In The Plague, Albert Camus describes the French town of Oran, which is swept by a plague leading to the death of thousands of inhabitants. Camus’s novel is the story of a community struck by a destructive force, to which it refuses to surrender. The outbreak of the COVID-19 Novel Coronavirus epidemic and the response to it from people and countries are not so different from Camus’s plot.
In India, there has been an unprecedented response to this brewing pandemic. Conferences and public events have been cancelled, weddings postponed, schools have been closed and even Prime Minister Narendra Modi called off the regular Holi milan programme fearing the spread of the virus. Visas have been cancelled and the country is in a virtual lockdown. The frantic buying of protective masks and hand sanitisers and the surge in prices of these items is a small indicator of the collective paranoia which has swept us. The WHO has declared the disease a pandemic.
In a situation like the current one, there is a thin line between paranoia and logic and the reinforcement of one leads to the natural erosion of the other. Having said this, let me clarify that the threat posed by the COVID-19 Novel Coronavirus pandemic is very real but our paranoid response to it is not. A scientific and historical perspective is thus essential to understand why the fear of the coronavirus in India is exaggerated, if not hyped.
Flu pandemics are among the commonest ones to affect the world. Three influenza pandemics occurred at intervals of several decades during the 20th century, the most severe of which was the Spanish Flu (caused by an A (H1N1) virus), estimated to have caused up to 50 million deaths in 1918-1919. The other two pandemics were the Asian Flu caused by an A(H2N2) virus in 1957-1958 and the Hong Kong Flu caused by an A (H3N2) virus IN 1968. Both were estimated to have caused 1-4 million deaths. A deeper analysis of these three pandemics reveals something interesting for the Indian context.
In a World Health Bulletin published in 1959, I G K Menon wrote that even at the peak of the Asian Flu pandemic of 1957, 44,51,785 cases of influenza were reported in India (in a population of 360 million at the time) with a case fatality rate of 242 deaths every million cases. The pandemic saw a total of just 1,098 deaths in the country. These figures are low when compared to the fatality of the pandemic in countries such as Singapore, Malaysia and China. There could be multiple reasons for this phenomenon, of which demographic patterns and the extant immune status of the population probably played an important role.
An analysis of the Hong Kong flu pandemic also reveals a similar picture. The pandemic, which reached India by September 1968, killed around 33,800 people in the US and had affected about 15 per cent of the total population of Hong Kong. Yet, its fatality rate was low in India. The exact number of deaths remains uncertain but multiple papers asserted that among the Asian countries affected, India reported a very low death rate.
Besides these major pandemics, other influenza outbreaks have also had a minimal effect in India. According to the US’s Centers for Disease Control and Prevention (CDC), the 2009 swine flu (H1N1) affected nearly 61 million people in the US. It caused 12,4699 deaths in the US and 5,75,400 deaths worldwide. On the other hand, India reported 33,761 cases and 2,035 deaths from swine flu. The lower death and infection rates in India can again be attributed to many sociodemographic and genetic factors. Other global pandemics have also followed a similar pattern. The Severe Acute Respiratory Syndrome (SARS) of 2003 and the Middle East Respiratory Syndrome (MERS) of 2012 are classical examples.
This historical perspective on influenza pandemics in India notwithstanding, it is imperative to take action against the ongoing COVID-19 pandemic. But to believe that we are facing an apocalypse and react accordingly is sheer madness. Yes, we must not lower our guard but we must also not fall prey to propaganda.
It is interesting to note that there are businesses that do quite well out of disease. During pandemics like the present one, the sales of respiratory masks, hand sanitisers, anti-fever medicines and similar drugs have skyrocketed. According to data from the All Food and Drug License Holders Foundation (AFDLHF), the total market for masks has swelled up to Rs 450 crore over the last two months alone, from about Rs 200 crore annually. Donald Rumsfeld, former US Defence Secretary, has made more than $5 million in capital gains from selling shares in the biotechnology firm that discovered and developed Tamiflu, the drug which was bought in massive amounts by different governments to treat a possible bird flu pandemic.
It is important to know that we are neither China, Japan nor Italy. In a country like ours, where health struggles to find mention in the common political discourse, it is assuring that the current pandemic has caught the national imagination. But we must remember that the health of a nation is not measured by its response to pandemics. It is determined by the health of its poor, its women and its children. Unfortunately, we have failed them at every level.
Our national consciousness should be equally sensitive to diseases like tuberculosis and malnutrition, which kill more people than all the influenza pandemics put together. We need to be vigilant but not vehement in our response to the coronavirus pandemic. The best option would be to undertake a dynamic risk assessment of the situation using available scientific and historical knowledge and to maintain trust and confidence between the organisations and people who are at the helm of affairs. If we are to avoid the so-called coronavirus apocalypse, we need to be guided by evidence, science and collaboration, not hype, hyperbole and impulse.
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This article first appeared in the print edition on March 13, 2020 under the title: ‘No apocalypse now’. The writer is professor of orthopaedics, AIIMS, New Delhi. Views are personal.
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