We live in a state of coronavirusfuelled anxiety. In such times, we try to build walls and fences to keep the danger out. So, India has enforced sweeping restrictions on outsiders coming into the country, and stringent testing for those returning from abroad. The government’s strategy to contain this pandemic is largely based on surveillance and restrictions on international travellers, and now, a push towards social distancing. Will this work to keep the virus from spreading in the country? Or is the enemy already within, slowly entrenching itself?
The evidence from other countries is mixed on how useful travel bans are in stamping out the virus. The United States (US) was the first country to ban travellers from China on February 1. India followed suit a few days later along with Singapore, Vietnam, Russia, and the Philippines. But this did not stop the virus from entering any of these countries. The US is seeing an explosion of cases, while other places, including India, are seeing slow, steady rises in case numbers.
This particular coronavirus spreads easily from one human to another, carried mostly by respiratory droplets. It passes from human to human in difficult-to-detect chains of transmission. This is because the majority of those infected have mild symptoms — a cough or a barely detectable fever — and may not realise they are infected, but can still pass the virus on to others. A recent study published in Science estimated that mild and asymptomatic patients in Wuhan, who were never tested and did not know they were infectious, played an important role in the spread of the coronavirus disease (Covid-19). This being the case, restrictions on travellers from abroad will only bring a brief respite since the virus is already in the country.
Once the virus is in a country, governments across the world have responded in three ways.
The first is aggressive testing, to quickly detect and isolate sick patients and trace their contacts before they have a chance to spread the virus further. As the director-general of the World Health Organization put it, the only way to contain the virus is to “find, isolate, test and treat every case to break the chains of transmission. Every case we find and treat limits the expansion of the disease”.
The second way is through social distancing, to the extent of shutting down normal life. This is what Wuhan and other cities in China did, and which cities and regions across the world, including parts of Italy, and the bay area in California, are doing. The “shelter in place” order that was imposed on parts of California required people to stay in their homes except to shop or for medical emergencies.
This is what India seems to be moving towards, with the “Janata Curfew” on Sunday. But more will be required if the speed at which the virus spreads is to be slowed down. Wuhan and other cities in China shut down transport systems, issued stay-at-home orders and kept only essential services going for an extended period. In India, an extended Wuhan-type shutdown is going to be extremely difficult to implement, and the impact will be felt disproportionally by the poor, who need to work every day for their survival, and don’t have the luxury of working from home. Wealthy countries like the US can afford to dole out money to lessen the shock. Countries like India cannot.
The third, and most important way governments across the world have acted, is by strengthening the hospital system. The majority of those infected by Covid-19 will have mild, or perhaps no symptoms. But the 20% or so who get infected will require hospital beds, and the more severe cases will require intensive care beds. Once the virus really gets going, and case numbers take off, patients requiring hospitalisation will come not in an orderly way, in ones and twos, but in waves. From the experience so far of how this virus behaves, those above the age of 60 with other underlying medical conditions will be at the greatest risk of severe illness.
Doctors, nurses and other health care workers will also be at great risk, given the high number of infected patients they will be examining, and the long stressful hours they will have to work. Infection control protocols become even harder to follow when health personnel are stressed and overworked. Supplies of ventilators, oxygen, masks, gloves, disinfectants could run short. Any lack of preparedness in India’s health system will be cruelly exposed.
By the Indian Council of Medical Research’s reckoning, the disease is not yet spreading in the community beyond immediate contacts of infected people. But given the experience of other countries, it is highly probable that the virus will spread in the community, with cases popping up all over the country.
The walls and fences that were built have not kept the virus out. But they have bought the country time to prepare for its eventual spread. That time needs to be used wisely to prepare people as well as the hospital system for the full impact of a pandemic.
Thomas Abraham is the author of Twenty First Century Plague The Story of SARS. He is an adjunct professor at the Journalism and Media Studies Centre, Hong Kong University and worked in the WHO during the 2009 swine flu pandemic