“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm is all about” - Haruki Murakami, in Kafka on the Shore

As we tackle COVID-19, several issues continue to baffle us. One, does a negative PCR swab test rule out the infection? Even though the PCR test is currently considered the gold standard, it has only 60-70% sensitivity in picking up the infection. Two, can patients become re-infected? Up to 10% of patients in China and South Korea who were discharged from hospitals after recovering from the infection subsequently tested positive by nasal swab PCR. The implications are unclear. Three, do masks for the public help? With increasing evidence of transmission from asymptomatic persons with COVID-19 and the possibility that masks may partially help prevent viral transmission, cloth masks for all public is likely to be recommended. Four, will an early vaccine release help the pandemic? Vaccines, if effective, will be a definitive answer to the pandemic. However, vaccines need to undergo safety and efficacy studies in an animal model followed by human volunteers, which will take up to 12-18 months. Five, is plasma therapy an answer? It is too premature to expect that it will cure the infection. It appears less promising than it appeared initially.

Understanding viral dynamics

We need to understand that the lockdown has helped only to slow down the progression of the infection and has done precious little to eradicate it. Flattening the curve only gives the healthcare system a breather, to prepare for the onslaught of the virus. The real problems will start when the lockdown ends.

At present, infections are doubling every eleventh day in India. Once the lockdown is lifted and life resumes, there is bound to be a surge in the number of cases, with no indication that the exponential growth of the virus will stop. This will cease only if a significant number of the population is infected or immune. In fact, the pandemic will end only when over 60% of the population is infected, leading to herd immunity, or if a vaccine is available, both distant options at this time. We will be in a position to lift the lockdown only if we have had no new cases for at least two weeks. This would wreak havoc on the economy of any country and be detrimental to the health of infected persons, and also deleterious in the management of non-COVID health issues.

What are the options? Will a partial and periodic lockdown for weeks help? Can we lock down the entire world till we stop the pandemic? Both of these will lead to massive unemployment and recession and ruin the economy. It appears prudent to try to save lives now rather than stave off a potential future catastrophe. Even when the ban is lifted, several industries may not show revival for up to a year. So the current lockdown, however harsh it may seem, is our best option.

Discipline of the community at large, in times like this, is an enormous challenge. Unfortunately, this is a war, albeit without bombs, bullets and tanks, during which we cannot ask for freedom to do whatever we want. Only resilience and perseverance can help.

Realistic optimism is key

Jim Collins, a business strategist, in his iconic book Good to Great, talks about the ‘Stockdale Paradox’, named after Admiral Stockdale of the U.S. Navy, who was imprisoned and tortured for seven years during the Vietnam War. The psychological duality of ‘balancing realism with steadfast optimism’ defined his endurance and survival.

All of us are weathering the same storm, but we are not in the same boat. The implications of this crisis vary from financial catastrophe to emotional black holes. We are on different ships looking to survive, and survive we will. One has to be realistic, yet solid in the belief that ‘this too shall pass’.

We need to face this period of turbulence with calm efficiency. “Maturity of mind is defined as the capacity to endure uncertainty” said John Finley, an English historian and mathematician. During a crisis like this, India needs to invest in community education and community participation. Trust in the government is an important component in any emergency health response. An increased expenditure in a robust public health system is important to building trust and confidence. We also need to bolster infectious diseases surveillance.

The media and the public health system should ensure that the correct messages reach the common man. Whether the concern is with risk of infections from dead bodies, or the safety of groceries or newspapers, scientific and evidence-based information needs to be disseminated. One should realise that the cure should not do more harm than the disease. Hence, we need to temper enthusiasm about treating COVID-19 with wishful therapies and gather evidence by scientific and randomised trials.

Opportunities for innovation

While the clear priority right now is to cope with the number of cases and the economic havoc that the pandemic is wreaking, it is also time for the community and the government to take steps to minimise the pain of another pandemic. Humans cope with trauma by repressing its memory. The temptation to forget COVID-19 and move on will be overwhelming. But India must let not let that happen. These crises create opportunities for innovation. We need a vision of a post-COVID-19 economy that is not ‘simply a return to normal’. A new normal can build upon what we have discovered under lockdown, about making a living and living well. Let us work on an economy that conserves earth resources, avoids future pandemics, and enhances physical and mental well-being.

Finally, as Thomas Sowell, sociologist and economist at Stanford University, said, it is time to realise that “there are no solutions to managing a crisis of this nature, only trade-offs”. Our destiny is in our hands, so let us keep them sanitised, let us maintain physical distancing, and let us pray for wisdom to make wise choices in this war against the virus.

Dr. Ramasubramanian is Consultant, Infectious Diseases, Apollo Hospital, and Director, Capstone Clinic; Dr. Aruna Mohan is Consultant Paediatric Dentist, and Director, Capstone Dental Care