Citizens’ war against an enemy unknown; the rich can’t win without taking the poor on board

Surely, the novel highly contagious virus covid-19 threateningly embodies secrets the humankind’s scientific knowledge is struggling to explore and decipher to contain and crush the deadly disease that first raised its ugly head in China. The foremost question that confronts us all in India at the moment is whether the 21 days lockdown announced by our government is good enough to block the virus in its tracks?

When it’s found, the answer will be of relevance to the entire world. No country, not even those best endowed in terms of money, technology and scientific know-how, is safe from the hitherto unknown enemy. That it’ll be more lethal than even a less likely nuclear war was predicted as far back in 2015 by Bill Gates in a TED talk he delivered on the possibility of a pandemic attack without, of course, knowing the specific nature of the scourge.

That Bill Gates foresaw a pandemic was in itself significant. But he wasn’t heard in his own country, as proved by the United States’ abysmal preparedness. The country from where Bill Gates comes currently has the highest reported cases of the corona at over 82,000 and rising by the hour.

We doctors and medical researchers need time to analyse scientific data predicated on multiple trials before reaching reliable conclusions. But as per global trends, even if 10 people in a city are out on the road in a group, without maintaining social distancing and if that city is not insulated from commuters and non-sterile inanimate objects, then the lockdown will keep getting longer —and progressively ineffective!

Please note that this disease cannot be prevented with just a big section of the population staying indoors and other groups taking to streets for any religious cause or in search of food or withdrawal of money from ATMs. For any lockdown to successfully break the corona chain, potential and detected carriers have to be treated and isolated to cut transmission —for which human-to-human contact has to be reduced by almost 99%. That alone will lower the mortality rates besides the spread of the contagious and highly pathogenic covid-19.

In our country, unlike the US that still doesn’t have a countrywide lockdown, the Narendra Modi government’s decisions thus far have been good. Rather than commenting /debating on any lost time, we now should work 24×7 to mobilise and energise our existing resources in the paramedical field which in today’s day and age is a responsibility to be shared by every citizen!

Yes, every citizen! It’s not just the duty of the police, civic bodies, civil servants and politicians. Each one of us has to lend his shoulder to the wheel, proactively or honestly observing the lockdown. For we are in a veritable state of emergency, a medical emergency never has seen before by our country and our doctors who have made a name for themselves across the world including in countries rated high for their public health track record.

Interestingly, as a dermatologist, I have often come across wealthy patients boastfully demonstrative of their spending power to engage doctors to rid them of skin ailments that smudge their persona, their well-heeled personality. The hardest part of treating such people was about telling that it wasn’t their money that’ll help; the real antidote was a healthy lifestyle to protect their glowing skins from allergies. It was more so during Delhi’s bouts of air emergencies in the winter months.

Mankind’s disregard of environment and relentless pillaging of nature’s bounties have brought upon us the Tsunamis and the viral threats that we are battling. We are today in a situation where our monies have no guarantee for good health. It’s a community’s war to prevent the community spread of the disease in which an early test, on the strength of one’s wealth, can only mean early quarantine.

Rich or power, the citizens’ fates are joined.

Once we tide over the crisis, which I am confident we will, be in a radically changed world, globalisation weakened by hardened borders and protective businesses, trade practices and employment policies. In sum, wealth will become difficult to earn, leave alone amass or flaunt it. But that’s a story to be told later.

The pressing question today is as to what the lockdown means? In simple terms we are locking down against the virus which is not a living organism, but a protein molecule (DNA) covered by a protective layer of lipid (fat), which, when absorbed by the cells of the ocular, nasal or buccal mucosa, changes their genetic code and convert them into aggressor and multiplier cells. Death happens slowly due to blockage by the formation of a mucous membrane impacting the lungs and internal organs in later stages which can happen at varying speeds depending on the afflicted person’s immunity level.

But thankfully the mortality rate in covid-19 is lesser than previous viral invasions which have happened almost every decade. They have occurred also due to spillover from animals to human beings.

There was the Severe Acute Respiratory Syndrome SARS 2002 and Middle East Respiratory Syndrome MERS COV 2012. As per the World Health Organisation (WHO) MERS had a mortality rate of 34.4% and SARS 9.5%.

But fear and shock are the most in the case of SARS COV2 as it very innocently can be present on inanimate objects over varying times depending on the external environment: humidity, temperature and the type of material on which the virus is stuck. This virus will slowly decay; it won’t perish outside the human body as it’s not a living organism. Exactly, active hours are yet to be scientifically ascertained, but the standard time being taken is 12 hours.

The asymptomatic carrier stage of covid-19 is another reason for concern. Though It has high reproductive quotient in comparison to MERS and SARS, its pathogenicity appears to be much lesser.

Only if the lockdown is strictly followed —socially and medically—then  there can be the hope of breaking the viral chain. The risk to the national endeavour of checking the disease’s march is presented by helpless poor people, migrant daily wagers and other sections of the underprivileged who are stuck in the middle of nowhere. The lockdown meant concomitant stoppage of mass rapid transportation that could have taken them back to their native places from big cities where they worked.

The State has to take measures, some of which have been announced, to reach sustenance to such needy sections of our society. The same holds for doctors, paramedics, policemen and sanitary workers who need personal protective gear and equipment (PPE) of varied hue. It’s in this area that corporates, civil society organisations, charities and religious, political organisations can lend a hand to governments at the Centre and in States.

A larger potential problem is that this virus can probably last longer in faeces, as per Lancet. If that’s found to be the case, special means will have to be deployed for disposal of human waste of suspected and confirmed covid-19 cases besides the masks, gloves etc used by medical professionals attending on them. A herculean task indeed! But it’ll have to be performed.

The personal protective gear and equipment (PPEs) are of utmost importance as the risk of infection for medical personnel is 4% globally. It could be higher in India in certain states where the disposal of hospital waste will have to be with more stringent safeguards.

As more is less in such situations, the effort has to be national, not just governmental. Please note that the disease burden will only be higher with ignorance and poor hygiene. On the public outreach front, the two-pronged challenge is to have the “people informed and encouraged to perform” as citizens and public servants. There should be no unnecessary burden on our heath infrastructure that’s already overflowing with patients with other ailments, not just corona.

As a doctor, I am sanguine that we shall overcome the viral demon sooner than later. In this hour, all 1.35 billion Indians must be one team to decimate the common enemy. Leave personal ambitions, prejudices and politics aside. Because, as the PM said, JAAN HAI TOU JAHAAN HAI…..

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