Thoughts on COVID-19
The COVID-19 has hit us hard. As of now, there has been as many as 159,033 deaths and still counting. This is not the same as the flu virus, rather it is worse than that. The new virus is highly infectious, and with the potential to have asymptomatic carriers, it presented itself as the cause for unprecedented global crisis that might not go away anytime soon unless proper measures are taken with haste.
The virus has a reproductive rate or R0 of 2.0 to 2.5; meaning one person can roughly infect two other persons in a susceptible population. This is crucial because, after just 10 cycles, the number of infected persons will rise to about 9,500; just add two more cycles, the case number rises to about 60,000. The epidemiologists use this number to determine the intensity of an outbreak, and hence important guidelines are proposed to contain the spread.
Wuhan, though initially devastated by the outbreak, has started resuming its regular life. Thanks to the decisions made by the Chinese Center for Disease Control authority and the Chinese Government. Wuhan was put under complete locked down and hospitals were built within a week. Social distancing was not only advised but also enforced. COVID patients were isolated and knotted with a GPS-tracker to have live location data. From a scientific perspective, social aka physical distancing is the only effective method right now to curb the COVID-19 outbreak. Because it buys us valuable time to design, test and prepare vaccines for the public. While vaccines are in the clinical trial, scientists are spending day & night in the Labs, checking back and forth for the feasibility of already available drugs against the new RNA virus.
The production of vaccine is a lengthy process, not because that designing takes times, rather it is the testing of efficacy and side effects that constitute the large chunk. Ensuring that the approved vaccine works across countries for people of different genotypes is a crucial task, and hence demands at least a year to complete the testing. If everything works well, we will hopefully have a vaccine in the next year. But the real question is, can we afford to sustain ourselves that long enough?
Experts are already discussing the post-corona period and how it is going to affect the global economy. The shutting down of businesses and the blockade in the supply chain will inevitably strike us, and it will be an especially challenging time for small companies to make up with the loss. Governments have declared million-dollar rescue packages to restrain economic fallout. Despite that, the pace at which the virus is spreading is altogether threatening.
The very reason why the virus is seemingly winning over us is due to our obliviousness of the warnings put forward by the experts. More than a decade ago, microbiologists cautioned that a large reservoir of SARS-like coronaviruses, together with the consumption of wildlife animals in China is the perfect recipe for the re-emergence of a new virus of zoonotic origin. In a TED talk given by Bill Gates in 2015, Bill forewarned that 10 million people could die if a highly infectious disease arises with asymptomatic carriers. Another contributing fact is the way we downplayed the severity of the disease by calculating case-fatality rate based on China, Korea, Taiwan or Singapore and compared it with ourselves. That was a grave mistake. The overall healthcare facility and the public’s willingness to abide by the law do not match across countries. In the case of South Korea, the infection rate was well under control until the “patient zero”, a 61-year-old woman, who unknowingly acted as a superspreader and infected 1,160 people alone. So each country requires its formulation of strategies to thwart the disease transmission.
Generally, public health epidemiologists and data scientists model the transmission dynamics of the virus and predict the outcome. Based on the numbers, healthcare equipment and facilities are increased. However, the novel coronavirus seems to have given a tough time to the statisticians with its reckless nature. So far the virus has mutated enough of itself to generate different variations and morphed into two haplotypes: (1) L haplotype and (2) S haplotype. While the former originated and devastated Wuhan, the latter mainly infected outside of China with less severity. It is a general fact that as the virus infects more people, and in doing so, it also mutates itself, it loses the virulence capacity and turns into a mild virus. Notably, there are 7 human coronaviruses. Of them, three cause severe disease, whereas the rest four cause mild fever and cold. But, when the mild viruses originated and jumped into humans thousands of years ago, they initially caused a severe infection, and then gradually turned into weak enemies. This is where the idea of herd immunity kicks in. When enough people (>50%) in a population are immune to a certain virus, they achieve herd immunity and win over the disease.
United Kingdom (UK) initially wanted to implement strategies for herd immunity achievement, but the idea seemed ineffective. They wanted to protect the elderly by using healthy young population as a shield. Nonetheless, the carelessness of the people proved the strategies futile, and the UK had to pay the price. On the other hand, Iran, Italy, Spain and USA underestimated the severity of COVID-19 and thus fell a victim to its lethality. The case of USA is saddening as they had more time to prepare themselves, but both Trump administration and people belittled the pandemic. Now, more than 70% of people in New York are suffering and healthcare is collapsing. As supply is short, doctors now have to make the decision who gets the life support and who doesn’t. If strict measures are not taken, the scenario will repeat in other countries as well.
As for Bangladesh, we stand at the edge of a breakdown. We neither have a strong healthcare system, nor economic strength to prevent a recession. The number of ICU and ventilators are way below what is required. Now to save lives, our only immediate option left is to lock down the country. This still is our best chance and the only chance to revert the situation. If we can track the cluster of positive cases, and restrict them, we can significantly delay the infection spike. This is our ray of hope. Because while we hold up the virus from spreading, there will be point-of-care rapid testing facilities available in the market. FDA has already approved of antibody-based COVID-19 testing. This way, we can test more people and isolate those who are sick and provide them with the necessary care.
Understandably, Bangladesh cannot go on with months of locked down. Economic instability, job loss, industry shut-down and a lot of other problems will ultimately jeopardize our social environment leading to chaos & violence. To stop what is coming ahead, we all must work in concert and help the authority to get the situation under control. Whilst IEDCR, ICDDRB, NIB and other scientific regulatory bodies try to figure out how to track the virus, we as citizens play the vital role to abide by the law.
In addition to following the basic WHO guidelines, we must also avoid any crowd — be it a market, gym, masjid or neighbour visiting — so that we can flatten the curve and slow down the disease progression.
