Community transmission in India unlikely – unconventional approach and not tunnel vision needed, stop ouroboros effort

Should we chase the novel coronavirus or COVID 19 patients to address the crisis? 

The increasing number of coronavirus positive people in various parts of India on daily basis has warmed up a new debate on the community transmission of the virus.  If we go by the conventional definition of community transmission; i.e., when the source of infection is not known, that indicates community transmission; no one can deny the fact that the virus has entered into all most all communities in India, long before.  

India’s uniqueness, doesn’t sustain the text book definition of community transmission and therefore we must look at the picture differently?  

We are detecting mere RNA of the virus and not the live virus in most asymptomatic people. 

The question is should we need live virus or viral RNA is to cause infection? 

The virus does nothing but it injects its genetic material – RNA (DNA in the case of DNA viruses) into the cell and then multiplies.  If RNA also can cause infection means what is our comment about detecting RNA of the virus in metro water source in Chennai city sometime back.  Immediately the experts chirruped, that was dead virus and not the live one. 

If we also conduct the test for live virus also alongside RT-PCR, only then we can conclusively say who is infected and or infective to the community in India.  Such kind of testing is not possible in a country like India. 

When, what is supposedly we should do is not possible, we make what we do as absolute and allows nothing to exist beyond that.

Secondly about the latency period of the virus in asymptomatic people also we need to know. 

In India, community transmission of the virus does not mean anything; because the susceptibility factor of people in India shows unpredictably great variability.  We failed miserably in our lockdown measure to curb the virus only because of the susceptibility-resistant diversity of our population to the virus. 

We must follow COVID 19 patients and must stop chasing the virus.  Even if all Indians turn positive for the virus (the day may not be far away), we must worry only about how to offer best treatment to COVID 19 patients because majority of people may not require either hospitalization or treatment. 

In a county like India, we cannot stop the entry of the virus into our population.  What we should watch out is how many are developing medical complication. 

But we propose to fight three types of war simultaneously viz., one against the virus, another to offer treatment to all COVID 19 patients and third against the life and livelihood of millions and millions of people. 

If we have limited our focus only on COVID 19 patients, we would have won the war long before.  Our economy also would have been saved. 

But our medical and scientific community may not allow that to happen.  Our policy makers also may not allow such simplistic and practical approach to adopt.  They all might go jobless if we make our strategy so simple and practical against the pandemic. 

Today if we ask any ‘average’ person what they fear the most, novel coronavirus or COVID 19, most would say virus than the disease.  We have created such an extent of paranoia about the virus.  Therefore most people are losing their immunity mostly to fear and not to the virus.  Scientists can explain what extent fear and anxiety can damage our immunity.  When we constantly damage the immunity by infusing fear, how ‘herd immunity’ is possible, even though herd immunity is a scientific mirage. 

How soon the virus establishes adhesion over the naso-pharyngeal region, how long it can survive on the mucus lining before it invades the cell, what would be the probable viral load or cellular damage needed to show up the symptoms etc., remains mostly as question and no answer has come so far.

But we are quick to shoot the gun to say community transmission has taken place by applying the text book definition of community transmission formulated may be for a ‘true’ pathogen. 

The relevance of community transmission comes only when all infected (if not, at least 80%) population is going to develop the disease more or less equally.   Hence the transmission of the virus at community or family level means nothing to India.  The test book definitions of community transmission are purely based on true pathogens and the novel coronavirus doesn’t behave like it is a true pathogen, however it may possess some pathogenic potential. 

The virus largely targets only a ‘sect’ of vulnerable group.  The said vulnerable group is vulnerable possibly to even Aspergillus, Rhizopus or other bacterial, viral and parasitic pathogens.  May be because the novel coronavirus is ‘novel’ the immune recognition of the situation is quite quixotic, results in cytokine storm and other over-reaching immune reactions and death. 

If we go by the classic definition of community transmission of coronavirus in India, probably already 85% of our population might have been positive for the virus sometime or other in the last three months.   The medical crisis would have been so alarming if the virus were a deadly pathogen.  But India has never faced such situation until now.   

COVID 19 IS SUSCEPTIBILITY AND IMMUNITY LINKED DISEASE AND MAY NOT BE TRULY VIRAL LINKED DISEASE, AT LEAST IN INDIA TO A LARGER EXTENT.  THE VIRUS MAY BE THE TRIGGERING FACTOR.

Further the virus has not developed obligate anthropogenecity to apply the science of community transmission jargon in India.

The coupled effects of Corona pathology and fear pathology may be we are witnessing now, and we the Indians must take the entire pride for sowing, selling and mongering such fear over novel coronavirus among people.  

If we look at the scenario from viral point of view and also from social behaviour of Indians, yes the virus might have reached community level long before. 

FROM THE PATHOLOGICAL PERSPECTIVE, COMMUNITY TRANSMISSION OF VIRUS RESULTING IN THE EMERGENCE OF LARGE NUMBER OF COVID 19 PATIENTS LOOKS REMOTE IN INDIA.  IF SO, MONTHS AGO SUCH SITUATION WOULD HAVE THUNDERED INDIA. 

In the case of novel coronavirus, we need to split the story into two equal halves because the pathogen-disease script in the case of novel coronavirus is not isobilateral like in the case of most viral infections. 

The ratio of viral positivity versus COVID 19 versus mortality doesn’t show any linearity or any statistical orientation that can be plotted on a graph sheet across abscissa and ordinate scale.

Therefore India is well insulated from COVID 19 despite community transmission of the virus thanks to the large number of asymptomatic insulator population or varied degree of susceptibility factor (s).     

When the community level outbreak of COVID 19 in all viral positive people is not possible then the text book definition of community transmission of the virus holds no charm expect like a monthly calendar hung on the wall in most government offices which no one sees or uses.   But still the calendar is useful.

We must stop chasing the virus.  Instead of the money spent on testing must be allocated for treatment.  Otherwise we must capture at least the ratio of RNA positivity by RT PCR versus culture positivity of live virus in cell culture condition in a statistically significant asymptomatic population to predict the real transmissibility of the virus and probable population that might turn COVID 19 in near future. 

Otherwise the mission of proving or disproving community transmission of the virus will serve only academically and not practically to address the pandemic. 

Certainly the non-isobilateral pattern in the relationship between viral positivity and COVID 19 is quite new.  For every pathogen, there may be ‘someone’ likely to remain as asymptomatic carrier but no true pathogen can afford to have about 85% people remain as asymptomatic carriers.

We have only defeated our war against the virus.  Instead of focusing on the patients and treatment improvement, we focused on asymptomatic people in the name of chasing the virus, put them in quarantine chamber, declared containment zones, paralyzed economy, euthanized livelihood, finally we have left our mission to roam around in the street like an orphan. 

At least from now on, we must focus on COVID 19 patients and not the virus. 

Even UK, US, France, Germany, Italy are re-defining the mortality as due to COVID 19 and with COVID 19 separately. 

The description of ‘with’ COVID 19 must open our inner wisdom to understand a little more about the virus before we press alarm button. 

In the beginning if the government has sensitized people and told them to consult doctor if they suffer from fever and other symptoms of COVID 19 and not to resort to self-medication, people would have gained confidence and would have gone to hospital and we could have achieved reasonable control over the situation. 

But we scared them, threatened them, used police force, used litigation, killed their lively-hood; put them in quarantine zones…. We defeated our war ended up in ‘ouroboros’ situation.

Community level outbreak (entire community developing the disease simultaneously or at regular interval) is quite unlikely due to large number of insulator population and hence we must focus on COVID 19 and must stop chasing the virus and testing.  A few sporadic outbreaks from different community zones may be possible in future due to susceptibility reasons and not due to viral reason.

In COVID 19, the contribution of virus looks limited than the contribution of immune defence of the host.