Virus Isn’t Going Away, Prevention Is Our Best Bet

Coronavirus has turned our lives upside down in more ways than one and even after a year of the pandemic being officially announced, the world is not in the green. As a community medicine practitioner in Epidemiology, I have been studying the behaviour of the novel Coronavirus and its host, us, the humans. Yet, no matter how much I study things in detail, I always come to the same conclusion about the Coronavirus: This virus can change forms (mutate) and come up with new strains faster than we can figure out its cure or vaccine. So, our best bet right now is to avoid the virus! The prevention is easy; the cure may not be.

Our best preventive tools – masks, hand-wash and sanitisers are now easily available. What is not easily available is the will in most people to co-operate and use these tools both for individual safety as well as public health. Even as the number of infected cases and resultant fatalities rise, there is a certain nonchalance in public behaviour regarding the risks. On March 27, more than 62,000 new cases were registered across the country, with over 300 deaths. The first time that the number of people infected in a single day went above 50,000 was July 27, 2020. The last time that the number of new cases went above 50,000 was November 6, 2020.

Even though the number of new infected cases is going up, the ratio of the number of people losing their lives to the infection, is so far less in 2021, than it was in 2020. However, those suffering with manifestations are showing somewhat severe symptoms than before. Though panic is never a way forward, but we should not definitely let our guards down yet as well.

We are seeing a renewed, fresh wave of the virus because the virus has mutated (changed its basic genetic structure and developed newer, more dangerous strains) to survive in its human hosts. We have learnt some strategies to cope with them and the virus too has gained new skills to dodge the human immune system! The influenza virus mutates almost every year and develops new strains. We will have to see which way the wind blows for the novel coronavirus. It definitely has mutated within a year.

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With newer mutations coming up globally we are faced with the threat of the new strains, the UK strain, the South African strain, and the Brazilian strain. It is the antigens that are responsible for stimulating the production of antibodies by the immune system. Even minor mutations depending on the area of the virus they have occurred in, can play in a big way with our immune systems, and are known as ‘variants of concern’. These new variants are identified using a process known as genome sequencing, which reads and then interprets the genetic information found in the RNA- Ribonucleic acid (in this case) of the virus. We need to study the virus to be able to fight it better.

India, through genome sequencing has also detected what is known as a new “double mutant” COVID-19 variant. This means that two important changes are coming together in the same virus. The mutations are basically affecting key areas in the spike protein (the crown-like area which helps the virus to latch on to human cells) of the coronavirus and thus helping them skip or escape the resistance offered by our immune system. This is mostly affecting states like Maharashtra and Delhi the most. Other states closer to these two are also reporting increased number of cases. This is probably because these two states have the maximum international travel (both inward and outward) and thus the maximum exposure to the virus, both by way of the original strain (from Wuhan, China) and the 3 newer strains. At least 18 states and Union Territories in India now have different strains of coronavirus running amok: the UK strain, the South African strain and the Indian strain, so to speak. The threat of infection is high.

What all this means is we are taking one step forward and two steps back in terms of handling the pan-world health crisis. We were all thinking that with the vaccine we would now be saved, but the virus is changing in ways that render the vaccines weak. We cannot say that a person who has been infected once and has received the vaccine as well, won’t be re-infected, though it depends upon an individual’s immune strength as to how his/her body will react and to what level they would be affected.

However, the scientists suggest that the severity of the disease will be bit lesser among the vaccinated individuals – a ray of hope, but still the battle against spread of infection, is on. During the first wave of coronavirus in March 2020 what saved us was the lockdown; it helped in more ways than one to trace and isolate and further treat infected people. However, for all purposes, a second nationwide lockdown doesn’t look feasible, because it affects the people financially when they are not able to earn their livelihood.

What we need right now to handle the second wave is a really strong execution of the plan we already have in place. Public health awareness was already achieved during the first wave; almost the whole population is aware of the crisis as well as the solution, but what is missing is a respect for solutions and the motivation to enact those simple behaviours.

We need strong public health advocacy. Everyday we need to educate, organize and mobilise to change the reluctant and seemingly over-confident attitude among the mass as a whole.  We need people at the grassroots level to reinforce for good the safety measures. So many people have let their guards down after one year of the pandemic. The various state elections, the many political rallies, the many religious festivals (we have the upcoming Kumbh Mela) have all contributed to the pandemic still holding fort really strong. We need strong community level leadership at every possible level. Anyone with a voice that is heard and respected should advocate for the use of masks, regular handwashing and social distancing. I wish some religious leaders across faiths weren’t so dismissive of the severity of the pandemic; since many people listen to them.

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We need to reach out to these leaders so that they can influence their followers. Faith must meet science if we want to overcome the pandemic. Political leaders at centre and state levels need to reach out to every kind of leaders possible, to bring about behaviour changes among the people to eliminate the virus from amidst us. To use a sociological concept, we need to the diffuse ideas of public well-being and precautions so that they become culturally acceptable and thus practiced among large parts of the population. The media plays an important role here.

The onus this second time around is truly on the public. We will keep losing the race to the virus until we follow the basic measures stringently. Lockdowns can only stop inter-cluster exchange or two areas with infection from interacting with each other and thus ceasing a larger spillage, but it may not stop intra-location infections. Nowadays, we have a huge number of people living in societies and apartments. Even if they go out only to buy essential items, but don’t follow basic precautionary measures like masks etc. they can still infect or be infected.

All of us depend on each of us this time. It’s kind of “One for all, all for one” idea! As a Community Medicine expert, I once again want to emphasise that it is the community spirit which will keep us safe and alive. Each one for another! The virus alone is not the real enemy, but our relaxed approach to the virus certainly is! We can weaken it in some time if we strictly follow the rules. The so called herd immunity has not shown promising results in this case, so individual immunity is all we have to turn our communities healthy. If we don’t want another lockdown, let’s bring out masks, sanitisers and the will to keep fighting the contagion – by respecting the social distancing norms. Let us put all efforts to develop a “behavioural herd immunity” this time.

The writer is an epidemiologist at College of Medicine & Sagor Dutta Hospital in Kolkata)

Get Ready For ‘New Normal’ In Post-Corona Times

Wherever you are in this recently-turned-surreal world, you’re either locked down at home; or self-isolated with minimal social contact; or, in the worst case, quarantined somewhere. In India, the entire population has been locked down now since March 24, and people’s movement has been severely restricted. The lucky ones have work that they can do from home; the less fortunate are seeing their incomes dwindle. Elsewhere in the world, such as in Finland where I temporarily reside, the population is so sparse that voluntary self-isolation and social distancing are thought to be enough to curb the spread of the deadly Covid virus that has held the world in suspended animation.

But no matter where you are, the weeks of isolation have probably begun to take their toll and affect your life in more ways than you could have imagined. For those eking out a living at the margins of the economy such as daily wage earners, casual workers, or those employed in the informal sectors (in India that means more than 80% of the workforce), the lockdown is like a devastating blow to their lives, a blow from which they could take months, if not years, to recover. For others, it has changed their lives in lesser but still significant ways.

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Some symptoms of those changes are palpable. When liquor sales were allowed in several Indian locked-down states, queues, some of them albeit socially-distanced, snaked outside liquor shops, and, in some places, stretched for several kilometres. Alcohol-deprived, locked-down denizens just wanted to stock up on booze, which to many is a convenient aid to escape the monotony and depression that sets in when movement is restricted, economic fortunes seem uncertain, and fear and anxiety looms large. The queues outside alcohol shops were probably longer than those outside stores that sold essentials such as food during the lockdown.

Several state governments, which get to set their own excise duties on liquor, raised the rate of taxation, some by as much as 70%, trying to maximise the revenues that can earn in an economy that has sputtered to a halt. These high prices for booze are unlikely to decline even after the Corona virus scare has ended (and no one still knows when that could happen).  

Alcohol consumption could be on the rise during the lockdown but there are less visible changes that are already affecting people’s lives. Staying indoors, often with children and other members of the family, 24X7 for weeks on end can take its toll psychologically. Even in a developed country such as Finland, police admit to getting increased number of complaints of domestic abuse and violence towards women and children. In India, data is as yet unavailable for that sort of behavioural changes but with entire families cooped up in (often) cramped homes; strapped for cash; or for even food and other daily necessities, it could be like ticking time-bombs.

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With much of the privileged world shifting to school education online during this period, many parents feel the pressure to cope with enforcing discipline on their children to adhere to the new norms of lessons via the internet—not an easy task, particularly when their children are very young and unaccustomed to the process. According to a few family therapists, in many cases, this could lead to abnormal tensions within families and affect family members adversely. Coupled with their own predicament—job cuts; reduced earnings; and the uncertainties about the future—such pressures, not inconceivably, this could lead to serious long-term psychological effects on people and even lead to familial fragmentation.

No one knows yet when the threat of the pandemic will ebb but psychologists and trend forecasters are already talking about a new way of living that may emerge. In many countries, notably in Europe, restrictions are being slowly relaxed. In Finland, restaurants will be allowed to operate in a limited manner (no more than 50 diners at a time) from June1. Schools are being opened for 11 working days from May 14, ostensibly to gauge whether the virus spreads further or not. In India, in some cities, people are being allowed to move around between 7 am and 7 pm in a sort of curfew relaxation. And standalone stores in many cities are now operating normally. Yet, as the threat of the virus refuses to die down, people have grown cautious about social mingling or being out and about in places where there are others.

These are trends that could come to stay. Many business models that are pinned on attracting volumes or numbers of people to make them viable—such as big restaurants; sports events; shopping malls; and so on—could be hit for a long time as customers and consumers decide to err on the side of caution even after the restrictions are gone. In some Chinese cities, after movie theatres were opened partially, they had to be shut down again not because of the renewed spread of the virus but because people just didn’t want to go and watch movies with others as they normally would have.

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The flipside of the pandemic-led paralysis of society could be in the form of innovations. Artists and musicians have already begun online virtual concerts on platforms such as YouTube with a pay as you please business model. Restaurants are cutting their overheads and focussing more on home deliveries of their fare as customer feel more comfortable and secure eating at home rather than visiting public places. Air travel is likely to change forever as business and leisure travel shrinks and people and businesses use the Internet to get work done. For many businesses that could lead to substantial reductions in cost.

Many may believe that these will only be a short-term impact of the pandemic. But perhaps not. The after-effects of the pandemic could be longer lasting. The ongoing crisis that the world is experiencing could upend many of the ways in which we live, communicate, and consume. The new normal after the Corona scare is over (whenever that is) would be very different from what we have been used to till now. It could be a not-so-brave new world.