never come.
Or we can choose to take responsibility for our health. We can clean up the air and stop damaging the environment. And perhaps, in the process, become human again.
Surgeons Ishrat Syed and Kalpana Swaminathan write together as Kalpish Ratna. In The Secret Life of Zika Virus (2017), they examined the emergence of congenital Zika syndrome. Their last book was Synapse (2019). Their newest book, A Crown of Thorns—The Coronavirus & Us, will be released on August 24, 2020.
The editor acknowledges the help of Ayushi Agarwal, currently interning at The Wire.