A month ago, few in our country would have thought that in a month’s time we would be confined to our homes for weeks on end, and with all the disruptions that we are facing now. Today we are in the midst of an unprecedented and concerted attack on an infection, mobilising the resources and ingenuity of the entire world to control (and not even annihilate) a single virus. The new strain of the coronavirus, named SARS-CoV-2, has been ravaging the world, with nearly a million-and-a-half infected and more than 75,000 confirmed deaths. And the end is nowhere in sight. How did we get to this situation?
About 12,000 years ago, our ancestors decided to settle down in various places, mostly large river deltas, and began agriculture and the domestication of cattle. This is deemed the birth of civilisation, as once the need to constantly gather or hunt for food was removed it gave mankind the time and the opportunity to develop art, music, language and science.
During the period of hunting and gathering, many died of injuries from encounters with predators or rivals, and starvation and disease. But those who did survive were strong and healthy. This changed once they stayed in one place and shared their settlements with animals. This also allowed microorganisms to mutate and jump from animals to humans. It is estimated that 60-70% of human infections may have been acquired this way, and the new coronavirus is one of them.
Health-care ripple effect
Our public health system has done a tremendous job of eradicating two other viruses from the world: smallpox and polio. The objective this time is not to eradicate SARS-CoV-2. Considering the ease with which it spreads and its ability to produce asymptomatic carriers, that would be almost impossible. On the other hand, it may be possible to slow the spread of the virus to give the health-care system time to cope with it; meaning that eventually, hundreds of millions or billions of people will be infected once the lockdowns and travel restrictions are eased.
However, it is not all doom and gloom. The current measures in India may have slowed down the spread of SARS-CoV-2. But it also probably would have prevented thousands, and potentially millions, from being infected by other respiratory infections too. Tuberculosis is still the world’s single most lethal infectious disease, killing 1.5 million worldwide in 2018, 220,000 of whom were in India. Further, 27% of tuberculosis cases in India is drug resistant.
The present steps being taken in the containment of the novel coronavirus are equally effective in preventing the spread of tuberculosis. However, if we are to take full advantage of the present scenario, we should piggyback a tuberculosis control programme on the existing CoV-2 programme — which would be simple sputum testing for tuberculosis bacilli (which could be one hundredth the cost of testing for the coronavirus), chest X-rays if required, and complete treatment of identified cases.
With the current steps, tuberculosis is not the only infection that we can prevent from spreading. Other common respiratory infections killing thousands in India every year are Influenza, Respiratory Syncytial Virus, Pneumococcal Pneumoniae and Haemophilus influenzae.
Some of the beneficial effects of the lockdown and other measures may be long standing. Hopefully the culture of personal hygiene which includes taking showers, practising hand washing, and avoiding spitting in public places will stay even after the threat of SARS-CoV-2 has receded. Moreover, there may be a more widespread awareness of how infections spread and the difference between infectious and non-infectious diseases. Among the temporary benefits are fewer road traffic accidents and reduction of respiratory deaths due to cleaner air.
We can take heart in the remarkably decisive way in which our country has reacted. It is obvious that: our government can make quick and well-informed decisions; our administration can put in place effective steps despite the size and diversity of our country, and our scientists and doctors can lead the world in providing useful and timely solutions and information.
A new concern
Finally, it may seem a bit illogical to be terrified of COVID-19 but not worried about other diseases. Today, a person above 65 years of age in India is still far more likely to die of a heart attack, stroke or even tuberculosis than of COVID-19. Somehow we seem to believe that these diseases only affect “others” and continue to smoke, eat and drink in excess.
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A dose of terror here may do some good. Moreover, there is an air of familiarity with these diseases. Our minds have adjusted to live with them. But it would be prudent to remember that about 20,000 people die every day in our country, about 5,000 due to heart disease and another 2,000 due to strokes. Even if there is a 10% increase in these numbers caused by delays or denied access to health care in the current scenario, it could translate into thousands of additional deaths every day.
But COVID-19 is a new threat. Many things about it are still unknown. And every one of us feels the possibility of becoming its next victim.
In this latest crisis, no country can expect to come away unscathed. But we would have surely learnt a lot. And only time will tell if we used the lessons well and it was all worthwhile.
Dr. Raj B. Singh is Consultant Respiratory Physician, Apollo Hospital, Chennai