India-Corona is already here, in the asymptomatic youth

Shutting down India won’t be enough, save the old from the young

Yesterday I called my younger brother Vipul, a doctor in New York, after reading about how doctors are increasingly getting infected in Europe.

He told me that there is no hiding for him anymore — Corona is here. He had many patients admitted already, and many doctors and people are coughing. It seems like the world is already infected, we are just not accepting it, still hoping somehow we won’t get it. While the top scientists are saying, 70% of the world will get infected and most of us will just get a routine viral fever.

My younger brother is at the frontline of the war, while I am hiding in my room at Stanford, how ironic. Tables have indeed turned in my life; fear like most of the world had gotten to best of me. How far I have come, from being a doctor in Lok Nayak Hospital, Delhi, from being the IAS commissioner of Kota city Municipal Corporation. This is the time to act not hide.

What will happen to my brother in New York, to my grandfather in Jind, to my dear country India? What should I do? The picture seems very grim, from my viewpoint. But l must tell you what I am thinking. I have to prepare you; a lot of youth already have Coronavirus; they are just asymptomatic.

What is happening in the world

In the past three months, countries after countries are getting engulfed in the wave of Corona — China, the USA, Italy, Iran, and many more. The political leadership everywhere played it cool until the health ministers and presidents themselves started falling sick; until mass graves were detected from the sky; until doctors were forced to decide who to save and who to let die; until not even a single person was left on the bustling streets of Rome.

Leaders have to keep calm and show strength; to keep the countries together. Yet, at the same time, their response can’t be guided by ignorance. Most of our knowledge of Corona is just two weeks old. However, two weeks seem a lifetime for Corona. We must learn from the mistakes and successes of China, Italy, Korea; and learn very fast, we only have one chance.

Stage of Denial

They say India will probably not see the worst of the infection, or we will be able to get away just by handwashing. Well, that reminds me of a childhood story, “When a pigeon sees a cat, it closes its eyes. That way, It assumes that since the pigeon can’t see the cat, the cat does not exist.”

People in my home town are thinking China, Italy, are already struggling so is the USA, and they are safe, life is just normal. They need to know, that the virus will erupt once it has built up a self-sustainable base in the community. Real-world doesn’t work like, “The Walking Dead”.

Don’t be delusional; all the countries of the world are on the same path. It takes for any infection, a specific time, and a minimum no of infected people to start a chain reaction, and once that happens, there is no stopping it. The time from the first infection to the thousandth, from first death to the thousandth, is the same in each country, not even a single exception. India is where Italy was three weeks back, and the USA was ten days back. We all are on the same path. After a threshold of 200 diagnosed cases and ten deaths, infection doubles every third day.

See this data for yourself.

ourworldindata.org

Well, you would reach a conclusion lets quarantine these 100 infected, and stop the new ones from entering the nation and we will be fine. That is where we are making a serious mistake as a nation; real infected numbers are hundreds of times the diagnosed cases. This is because of asymptomatic adults, who have the infection but no symptoms. This calls for a rethinking of our current national efforts.

We have to change the path, by national will and strong action, and I am sure we will.

Case of asymptomatic infected- Good and bad news

People show signs of fever after ten days of incubation, while they are still infected from the first day. At most ports of entries internationally, screening is only for the fever. Only symptomatic come in hospitals to get tested. That too if we have enough testing kits. We are no different than the world; we have no alternative; no country has that many testing kits to check every single individual.

Well, one country just did that, what can we learn from them.

South Korea is the only country that tested asymptomatic under thirty; they were positive for the virus, yet no fever or other signs. And the death rate is nearly zero in this population group.

What does that tell us? That under thirty or even under forty population is infected much more than our current estimates. The focus should be on the transmission from young people with a mortality rate of near-zero to those above 50. Above 50, the mortality rate rises exponentially from .4% to 7.2% in people older than 80. That’s why 350 people died in Italy in the last 24hrs.

statista.com

The life cycle of corona infection

Two third of us will get infected today, next month or in a year. We have no immunity to it, and no one can escape it. No vaccine will come before one year. Out of each hundred infected people, twenty will end up in the hospital and up to ten in ICU. Out of each hundred!!

The overall death rate is 1%, but with a well-functioning health system. In an overburdened system like Delhi, with only 8000 ICU beds, serving a population of 20 million, the death rate can be ten times, 10%, even more, especially in above 60. While most of those younger than 30 will get an episode of viral fever.

Current National efforts

As of now, our national efforts have been focussed on finding symptomatic individuals of any age and to self quarantine them. Checking people for fever and running a handwashing and social isolation campaign.

If we believe the data, the virus is much more spread out in the young population even before the first casualty. Probably behind one death, there are more than 10000 asymptomatic adults in the population and in multiple cities.

Now is the time to rethink how screening at the airports will be enough when a lot of our under 30 population is already infected. If we have all diagnosed cases in hospital than why is the infection increasing? Should we be really going after each diagnosed case with all the agencies? I have seen files notings by municipal bodies tracking each case, I fear it's a little late for that.

A random test on 1000 people under the age of thirty in metros can confirm the finding. At such a moment, shouldn’t we start focusing on the vulnerable groups?

Social distancing is a must for young or elderly to stop further transmission. But, are our social distancing protocols short-sighted? Maybe we should keep in mind the virus is very well in circulation, not just outside borders and in hospitals, only in a few individuals.

Our preparedness as a country

A doctor friend told me that in Italy, patients older than 65 are not getting intubated; in short, they are being left to die. Left to die because doctors and equipments are limited. This is a country with the second-best healthcare system in the world; Indian healthcare is at 112th place.

In the year 2018, we had thirty-plus deaths in the city of Kota because of dengue. Even after deploying full might of government, the system not only failed to control the infection but also couldn’t even agree on the numbers of deceased people. And surprisingly, this was with just 200–300 total cases spread across four months.

But Corona is no Dengue, it spreads like a jungle fire, much faster than mosquitoes, engulfing millions in a few weeks.

What to do

Our developing nation is unique. While we have no dearth of courage and fighting spirit, yet we are limited by our resources. We have far fewer hospital beds than the world; our cities are more crowded, and our people too simple to fathom the complexity of such an infection.

No one can concretely say if the summer will impact the virus. I know every part of your body wants to believe that, but it’s not scientifically proven as of now, just blind hope. Spanish flu came in March 1918. The second wave after a break in summer was much, much more deadly!!

Locking down the country of a billion from outside will not be enough now. Neither will be tracking each case as it comes. We have the virus in good enough circulation nationally.

Save the old from young, not the young from outsiders. Minimize the contact of elders; people above sixty should not meet below 40 in any case — separate rooms and bathrooms in houses. A national campaign can be run to keep them isolated.

Social distancing protocols is a must for young or elderly to stop further transmission. Suspending exams and schools fully, all non-urgent government offices must be shut. All assemblies above 25 to be banned before its too late. Give people a paid holiday, subsidiary allowance, wage protection.

On January 24th China shut down 15 cities. And that was the only way for them to control things. We might have to also start thinking on those lines now. This is the final solution, stop every social contact for 2–3 weeks, and the virus will perish on a large scale. But when to do it? I don't know that.

Can Corona eliminate us from the earth? Not at all.

We, as a nation, have survived much more than just a virus. But will it take the lives of many loved ones? Most probably. Will it disturb the process of nation-building? Definitely. The government has courageously taken steps of closing down the borders and schools. They have timely brought back our citizens stranded in Italy and Iran.

We are a country of armchair critics, who will soon start evaluating every governmental action, by new limits on civil liberties and economic hardship. In this emergency, many steps must be taken against popular opinion. Everywhere the governments are being too cautious in taking the necessary steps, just to avoid the political fallouts. Soon the government will run out of options, and we will blame them, without realizing, they didn’t bring the virus, they didn’t build the poor healthcare infrastructure in the last sixty years. Our criticism will only tie their hands further and lead to policy paralysis.

We need to stand with our national leaders and tell them, “Take as hard decisions you need to take, bring the nation to stand still, but make sure we don’t lose millions of lives. And we will never judge you for failing if you try your very best.”

To summarize, “Infection is much more than the cases, Save the old from young, and Keep young away from each other to stop the spread.”

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