Updated: March 20, 2020 4:08:31 pm
The new coronavirus infection that emerged in China in December has now been confirmed in at least 166 countries and territories around the world. It has sickened over 2.3 lakh people and killed over 9,300, with over 82% of deaths occurring in the three countries of China, Italy, and Iran. By now, a significant volume of data and research has been generated, and some key trends have emerged.
1. Testing is crucial…
Examples of China and South Korea have shown that countries give themselves a fighting chance when they take steps that assume they’re worse off than they appear to be.
This is because it can take up to two weeks for an infection to be diagnosed. The virus’s incubation time (time taken for symptoms to appear) is thought to be five days — and even after that, it could be several days before people actually go for a test if they are inadequately informed, can’t identify their symptoms, or are discouraged by the absence of resources or facilities. Once tested, results could take two days to be available. For this entire time, the virus could be spreading. Uncontrolled circulation could lead to cases doubling every two days — and the number of infections may, in fact, be up to 128 times what it seems to be. If so, the community may actually be facing a full-blown public health crisis.
Taking aggressive steps that look like an overreaction could, therefore, be just the right thing to do. Not only is acting proactively better than being reactive, it may actually be impossible to get on top of the situation after the virus has already spread widely. Any set of hospitals can tackle only a finite number of cases, and too many at the same time will invariably overwhelm them.
And thus the importance of testing. As a government Minister in South Korea — which tested massive numbers with great speed and efficiency — said: “Testing is central because that leads to early detection, it minimizes further spread, and it quickly treats those found with the virus.” Testing, he said, was “the key behind our very low fatality rate as well”. Data upto Thursday night showed 8,565 cases and only 91 deaths in South Korea.
China too, tested very aggressively alongside imposing massive lockdowns, even if belatedly. On Thursday, China reported no new cases for the first time, and fell behind Italy in the death count.
2. …As is contact tracing
Singapore, South Korea, and Hong Kong have shown that running detailed forensic investigations into every patient’s history of recent contacts, followed by tracking them down and, if required, quarantining them, helps. The South Koreans have used apps and GPS tagging of patients, and gone through location and credit card transaction histories; the Singaporeans have proactively identified large networks of possible transmission from each patient, and tracked down the individuals in those networks.
In both these countries, as well as in Hong Kong, details of infected patients have been broadcast for the public. “We want to stay one or two steps ahead of the virus,” a top Singapore official has been quoted as saying. “If you chase the virus, you will always be behind the curve.”
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Steps like these would, however, be very difficult to take in a country like India, both for its size and the characteristics of its population, as well as for reasons of privacy.
3. Free healthcare helps
A major factor in success or failure in the fight against an epidemic is the degree to which the public responds to the crisis. People must see an incentive to raise their hands to help the government, including by declaring their own illness.
Analysts have note that in South Korea and China, where healthcare is heavily subsidised or paid for by the state, people have come forward to test and be treated. Testing is free in India, too.
In the United States, by contrast, the enormous costs of healthcare nudge people to avoid coming forward, or to wait for long even after symptoms appear. Analyses have shown that fear of healthcare bills may have stretched out the 2009-10 H1N1 outbreak, which killed nearly 12,500 people in the US. On Thursday evening, the number of COVID-19 infections in the US was approaching 10,800 and 154 people were dead — nearly three times the number of deaths (58) just two days ago, on Tuesday.
4. Timing holds the key
An analysis in The New York Times by Max Fisher and Amanda Taub on the lessons from the coronavirus pandemic mentions a study that used computer modelling to show that had China implemented its testing and lockdown policies a week earlier, 66% of infections would have been prevented — and had it acted three weeks earlier, 95% of infections would not have occurred. Taiwan, which was watching China, actually imposed an epidemic-level lockdown even before the epidemic actually came — and is today only mildly affected, despite being next-door to China.
Italy, on the other hand, is paying the price of getting the timing wrong. It waited too long to impose the lockdown, and by then COVID-19 had spread too far and too deep for its healthcare systems to handle. Fisher and Taub referred to a University of Oxford study that shows how timing was central to Italy’s disaster: the cities of Lodi and Bergamo in Lombardy saw a few cases at the same time in February, but while Lodi imposed social distancing rules immediately (February 23), Bergamo didn’t do so until as late as March 8. By March 13, Lodi had 1,133 cases and a slowing infection, while Bergamo had 2,368 cases and an accelerating infection.
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India has so far seen only a small number of infections, and one reason could be the speed with which it moved to lock out individuals with the potential of bringing the virus into the country.
5. Inequality hits everyone
Several studies have shown that in an epidemic, the risk of infection and death is greater for everyone in societies that have greater wealth and income inequality. The reason: while the poor are more vulnerable, epidemics do not respect the physical and social barriers between a society’s haves and have-nots, and therefore, everyone faces higher risks of infection. This, Fisher and Taub write, is one of several reasons that health experts are watching India closely.
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