As the COVID-19 pandemic fells country after country, many in India are wondering if we are somehow different. Globally, it took roughly 45 days for the first 100,000 cases. It is likely to take nine days for the next 100,000. The global death count is now doubling every nine days and stands at 8,248, with 207,518 confirmed cases. That is how epidemics work — they gather steam as infected individuals go on to infect even more people. Confirmed cases in India, as of today stand at 169 , much lower than small countries such as Iceland (around 250). Could this really be the case that we have fared better than everyone else?
Probably not. Testing in India remains abysmally low. Only about 10 in a million people in India have been tested, compared to say nearly 120 in a million in Thailand or 40 per million in Vietnam. The stated explanation is that the limited number of test kits are being conserved for when they are truly needed but when is the need greater than right now? There are probably shortages even in being able to procure adequate supplies given that many countries are seeking to buy the limited stocks. Testing is the most important thing we could be doing right now. As the Director General of the World Health Organization, Dr. Tedros Ghebreyesus, said recently about the need for more testing, “You cannot fight a fire blindfolded.”
We need to identify coronavirus-infected patients in a timely manner in order to increase our chances of preventing secondary infections. There is no shame in saying that we have far more cases than what we have detected so far. Even the United Kingdom, which has a far better health system than India, has admitted that it is probably undercounting its true infections by a factor of 12, and is likely have about 10,000 cases. Is it possible that India with 20 times their population has only 169 cases?
If widespread testing were to commence in India, the number of confirmed cases would likely climb to the thousands very quickly. This is something we have to be prepared for without panic or fear-mongering. This is how epidemics move and the real numbers should spur us into positive action. At some stage, it is possible that the government may have to put in place very strict measures on quarantining and closures, much like what China had to do to control the epidemic in Wuhan.
From a disease perspective, I often get asked how bad things could get. There is no easy answer. If we escape the worst, either because this virus mutates to a less virulent form or because there is something about its temperature or geographical sensitivity that we know nothing about, then we should count our blessings. Viruses do mutate and generally to be less lethal. If the projections from Europe are applicable in India, our ‘namastes’ and clean hands notwithstanding, the prevalence in India would be upwards of 20%. In other words, we should expect to see about 200-300 million cases of COVID-19 infections and about four and eight million severe cases of the kind that are flooding hospitals in Italy and Spain at the moment. More importantly, these cases are projected to appear in just a two to four-month window.
In the current scenario, we are not ready. India has somewhere between 70,000 and 100,000 intensive care unit beds and probably a smaller number of ventilators. That is simply inadequate. The next two weeks should be spent on planning for large, temporary hospitals that can accommodate such numbers. If we are lucky, we will not need them but as Dr. Anthony Fauci, Director, U.S. National Institute of Allergy and Infectious Diseases, has said, “we should get criticized for over-reacting” rather than being under-prepared.
Unprepared for pandemics
This all sounds doomsday-like. But we have known for decades now that of all catastrophic events to befall humanity, between an asteroid hit and a nuclear war, a disease pandemic has always been the highest on our list of impact and probability. My community of infectious disease epidemiologists have spent years warning governments to prepare for such an eventuality, and have written countless articles and hosted many meetings on this subject. There were some changes after the Severe Acute Respiratory Syndrome (SARS) but not nearly enough. Pandemic preparedness always took a backseat to the crisis of the moment. And in fairness, there is truly no amount of preparation that can fully mitigate such an occurrence.
In a time of crisis, it is easy to blame government or China or someone else. But this is really a time to stand together, keep an eye on our neighbours, friends, families, co-workers and indeed anyone who has less than we do. That includes your household help, security guards, vendors and indeed anyone who touches your life. It is a time to see how we show the best of our human values while facing a crisis of a proportion none of us has ever witnessed in our lifetime.
Things are about to get a lot worse. Let us hope that this brings out the best in us, and not the worst. Whether we know this or not, these events are just a dress rehearsal for the more challenging events such as climate change that are likely to be with us this century. And if we take care of each other, we will survive both these challenges with our humanity intact.
Prof. Ramanan Laxminarayan is Director, Center for Disease Dynamics, Economics & Policy, and Founder, HealthCube