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The Covid Puzzle

When Amitabh Bachchan tweeted that he had Covid, my reaction was the same as that of most people:

shock, concern and a silent prayer that the actor would fight the Corona virus as effectively as he has fought the various health issues and ailments that have plagued him over the last 50 years.


But, I also had a second concern. How, in God’s name, had Amitabh got Covid? He is one of the most fastidious and careful people I know. His son Abhishek (who also tested positive a little later) had said in an interview, that they were extremely mindful of the possibility of infection at their homes. They used physical distancing and masks when they went outside and when they came back they changed their clothes immediately. Moreover, anything that came from outside was quarantined before being used.


   The case of the Bachchans confirmed what I have been increasingly feeling over the last fortnight. The more we live with the Covid virus, the less we seem to understand how it functions. And, sadly enough, there is an element of destiny to its choice of targets. If you are going to get it, well then, you are going to get it.


   As of now, the medical community is locked in a dispute over how the virus spreads. The traditional view is that the infection spreads by droplets. If somebody with Covid coughs, sneezes or spits (while talking, shouting or laughing, for instance) and you inhale or ingest the droplets then you could get infected. Hence the six feet distancing rule: the droplets are quite heavy and don’t travel far.


   But, doctors say, these droplets could fall on surfaces. So, there is a danger of a two-step infection. You touch a surface on which a Corona virus filled droplet has landed. Later you touch a part of your face that is connected to your respiratory system: say, your mouth, nose or eyes. The virus can enter your system that way. Hence the instruction to wear gloves and to keep washing your hands.


   And then there’s the mask controversy. For weeks into the pandemic, the WHO and the US Centre for Disease Control (CDC) kept telling us that masks were necessary for medical professionals but not for the rest of us.


   This always struck me as odd. How could a mask which protected a doctor or a paramedic suddenly become unnecessary when you and I wore it? After many influential people asked those questions, the WHO and CDC reversed their policy and said that everyone needed to wear masks.


   So why had the early advice been so different? Appearing before a US Congressional Committee, Dr. Anthony Fauci, head of the US responses to Covid (till Donald Trump fires him, which could be any day now) explained that masks were always useful. They just didn’t have enough of them and did not want to increase demand so greatly that medical professionals could not get enough.


   This may or may not be an appropriate explanation in the US context but for the WHO to make this a global recommendation is unforgiveable. Every other country in the world was not short of masks. In India, for instance, we have ramped up production at an incredible speed. And even if there was a shortage of masks, should doctors have lied to us?


   My guess is that the shortage of masks was only one of the reasons for the CDC and WHO advice that lay people did not need to wear masks. They genuinely believed that social distancing was enough.


   At one level, this made sense. If a droplet can only travel a short distance and you ask people to stay six feet away from each other then why do you need masks? Only health-workers who can’t stay six feet away from patients are at risk from the droplets.


   But they made one serious miscalculation. If everyone wore masks, then the people who were Corona positive would not be able to expel the virus into the air. So even if masks were not necessary to protect the uninfected, they were certainly required to prevent the infected from spreading the diseases.


"Over the last week, the WHO has moderated its position and allowed for the possibility that there might be micro-droplets in the air and that they might be infectious."

   The current controversy goes beyond masks and focuses on the methods of transmission. Some researchers have said that while droplets do not travel more than six feet, there are micro droplets which are lighter and can float through the air, travelling a greater distance.


   The medical establishment countered this with two arguments. First of all, they said, all the studies that showed micro droplets travelling far into the air were based on experiments that required the virus to be expelled into the atmosphere from some kind of machine. But in real life, the human body did not expel them with so much force so the experiment did not mirror reality.


   A second argument was that there was no evidence that the micro droplets were infectious or contained enough of a viral load to pose a threat.


   Over the last week, the WHO has moderated its position and allowed for the possibility that there might be micro-droplets in the air and that they might be infectious.


   If this is true, it re-emphasizes the need for masks. But, more significantly, it also calls into question all social distancing policies. If the virus travels through the air, then a six foot perimeter is not enough. Which suggests that you can’t ever go out in public without a mask.


   Also up for debate is why the virus behaves differently with different people and environments. It is now clear that the Indian lockdown, one of the strictest in the world, did not prevent the spread of the disease: we have just crossed a million cases. But did it help at all?


   That’s hard to say because the government made it so difficult to test yourself for Covid. We don’t know how much the disease spread during the lockdown or even how many cases there really are because we are testing a much tinier proportion of our population compared to many other countries.


   Of one thing though, there is no doubt. Covid is killing a smaller proportion of those it infects in India than it does in many other countries. Our current death rate is around 2% which is very low by global standards. And if you believe, as most doctors do, that the total number of people infected with Covid is (at the very least) double the official figure, then the death rate hovers around one per cent or so.


   Why can so many Indians fight the disease more effectively than say, Americans? We don’t know. It could be, as one theory has it, because the BCG vaccine which we take as children gives us immunity. It could be that a less virulent strain of the virus is spreading through India. Or it could just be that we have a younger demographic, which is not as much at risk. Everyone has a view. But nobody knows for sure.


   But the Indian example pales beside some East Asian countries. Thailand is a huge tourist centre. Bangkok alone gets many times the number of visitors than the whole of India. So you might expect it to be badly affected by Covid.




   Thailand has recorded under 3240 cases in total. (Compared to a million for India!) There have been only 58 deaths. Some of this has to do with the fact that Thailand is a small country. (But European countries of the same size have fared much worse.) And yes, the Thai authorities have handled the pandemic much better than we have.


   But even so, the figures are startlingly low.


   Could there be some kind of genetic resistance? Because Vietnam is even better off than Thailand. It has not recorded a single death. Burma has had just 336 cases, Cambodia has recorded 168 cases and Laos has had 19 cases.


   I have not read a single convincing medical explanation of South East Asia’s low rates or of our encouragingly low mortality rate.


   But then that’s typical of this pandemic. The longer it rages, the less we know about the virus. And until a vaccine appears (by the end of this year, I think) we will all still be floundering in the dark.



Posted On: 18 Jul 2020 02:38 PM
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