Coronavirus in India: Should we only go by numbers? writes Sabyasachi Roy

//Sabyasachi Roy//***

March 30: Coronavirus in India is at the verge of taking its onslaught. Apprehension is there that within a short period of time India may slide down from Stage-2 to Stage-3. Although the presently available data of confirmed cases are not that alarming, but considering all boundary conditions it can by no means be said that India is on the safer side. This communication reviews the data exploring the trajectories of transmission and indications therein. The paper also studies the essential measures to be adopted to face and fight back the epidemic.

Should India only go by the present number of Coronavirus affected persons? Are not the numbers dumb? At least for India where around 70% of the population live in rural areas. India is the world’s second most populous country, a family of roughly 133 crores – majority section of which live life without proper support and idea of hygiene. And this not only just covers rural spread, urban areas even cities are also not having proper hygienic environment, not up to the level to fight the deadly coronavirus (CoV). This awareness on health and hygiene is
proportional to economic condition and education.

With diverse demography and economic disparity, with low literacy rate and with under-equipped health service it is always tough for India to fight the situations like present CoV epidemic. Diverse culture and socio-religious
practices are also retarding factors. The worldwide pandemic caused by the present form of Coronaviridae family member ,viz, SARS-CoV-2 has already posed to be disastrous in many countries. And, it is on the rise in
India now. If we rely on pictures of past epidemics, it can be understood that epidemics grow suddenly and exponentially. Exponential growth is the highest rate among all. In the present case of CoV the same contagion rate has been observed in countries like China, Italy and US where havoc has been done by this monster virus.

However, the data for India for the last fortnight is not that much alarming as in other countries like US, China, Italy. Starting with only 3 on 1 March, the number neared 900 on 27 March. On 15 March the number of identified affected persons crossed 100, after that the number increased gradually with increased rapidity, but the rate of increase remained around 70 on an average. Out of approximately identified 900 patients only 73 recovered, 19 died as on 27 March. The fatality rate is just above 2%. But the recovery rate is low, presently at around 8%. The low recovery rate might be a point of concern. However, the number of critical cases is nil.

Further, the onslaught in India has begun a little bit late. So, it can be said that sufficient time has not elapsed for recovery of the infected patients. Here it is to be mentioned that South Korea has been successful in containing the fatality rate within 1%. Moreover, at present the virus has not been able to penetrate all the States in India. Only in two States – Kerala and Maharashtra the number of CoV affected persons crossed 100. Rest 25 States have this number below 100, of which in 11 States the number is in single digit. In northern India specially in North-Eastern States the number is minimal. But then the virus is assumed to have remained more or less confined in urban areas and so the basic reproduction factor (R0) is low till now.

It is important to remember that CoV has R0 value at around 2.5. That the virus has not infected rural India is a sign of relief and reason of almost flat curve for daily increase of cases and a comparatively low fatality rate. The average fatality rate of CoV ranges from 0.5 to 4 percent, in India it is 2%. But then, there also lies the reason for apprehension and panic, if ultimately, we fail to restrict it. If the extremely contagious virus penetrates our rural and slum areas then the fatality rate would rise. The low recovery rate is also an added concern in this regard.
If we look into the world scenario, it is now alarming – presently in every two days the number of confirmed cases is increasing by one lakh, US has overshoot all other countries, situation in many other countries like Italy is grim. Total number crossed 5 lakhs; death toll is nearing 25000. But the good sign is that the recovery rate is around 25%, much higher than the present rate for India.

That India has a recovery rate lower than the world average is due to the fact that the onslaught in India has started a little bit late. Next couple of weeks will give clear indication. To the extent of attack of the virus and our response and also our future. Apprehension of en￾masse infection is there and so government acted sharp in enforcing lockdown. It’s a kind of primary prevention measure. But question is there on the reliability of available data which is dumb on the actual cases of infection. One simple information will clear this picture. During the period before lockdown around 15 lakh passengers were checked through thermal screening at the international airports. Many of them have been advised to go for self-quarantine or isolation. But only a few among them with signal of having possible trait of the deadly virus have taken shelter of health services.

Question is where are the rest. The main reason for lockdown is to contain the spread of the virus through those unidentified virus carriers, given the high multiplication rate of the virus. Testing gives the idea of the trajectories of transmission. In next few days, the testing rate would also be a big factor in managing the situation. In initial stage, during first half of March, there has been more inward influx of infected persons from foreign countries. After shutdown of air services, the concern has veered round local transmission through the unidentified infected persons. All the cases identified on and from third week of March are consequent upon this local transmission. Presently there are cases also with no travel history.

There is burgeoning number of cases for transmission within locality. If this is not restricted within next couple of weeks there is apprehension of going down to Stage-3 which accounts for community transmission. There are different pictures presently available in literature which are based on mathematical modeling. Models allow us to explore and predict. It guides us to decide what are the different methods of intervention on which we can rely upon to fight the epidemic and on which intervention emphasis should be given. None of the predictions on CoV is very ambitious to predict overcoming the situation in very near future, say, in April. However, everything depends upon how we respond and how we fight back. Lockdown and social isolation would certainly facilitate to keep the graph flat.

An early lockdown eases the multiplicity of the chains, which India did. Need is to break the already formed chains. Putting infected persons under quarantine and putting their contacts under isolation is the first step. India is doing so right now. But, identifying still unidentified infected persons is necessary, which is a huge task. For this, some experts feel the need for local enumeration – word to word or door to door. This lockdown for 21 days is an opportunity for government and the entire health service to chalk out exhaustive plan for the worst situation and then go on fighting this epidemic. Given the limited health support service to face this situation, if time demands government should also go for acquiring all private hospitals making them CoV treatment centres.

The incubation period of the CoV within human body is 5 days on an average. So, daily number of already symptomatic persons is expected to start decreasing after 5 days of lockdown, provided in those 5 days all the conditions of lockdown are strictly followed by the citizens. Though, this is only the ideal picture.

The dismay – the rising number and the alarming world scenario – should not however make one discouraged. Through the lockdown the government has got the opportunity to find time preparation. Meanwhile, the testing capacity need to be improved first. Testing is the basic ground on which the system would respond. At the same time hospitals need to be strengthened by increasing the capacity of attending infected patients and number of ventilators.

If we rely upon the recent predictive models for India, then in next few days the numbers of new cases would increase and so also the slope of the number vs date graph. The inflection point, the point at which the graph becomes flat and tends to come down, is the all-cherished point now which would give us the good news that the epidemic starts to hold and slow down. China reached inflexion point after 13 days of lockdown. India started responding reasonably with an early lockdown. The situation with India after 10 days of crossing 100 cases (15 March) is better compared to other countries. The daily growth rate at this moment is also comparatively lower for India.

Given the present situation, if we become successful in restricting the virus in moving to stage-3, then within next 7 to 10 days good news would be available for us. Further very recent study indicates tantalizing suggestion of a geographical separation between worldwide distribution of malaria and CoV infection. Fortunately, India falls in the region of malaria infection. Further, countries that have suffered CoV epidemic mostly lie in the regions where malaria has not been active.

Although not proven analytically or empirically, the lower infection rate by CoV in Indian continent is a clear indication for consideration of this hypothesis. It appears that the malaria infected regions have developed some kind of herd immunity towards CoV. Analysis would reveal the validity of this presumption. None the less, it’s time to fight with all our zeal and amenities. We should overcome stress and anxiety and need to be calm and composed. Most importantly, all the untested and unproven ideas and remedies should be kept at bay at this time of health emergency.

Human mind always over-predict danger and this easily turns into panic. Panic is socially contagious. During lockdown period, we should religiously follow self-isolation. At the same time, we should also take care of our mental health, especially of the senior citizens who would easily succumb to loneliness out of isolation. We should make it a point to strengthen our social bond, even when we are at distance with each other.

CoV or SARS-CoV-2 is so much deadly because it is highly virulent. It is a member of the Coronaviridae family having at least 7 members. SARS-CoV-2 resembles 80% with SARS￾CoV which caused epidemic in 2003. The deadliness lies in its spike glycoprotein (S-protein) which has typical evolutionary features. It binds to the Antiotensin Converting Enzyme 2 (ACE2) receptor in human which mainly manifest in lungs, heart, kidney and intestine cells.

The unique furin cleavage site allows the virus an easy entry into cells of human beings. At the same time, the SARS-CoV-2 has the ability to mutate as it is being exposed to human population with variation in ACE2 receptor gene. And so, it is highly contagious and virulent. Also, the ability for mutation and adaptability have made it tough to develop vaccine for this version of the virus. And, without proper vaccine, if we rely upon attaining herd immunity, then by then a majority of the world population would be infected by the virus. It is also apprehended that the virus can change its genome to infect animals also and there are chances of zoonotic transformation of the virus between human beings and animals, creating more dangerous pandemic situation. So, the need of the hour is to break the chain. For that, if situation demands, we must go for complete shutdown.

It is being said that CoV attacks our respiratory system easily. One having strong immune system can fight back CoV attack easily. So, it’s better to boost our immunity in this lockdown period. In that way we can also contribute our individual bit towards the battle against this worldwide pandemic. Lastly, the brighter side is, as epidemics grow exponentially, they also die out exponentially.

(The author acknowledges the technical support extended by Dr. M J Bhattacharjee, DST-SERB. National Post-Doctoral Fellow, Advanced Institutional Biotech Hub, Karimganj College)

Courtesy: reaserchgate.net

***(Centre for Theoretical Physics, Department of Physics, Karimganj College)