This is war: A doctor on our failure to imagine the extent of the coronavirus outbreak

The number of COVID-19 cases has surpassed three lakhs globally, according to a situation report that the World Health Organisation released on 23 March. Of these, 5,687 cases were reported in the United Kingdom. The number of cases in India reportedly crossed the five hundred mark on 24 March—remaining far lesser than many other countries. “Part of the whole story around the world is a failure of imagination as to what it would be like when it hits you. Because it hasn’t hit you,” Amit Gupta, a neonatal consultant at the John Radcliffe Hospital in Oxford, United Kingdom, told Lewis Page, a Luce Scholar at The Caravan. “And that’s what happening in India. People haven’t been seeing an absurd amount of the cases of COVID-19 just yet.” 

The pace of the coronavirus pandemic caught everyone in the medical profession blindsided, according to Gupta. “There were a fair number of us that were getting increasingly anxious, but it was only when the actual numbers started to rise when people began to realise how serious this problem is,” he said. While Gupta is not on the frontlines of dealing with COVID patients currently, he said the crisis has affected everyone. “We’ve had potential COVID patients—mothers who have been admitted to the delivery suite,” Gupta said. But he added that in “two weeks, I wouldn’t be surprised if a lot of mothers show up who are infected.”  

Gupta was trained as a doctor in India, and has previously worked in the country as well. According to him, the country needs to strategise better about how to deal with the outbreak. “I know these guys are not prepared, because my colleagues write to me. There are a huge amount of problems on the medical side of things,” he said. Like many countries, India has wasted time in denial about the situation, according to him. “Of course, the shutdown will create issues, but it is necessary,” he said. “The virus behaves the same irrespective of the where it operates. It won’t spare India. Why would it?” He wrote for The Caravan about this disbelief and why the government should not underestimate the pandemic.  

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The public reaction to the rapid spread of the novel coronavirus illustrates that when faced with a monumental and unprecedented event, people often minimise it or simply ignore it. Sometime in the middle of January, I had a conversation with a colleague about this strange virus. We discussed that the upshot was that even though the situation looks bad, it will just die in China or, at worst, it will extend to other countries in East Asia. A couple of weeks later, we complained about the fuss. The virus seemed to be no worse than flu and we concluded that people, probably wimpy millennials, were reading too much into it. After all, we have around fifteen thousand deaths with flu in the United Kingdom annually. Coronavirus seemed puny in comparison. But we were wrong.

The virus has spread at a surprisingly fast pace, which explains why many have been caught unawares. The genius of the virus lies in its infectivity. As a comparison, a person with a flu virus infects 1.4 people on average. If each infected individual transmits the flu it to another, by the tenth cycle of transmission, 28 people would be infected. A person with COVID-19 infects three people on an average. By the same math, if each of the three were to infect another three, by the tenth cycle, the number of people infected would be a staggering 59,059.

Barring the East Asia, many countries seemed to respond too tepidly to be effective. Italy saw insufficient testing in the early stages of transmission and the government shutdown the country too late. While data from Europe was showing an alarming increase in cases, the British showed no appetite for banning mass gatherings till the second week of March. The government’s idea of allowing a huge percentage of people to get infected to generate “herd immunity” prompted a group of scientists to write to the government, and it was only then that the country went into a quick reversal mode and took stringent measures. New York in the United States, too, had a blundering response to coronavirus and is now the new epicentre of COVID-19. According to an estimate by Dr James Lawler, an infectious-diseases specialist and public-health expert, 480,000 would die in the United States if the epidemic is not controlled. 

So far, India has remained an outlier in the number of cases, but only in theory. India has tested 19,974 individuals, as of 10 am on 24 March 2020, a pittance compared to other countries. On 3 March, the government extended thermal screening to passengers, but the test is unreliable as it would miss the many infected people who did not have a fever at the time. Testing individuals who were in contact with international travellers revealed a low number, but then cases started popping up in different places. Several reports have surfaced of people escaping quarantine, using public transport and potentially infecting hundreds by attending weddings or parties. Even to a rookie epidemiologist, it would be clear that the virus had escaped out into the community. Worse, since we do not have any data that shows community transmission, we do not know how much and how far the virus has spread or where it is heading. 

There is little time to scale up medical infrastructure or the number of ventilators—nevertheless, it must be done. Unless an objective, scientific and focussed response is forthcoming, we will be losing more lives very soon—the death toll in India stands at nine as of 24 March. 

The virus is the most dangerous for the elderly, but it also does not spare younger people. For instance, 38 percent of all ill enough to be hospitalised in the United States were between 20 and 54 years of age and almost a quarter of all coronavirus patients in Italy are reportedly between 19 and 50 years old. It seems that the young and unwell will use a significant portion of healthcare resources.

The poor will suffer disproportionately because critical services in the public-health sector, which work at near full capacity normally, cannot take on the additional burden of this virus. In all likelihood, the cause of death will not be declared as COVID-19 deaths as testing kits are not available widely. The government data is likely to look rosy for a while. But sooner or later, the number of deaths will rise enough to be registered appropriately in the records. 

The government is trying its best to muster resources and has started preparing. The tactic acknowledgment of the seriousness of the situation can be judged by the imposition of a 21-day lockdown on 24 March. It needs the support of the private sector. The protocols to manage the cases are not implemented everywhere and lack the practical details needed by physicians who are at the coalface. 

Availability of personal protective equipment could be a massive issue—India had failed to create stockpiles of PPE required for healthcare workers despite the WHO issuing guidelines to do so as early as 27 February. Newspapers in western countries are replete with stories of shortages of special masks—India would be either no different, or probably worse. Doctors without the right protection will do what they can do. Private hospitals will be reluctant to admit patients. Those working in the public hospitals may not have a choice, but to work with whatever is available—they will fall ill, or even die, as has happened in other countries.

There are several strands of what needs to be done. Be it constituting a national task-force, increasing public education, enforcing curfews or opening up field hospitals—all this and more needed to be done two weeks ago. Now, there is no time to be complacent. The virus took 67 days to reach one lakh people, then 11 days for the next lakh and just four days to reach three lakh across the world. The virus is unforgiving, relentless and in no mood to cut anyone any slack. In India, this is the quiet before the storm. This is war—plain and simple. Any response which is milder than what is warranted during war risks scores of deaths and economic devastation.