By Dr Saahil Nongrum
After the biggest and most aggressive Covid-19 wave in China, there have been rumours of a fourth wave in India. National and state officials have had high-level discussions, practise drills, and issued some advisories based on speculations. Naturally, this has led to some apprehension and uneasiness among the general public forcing us to ask, “Is there a possibility that a fresh national Covid wave would hit India?” The XBB and BF.7 variants have been around for a while, and they haven’t caused an upsurge in India and in the absence of a variety that is even more highly contagious another wave is highly unlikely.
A five-step plan of test-track-treat-vaccinate and Covid-appropriate behaviour was used by India to restrict the spread of the coronavirus, according to a letter that the Health Ministry of India sent to all the states and Union Territories on December 20, 2022. The letter draws public attention to the operational guidelines for the updated Covid-19 surveillance strategy, which were released in June, 2022 and calls for prompt identification, isolation, testing, and management of suspected and confirmed cases in order to identify and confirm outbreaks of new SARS-CoV-2 variants.
The letter also recommends that the states and UTs ramp up their genome sequencing efforts through designated laboratories to enable the prompt identification of novel variations that will aid in the implementation of necessary public health measures. The administration has also decided to reinstate random testing at the nation’s airports for visitors from outside.
All of this reads well, feels important and has awarded itself a lot of pleasurable moans, but here’s where some of us have an issue.
Question one – are these automatic responses supported by facts? We’ve been dealing with the pandemic for the past three years. If we choose to heed them, we have sufficient evidence to guide our actions. What do we have in its place, though? We receive bureaucratic letters that reiterate the flawed policies that brought much suffering and collateral damage.
Ritualism has taken a pedestal of importance, leaving science to fester in the corner of the room. We may excuse the mistakes made in the early stages of the pandemic when there wasn’t enough information. In contrast, if the same errors continue to be made after sufficient information is accumulated and the virus is no longer a novel threat, they would represent acts of commission rather than omission.
In our nation, we have a huge population that live in close quarters. Over the past three years, the majority of people who naturally contracted various coronavirus strains have recovered. With the “test, track, isolate” approach, a very small number of infections were found. Instead it was incredibly expensive, labour-intensive, and time-consuming, upsetting a lot of individuals who had no symptoms.
The “test, trace, isolate” routine is useless for determining transmission. It will only lead to official tyranny, stigma, and the exploitation of the common people. Panic at the population level might have negative health effects. This is akin to searching for a needle in a haystack. Random airport screenings of international passengers will inconvenience the passengers and leave them open to abuse.
It is exceedingly irresponsible for authorities to provide directions that are unnecessary. The Indian experience during the second wave was mostly panic that caused a medical rush resulting in countless fatalities. As we saw during the second wave in our nation, these are swiftly picked up by the 24-hour media to intensify the level of terror among the populace.
Low fatality rates reported from various sero-studies ought to have been extensively publicised to assuage public anxiety and terror. Such encouraging messages would also help to rebuild people’s trust in public health organisations, which are currently at an all-time low, globally. Such panic-reduction measures would undoubtedly be a big setback for those who make money utilising the “fear is the key,” marketing ploy. Genomic surveillances for novel variations are an expensive but fruitless endeavour too.
Coronaviruses frequently undergo mutations. Four circulating coronaviruses, which are less severe than the initial SARS-CoV-2, are responsible for the common cold. A person is not invulnerable to colds indefinitely after contracting one from one of these viruses. The person may come into contact with other coronavirus strains or their immunity may wear off. Furthermore, because the viruses that cause colds are continually evolving, it is hard to develop a vaccine that is effective against every strain that is currently in circulation. Even if one were to exist, the immunity it would confer would not be permanent.
There is no reason to believe that SARS-CoV-2 operates differently from other coronaviruses, so it is most likely that we won’t be able to create an efficient and long-lasting vaccine, even if many are created and used in record time as was done in unholy haste during the present pandemic.
Whether or not anthropocentric humans like it, nature provides equal opportunity for survival to all living things. All thriving living things adapt to their environment according to Darwin’s Law in order to survive. These adaptations occur via mutations, brought on by unintentional replication faults and probably under selection pressure from widespread pandemic vaccinations.
Such flaws, according to the rules of successful parasitism, are advantageous to the virus and to people. Errors that make the virus more likely to survive spread, while others are eliminated in the natural selection process. A deadly virus does not travel far; it dies along with its unfortunate host, resulting in a terminal infection.
Even a variety with severe symptoms won’t spread because such patients will isolate themselves and avoid social interactions. They will eventually lose the virus because there is no chance for transmission. The less virulent strains that do not kill the host and cause only very minor to no symptoms are the ones that will endure and spread far.
People who have these strains of the virus will mix and spread the virus’ benign offspring widely. High lethality is inversely correlated with high transmissibility. Contrarily, benign variations will cause far more significant population-level immunity through minor natural illnesses with very little mortality.
Sterile mathematical models incorrectly anticipated the end of the world at the beginning of the epidemic, resulting in harsh measures, accompanying collateral damage, and economic setbacks. Genomic sequencing and surveillance shouldn’t cause us to panic and launch comparable illogical catastrophic actions just as the pandemic is coming to a stop.
While policy should be based on real-world circumstances, such as how frequently critical cases end up in hospitals and intensive care units, genomic studies should remain academic exercises. Finding a mutant through genetic surveillance and causing panic that leads to restrictive measures is unwarranted. Chances are that a new variety has already imperceptibly spread throughout the population before it was discovered.
Contrary to humans, who carry out ecological balance clumsily and with a great deal of propaganda and fanfare, most of which turn out to be ineffective in the end, nature does it quietly and effectively. The sensible course of action would be to improve our nation’s public health infrastructure, which was made vulnerable during the second wave of the epidemic, and work toward achieving overall physical and mental health at the individual level.
It is useless to pursue a rapidly evolving virus with a low lethality. Without paying attention to the fundamentals, science has a propensity to become ritualistic. While religious rituals are generally good and offer comfort to the spirit, ritualism in science is not always good because intervention entails introducing active components with sporadic short-term side-effects and ambiguous long-term damages.
Additionally, without any proof of their effectiveness, senseless restrictions like lockdowns and social isolation create great suffering and economic hardship for the poor. What can we now do? First and foremost, we should take care of our health. A pandemic can be catastrophic in any country. Care for our health and making sure to pay attention to our nutrition, regular exercise, and eating enough to provide energy for the day are imperative. All types of viruses can be eliminated by keeping our bodies and environment clean. While travelling we still need to carry hand sanitizers and wash our hands thoroughly, following the WHO’s recommendations. The kitchen and bathroom should be clean, and disinfectants should be used in various parts of the house. The virus spreads through the mouth and nose and eventually even secretes from there because this is a respiratory illness. We must shield our faces, especially while sneezing. Using a mask in busy areas and avoiding contact with anyone who has an illness is good practice. A mask is still a must while travelling. If we have a respiratory infection we should stay home. If we need to go out we should be masked. If we are vulnerable, we ought to stay masked in unfamiliar company or if someone around us is obviously ill. If there is a lot of infections/cases in the community, staying masked in crowds is excellent practice.
We need to maintain a robust immune system. People with weak immune systems should pay close attention to their needs. If one is diabetic or hypertensive one should maintain the blood sugar under control. Heart disease patients are prone to a wide range of illnesses, including the influenza virus.
Even though the pandemic is undoubtedly abating, people must maintain their health for a better future. There is no harm in exercising caution even after Covid has disappeared since another illness could emerge. Hence maintaining both physical and mental health is of vital importance.
(The writer is CMO, Department of Accidents and Emergency, Mahatma Gandhi Institute of Medical Sciences and Kasturba Hospital, Sevagram)