The Pandemic of the Corona Virus - COVID – 19

The Pandemic of Corona Virus - COVID-19

By Dr. Sanjai Subha

Everyone in this world is now aware of the word – corona virus and the pandemic caused by it. It has created a tremendous amount of fear, as well as uncertainty among all classes of people, irrespective of the difference that exists among them. How did a virus of such small size evolve as a global problem? Why is everyone  afraid of it? Even the most economically developed countries like the USA, Spain, Italy, and China are finding it difficult to control it? What will happen to India? These questions haunt us daily. In addition, various forms of media like social media, newspapers, and television are fueling the fear and anxiety further. Thanks to social media applications like Facebook, Whats app, Twitter, YouTube, the news arsenal of this era, everyone is on their phone, surfing through various posts, messages throughout the day, panicking simultaneously. The emotion of fear has always been the greatest survival advantage we as humans had in the process of evolution. In previous days, we were afraid of animals, fire, rain, which now we seem to have control over it. However, nowadays people are getting afraid because they either don’t know about something or don’t understand it. For example, during the night, sometimes when you have a sensation of something crawling over your foot, you might never know whether it is a snake or a rope unless you turn on the lights. At that moment of panic, ignorance is the one pushing us into fear. Once knowledge clears the ignorance, as light clears the dark, then we are reassured. Likewise, if we understand pandemics and in particular, about this virus, we can overcome the unnecessary fear. Our minds will become clearer leading us to think and plan accordingly.

Let us first see in general about corona viruses, and specifically about this COVID – 19. The diseases caused by corona virus are not very new. These viruses are a group of viruses that has RNA (ribonucleic acid) in their genetic material. Most of the time, these viruses enter the cells of the upper respiratory tract that includes – ear, nose, throat and cause symptoms of running nose, nose block, dry cough, throat irritation, throat pain. Sometimes one might also feel low-grade fever, generalized body pain, tiredness, and joint pain. The fact is, even though, most of us have experienced such symptoms, many times during our lifetime, there has never been a time of fear and uncertainty like today. Why? Because this novel corona virus – COVID 19 has acquired a mutation or a change in its genetic material, that has armed it with the capability to attack cells even in the lungs, besides the cells of the upper respiratory tract.

           Let us assume that a person is infected. Whenever he sneezes or coughs, he is throwing out his respiratory secretions, along with the virus in the form of droplets – which are highly condensed and can hang in the air or can persist over different surfaces. When the virus within the droplets enters our respiratory tract, it attacks the cells lining it. While in that process, some of the cells might peel off, and shed into our lungs. In this way, the virus gets into the lungs. As a response, the immune system kicks in, trying to fight off the virus. During that process, the cells of the immune system collaterally damage our lungs too. This leads to the accumulation of fluid inside our alveoli – a grape-like structure at the end of the respiratory tract, where oxygen is being absorbed into our blood in exchange for carbon dioxide. Eventually, once water fills the alveoli, oxygen absorption cannot happen, and as a result, the person might require support for their breathing. This damage caused by our immune cells is known as Acute Respiratory Distress Syndrome (ARDS), and if the entire lung has been damaged, it can lead to death sometimes.

Since it is a novel or new virus, we do not know much about it, and we are learning rapidly about it because of the technological advancement of our era. Among the factors that have enabled this virus to become a pandemic disease, the following factors are  important:                                                  1. The ability to transmit easily between persons and the ability to infect many persons. In epidemiology, this is called R₀, and the value for this virus is between 2.5 – 3.5. What does this mean? It means an infected person can spread the virus to 2.5 to 3.5 other susceptible people 

             2.  Whenever a virus or bacteria enters our body, it needs some time for multiplication, before it can cause disease. This time is known as the incubation period, and the duration for COVID 19 is 7 – 14 days.  When someone inhales the virus-containing droplets, it enters the cells in the throat and starts multiplying. During that initial period, the amount of virus load is, so less, that the infected ones do not experience any symptoms. Once the viral load becomes higher, or the immune system is compromised, then the person starts to show symptoms. The issue here is, during that initial symptom-less period, one can contaminate very large number of people, without being detected during security screening checks.

            3. The last important factor is that the period for which a person remains infective is very long and so each person has the chance of infecting many others.

     Next, we shall move on to understanding the pandemics in general. Whenever microorganism like viruses, bacteria are causing diseases, it can be classified in the epidemiology into three different types:  

1.          Endemic – the disease is contained in a particular city or area. Moreover, most of the      time,  this disease will persist in that locality, causing disease intermittently.

         E.g., Typhoid fever in Tamil Nadu is an endemic disease

2.      Epidemic – the disease has caused more infections than we would expect normally. However, these would be contained in particular parts or areas of a country. E.g., Malaria fever in Africa, Dengue fever in India

3.      Pandemic – the disease spread rapidly, infecting many persons in many countries across continents. E.g., 1918 - Spanish Flu caused by Influenza virus, the current Corona virus – COVID -19

After understanding the basics, let us know why this particular pandemic is dangerous. Firstly, Covid 19 is not a deadly disease. Based on numerous studies and observations from other countries, it has been shown that most people will recover from this by themselves, without any intervention. For example, think of a situation where 100 people are exposed and infected by the corona virus. Based on observations, almost 80 people will recover spontaneously or might experience mild symptoms only. Another 15 people might have symptoms like fever, cold, cough, for which treatment may be required. The fact is these people too will recover without any complications. However, the remaining 5 % of the people might require Intensive Care support including ventilators, and among them, many may die. The other important issue is the availability of ventilators or other respiratory support devices. If these are not available to 5 % of people at the right time, they might die for sure.

India is a big country with a large population. In India, if we calculate based on the R₀ factor, the disease will slow down once almost 60 % of the people are infected. The numbers at stake are very high. Among a population of 1.3 Billion people, 5% is an unimaginably huge number. We are also heavily understaffed in terms of doctors, staff nurses, and ICU care support systems. Our entire health system might crumble if all these patients ended up in hospital in such a short time. That is why so many countries are finding it very difficult to control death rates due to this disease.

The only way to stop this nightmare from happening is by practicing social distancing. Based on this reasoning only, our government has announced, a historical decision of locking down the entire country for 21 days. By following this order, people will be staying inside their homes, thereby, reducing disease transmission.

The truth is, the majority among us, will recover smoothly from this disease. However, the effect on the entire nation will be substantial. Many of the people in our country are suffering from malnutrition, co-morbidity like diabetes, heart disease, putting these people at risk. Therefore, in the interest of protecting our fellow people, and, for the country’s sake, we must obey, and cooperate with the government during this lock down.

          During the last 2 months, the disease COVID – 19 has caused a tremendous amount of fear as well as mental confusion among many people around the world. Owing to the advantage of social media, the false news, rumors about COVID 19 are spreading widely and rapidly to every nook and corner of the country.

At this moment, we have to internalize or understand the fact, that all the pandemics that have occurred in the past eventually stop spreading and become a routine infective disease. Many people will acquire this disease, recover, and develop immunity against it. Others will die. So when the pool of susceptible people to infect reduces, the pandemic will wane. What we are afraid of is the level of damage it will cause, before stopping. The best way to minimize the damage is by self – isolation, which means staying inside our homes. Let us all follow this self-isolation, and wait until the virus takes its course. Let us hope and believe in humanity. Let us hope that the scientific community will come up with a vaccine in the earliest future. If we are united, we will be able to win over this virus one day. Stay at Home and Stay safe. 

Sanjai Subha