Are we to prevent death or illness or virus? Let us catch the bird on perch, not the flying one

It is an undisputed science that the God may give man (to the believers) peace and hope in the mind but the God doesn’t give clothe, food and money or anything that we can measure physically.

Therefore the logic or rationale of God only gives us everything; both pain and pleasure doesn’t hold any water.

If we are willing accept the above tenet then we can also easily accept the fact that the novel coronavirus when invades all of us, all of us may not suffer from illness, the virus may not replicate in all of us equally, may not results in COVID 19 and finally may not cause death. 

But today the world wants to see the novel coronavirus as the most deadly pathogen that man has ever seen till date.  The fear is so acute; many people may even be willing to enter inside liquid nitrogen or cryo-preservation container or a deep freezer to save the life.  The sad truth is that people may die in liquid nitrogen container or deep freezer but not the virus and hence when the well preserved bodies are removed from the cryo-preservation camber, surprisingly the virus may be alive and can again comeback to cause another epidemic.  

Therefore chasing the virus, we must abandoned and instead we must advice people to look for clinical symptoms, allow the nearest chemist shops also to dispense a list of drugs approved by the experts for mild cases and allow the pharmacist to test the oxygen saturation level by simple pulse oximeter.  If necessary, the patient may be hospitalized and then treated.  As on date, no treatment is available for COVID 19 and only the symptoms and problems alone are managed.  Government must review the above method of managing the problem with experts so that at every street level also we can ensure ‘some’ level of surveillance and reporting.  The chemist shops also can sensitize people about wearing mask, hand wash etc.

Unfortunately, we made a war cry against the virus, alerted people, destroyed their mental stability and asked people to be watchful of the virus in the neighbourhood; irony is that even with the help of a Scanning Electron Microscope, the virus cannot be seen so easily.

Before we make war cry over the virus, the government of India must ask the ICMR to release white paper on ‘death to cause ratio’ of various diseases in India with state wise break-up in the last 5 years.  We must get all such details and only then we can arrive at the robustness of the disease surveillance of ICMR. 

 

The people who are so scared of the virus due to the possibility of death if the virus invades them must know that several minute and micro details are necessary for us to declare the novel coronavirus to be deadly but the world had gone crazy with the virus, may be due to the fear that the virus is new.

The following epidemiological details are necessary to declare how dangerous is novel coronavirus and how wise is India to enforce lockdown to catch the virus. We must know the following details such as

1.     Crude mortality rate – Total death in give time versus total population

2.     Cause specific mortality – Different causes that are responsible for the total death in the given time

3.     Age specific mortality

4.     Infant mortality

5.     Neonatal mortality

6.     Post neonatal mortality

7.     Maternal mortality

8.     Gender specific mortality

9.     Combination of specific mortality

10.  Age adjusted mortality

11.  Proportional mortality

12.  Year of potential life lost (YPLL)

Only if ICMR provides all the above details, we can plot whether COVID 19 falls under single cause mortality pathogen tag or combination of specific mortality pathogen tag. 

Whenever a new pathogen emerges, we may not able to answer all the above questions instantaneously and hence we must focus on how to prevent the spread of the pathogen assuming the pathogen to be deadly.   The most eloquent question is how our scientific and medical community in India could afford to influence the government; mainly the political establishment to go for lockdown to contain the viral spread.  Lockdown has killed our economy and not the virus.  Lockdown cannot contain the virus especially in a country like ours.

We are continuously changing the goal post every then and there. 

We are still running after the virus with PCR kit in hand.  Instead of testing people and quarantine them to prevent the spread of virus, the government should rope in all chemist shops in every street in the state to dispense a list of medicines suggested by the expert to manage the mild signs and symptoms of COVDI 19.  Only those patients who need rigorous medical attention be shifted to the hospital.  People also would be happy consult the local pharmacy and the clinician practicing in the locality.

Through such people friendly measure, the challenge can be handled in a better way but we love to cause utmost fear among people through imposing senseless lockdown and police brutality (isolated incidents).  People today face three types of challenges, one from corona, the other is loss of livelihood and the third one is police brutality. 

Community spread of the disease is not possible in India due to our unique demography despite high population density otherwise called as diversity, the pre-existing disease burden and finally the age difference. 

Indian population will not offer sandwich effect to the virus but the above differences in the population will act only as fence resulting in mosaic pattern of viral spread. 

Therefore in India, the virus may stay far too long than in any other country. 

The pathogen may go for shift-cultivation mode of spread due to the climatic variations and then might get even spread and again might go for small pocket isolation. 

None of the epidemiological theories can be applied in the country like India and lockdown can only worsen the situation and would never help India to prevent the spread of the virus. 

When poverty and agony due to loss of livelihood spreads, the virus would use such an opportunity only to its favour.  The virus may go for latency phase in resistant population and may then come back to the vulnerable group.     

Therefore we may find a severe dips in the curve and then the spread may scare us, then the virus may shrunk to some isolated pockets then may raise again between different states in India. The virus may go for an indefinite Tom and Jerry game if we chase the virus than treat the patients.

Government of India must recognize the truth that the viral positivity in India might have gone far past 5 lakh and the death accounts for about 16000, but the rate of recovery is quite high which is over 51%. 

The number of infected people in the population not tested would be quite high and so shall the recovery rate which the government may not have tested. 

To designate the novel coronavirus are real killer, we must analyse the crude mortality and cause specific mortality ratio in India and only then the real picture would emerge.  Third world pathogens are almost our friends and are very much prevalent in India even today but all of them (amoeba, intestinal worms, Dengue etc.,) are quite virulent to US and European population. 

It is wise to leave the virus free and we must focus on treating people who really needs medical care and for the rest, we should allow even the local pharmacies to dispense the list of drugs suggested by the expert to manage very mild cases. 

People must gain confidence and hope and only with the hope and courage of people, the pandemic can be controlled and not by having the warriors who live in utter dismay, fear, penury and hopelessness.    We should focus on how to catch the perching bird and not the flying one.