Covid Chronicles XXII

By lockdown_exit - 30th Dec 2020, 11:28 am - Covid Chronicles



Way back in May 2020, New Zealand's Jacinda Ardern introducing "bubble lockdown" clauses to existing strict restrictions, publicly announced that her government would: "be strong and be kind". It became a one-sentence slogan for the Kiwis, united behind Ardern in their battle against Covid-19. That just about sums up why she needs to be this year's Nobel Peace Prize winner, not just because of her country's success at containing the most pernicious virus in a hundred years but more because of the manner in which she did it. 

There have been many events in the world in 2020, but at the end it has all boiled down to Covid-19 vs the rest and that includes one of the biggest events of them all, the US presidential elections. Even that finally boiled down to the battle against Covid-19. To wear a mask or not? To lockdown or not? Is Covid-19 a menace to civilisation or just a simple 'flu' that will "go away"?

In Hindu mythology, when a demon strikes humankind and the numerous gods have been routed, a goddess descends armed to the teeth with all the special weapons possessed by the (male) gods, and then dispatches the demon to hell after a fearsome battle. The goddess in question is Durga and her victory in many parts of Eastern India and Nepal and maybe elsewhere in the world is celebrated each year in autumn as Durga Puja. As of now most of the world battling Covid-19 should well be celebrating Durga Puja seeing how Jacinda Ardern in New Zealand, Angela Merkel in Germany, Katrin Jacobsdottir in Iceland, Sanna Marin in Finland, Erna Solberg in Norway, Mette Frederiksen in Denmark, not to speak of Nicola Sturgeon first minister in Scotland and KK Shailaja, health minister of the southern Indian state of Kerala as also the thousands of women doctors and nurses (of course there are many men as well) who've fought this demon that came out from the cold of 2019 to devastate the world this year. Forget about that ritual International Women's Day, 2020 has been the year that women finally ruled! At the helm of countries and administrations that battled Covid-19 and fought it to a standstill. 

In sharp contrast, we had strong 'macho' male leaders. Among them, US President Donald Trump and his Brazilian counterpart Jair Messias Bolsonaro. Trump led the charge against masks, refusing to wear one himself inside or outside the White House. He reversed his stand on masks in July saying "whether you like the mask or not, they have an impact, they'll have an effect." When the virus finally caught up with him, he went into Walter Reed Medical Center, run by the US military that he had once reviled as "losers" and emerged triumphant. Appearing on the White House balcony, he defiantly stripped off his mask to declare: "The president is in very good shape to fight the battles. I beat this crazy horrible China virus... I passed the highest test, the highest standards, and I'm in great shape," as quoted by Fox News. "Yes, and not only that, it seems like I'm immune," Trump told "Sunday Morning Futures" host Maria Bartiromo. 

The Trump campaign's election night watch party held in the White House East Room in November - with few masks and no social distancing - was identified as one of his several super-spreader events and yet another symbol of Donald Trump's cavalier attitude towards a virus that was infecting more than 100,000 Americans a day. Ben Carson, the secretary for housing and urban development, is the latest attendee to test positive, a department spokesman confirmed. The event has been under scrutiny since another attendee, the president's chief of staff Mark Meadows contracted the virus

Nearing the end of his term, Trump's USA continued to top the world table with 19,953,012 cases and 346,303 deaths, accounting for 60,106 per million and 1,043 per million respectively. An impressive record to leave behind given the world average of 10,555 cases and 230.3 per million in total cases and total deaths respectively. 

In December, barely a fortnight after Britain's Margaret Keenan became a global symbol of hope by taking the world's first anti-corona vaccine cleared for public use, Brazilian president Jair Bolsonaro lashed out at that very vaccine. He publicly declared that Pfizer's shot could turn people into crocodiles, among other bizarre claims. During the outlandish rant, Bolsonaro suggested that the vaccine could also lead to women growing facial hair and men speaking with effeminate voices. It might have been the funny ravings of a lunatic but for the fact that he's president of the sixth largest country (by population) in the world with the third highest number of Covid-19 cases (the highest in South America).

Perhaps the best chronicler of the life and times of the virus would have been the late, much lamented John le Carre spymaster par excellence. The virus did emerge amidst a conspiratorial cloud in China and in 2019 which is why it's labelled Covid-19 and not Covid-20 although it set about wreaking havoc in 2020. 

In late December 2019, Dr. Li Wenliang, an ophthalmologist at Wuhan Central Hospital, became aware of a possible disease outbreak after seeing seven patients with SARS-like symptoms. Li warned colleagues and former classmates about the outbreak in a closed group on WeChat, the Chinese social media platform, suggesting that they take protective measures. Days after his warning, Li was censured by hospital leaders and summoned to the Public Security Bureau in Wuhan, where he was forced to sign a statement in which he was accused of spreading false rumours and disturbing the public order. Just over three weeks later, Wuhan, a city of over 11 million people, was placed under an unprecedented and draconian quarantine which would last 76 days. On February 7, 2020, Li died after becoming infected with SARS-CoV-2. He was thirty-three years-old (Qin et al. 2020; BBC News 2020; Green 2020).

Li's death triggered an unprecedented public outpouring of grief and outrage within and outside China. The World Health Organisation praised his work via social media. The United States Senate passed a resolution to commemorate his life. The hashtag #WeWantFreedomOfSpeech received nearly two million views on Weibo before it was deleted. In response to the outcry, Chinese authorities conducted an official investigation into Li's treatment and reversed their stand. The personnel at the Public Security Bureau were blamed for their "irregular" and "improper" actions, while the Chinese government awarded Li with the title of "martyr," the highest honour the government can bestow on a citizen who dies while working to serve the state (Bostock 2020).

Straight out of a le Carre novel. Whether or not it was the result of Chinese research into germ warfare as many believe (Trump persists in calling it the Chinese virus) Covid-19 certainly emerged out of a conspiratorial cloud and the whistle-blower paid with his life. 

The Chinese government maintained an inscrutable silence about the virus despite having locked down a city of 11 million of its own people. Which is why nothing much was done worldwide until the WHO chief Tedros Adhanom Ghebreyesus declared it to be a pandemic on 30 January 2020. By then the Chinese already had more than a month's headstart in tackling the pandemic and they obviously knew more about the virus which is why they bounced back much faster than the rest of the world. In April 2020, China published a timeline of interactions it had had with other global and national bodies to try and set the record straight.

Since then it's been pretty much a question of managing things on the ground and wait either for an effective treatment or a preventive vaccine or both. Based on pure containment, managing the pandemic has raised numerous issues, the simplest of them all has been to follow elementary rules such as washing hands with soap and water or alcohol-based sanitisers, wearing masks in public, refraining from personal contact with others, and keeping a regulation "social distance." But these have been difficult to implement with anti-maskers in places like the USA who felt it infringed on individual rights. Going beyond masks and hand washing, the other containment step was a lockdown: the entire country, some parts of it and so on. Very few countries opted for no compulsory lockdown. Sweden was one of them, taking a conscious decision to avoid it, with an ageing population, hoping, perhaps, for herd immunity. As against all its neighbours, and indeed all of Europe.

Helmed by Mette Frederiksen, Sweden's neighbouring Denmark was arguably the first in Europe to impose a lockdown. It was also the first to get out of it with minimal infections, let alone deaths. It has, however, affected the economy rather badly. But its population is healthy enough to bounce back. Far from achieving herd immunity, Sweden's Covid rate continues to rise, and its citizens are barred from travelling to neighbouring countries let alone other parts of Europe that are gradually lifting their lockdowns. Its economy has fared better than some countries but worse than some such as Ireland which imposed repeated strict lockdowns.

Way back in May, Bloomberg reported: Japan's state of emergency is set to end with new cases of the coronavirus dwindling to mere dozens. It got there despite largely ignoring the default playbook. No restrictions were placed on residents' movements, and businesses from restaurants to hairdressers stayed open. No high-tech apps that tracked people's movements were deployed. The country doesn't have a centre for disease control. And even as nations were exhorted to "test, test, test," Japan has tested just 0.2% of its population - one of the lowest rates among developed countries. That was in May. As on 29 December, Japan had a total of 220,136 cases from the beginning and 3,306 deaths making an average of 1,767 per million cases and 26 per million in deaths.

On 25 March 2020, Indian Prime Minister Narendra Modi announced one of the world's most severe lockdowns all over India with four hours' notice. The entire country froze where it stood and everything shut down. The main problem was the 200-plus million migrant labour working in cities like Delhi and Mumbai and elsewhere. They'd left home to earn and remit money to their village homes, mostly in the northern states of Uttar Pradesh and Bihar. Far from being breadwinners, they'd suddenly lost their own means of sustenance. And unlike the well developed economies of Europe, the USA and the UK, there was no sustenance forthcoming. Or, for that matter, a state within India like Kerala that continued to regularly provide children with midday meals at home and adults with dry rations. Modi's lockdown could well have been an inspiration for someone like John Steinbeck; better still for India's own late lamented film maker Satyajit Ray. Millions of migrant workers took it upon themselves to leave where they were, stranded by the state and their employers. They had no choice but to trek back home. A classic case that could well become the focal point of a film was that of Jyoti Kumari, a 15 year-old daughter who carried her injured father on a bicycle 1,200 kilometres from the National Capital Region of Delhi to her home in Bihar in seven days. And more importantly, it's very clear that the migrants brought with them the virus that they had been infected with in crowded conditions in densely-populated cities to the more open villages where they originally belonged. Modi may well claim that his "decisive" action prevented many more cases and deaths. However, with 10,245,275 cases, India now stands second to the USA in the number of Covid cases in the world. Deaths stand at 148,470, fewer than Brazil (at third place on the case score). At 7,388 cases per million population and 107 deaths per million, India is way ahead of Pakistan (45 per million), Indonesia (79), Bangladesh (45) and of course Japan that had no real lockdown. 

Starting the second quarter of 2020, the world under the shadow of Covid-19 was pretty much tilted towards simple safety measures and lockdowns of varying degrees while waiting for a vaccine and/or a cure. In the case of vaccines, the achievements for humankind have been stupendous to say the least. Three vaccines have been cleared for emergency use in countries with strict regulatory regimes in less than a year. Several others, one from Russia and several from China, have been used before regulatory clearance (although most now have authorisations in some countries). Many other vaccines are waiting in the wings within an inch of the finishing line. In fact, there will probably be more vaccines of various sorts available in public that can find effective use for want of delivery and administration systems.

Clearly and correctly described as "the pharmacy of the world", India alone has one vaccine producer, the Serum Institute of India, capable of producing 1.5 billion vaccines every year, and there are several other units somewhat smaller. China has virtually as much, let alone others elsewhere. The problem lies in how to distribute such vast quantities of vaccines, store them and administer them effectively since most of them require two doses in fixed time frames. Some of them, particularly the first, Pfizer's vaccine for example requires two doses 21 days apart and storage at -80 degrees C and -60 degrees C, virtually impossible in all but the best facilities of the developing world. Even for the others in the queue with simpler storage requirements, the sheer logistics of administering two doses of the same vaccine 20 or more days apart boggles the mind when one recalls the difficulties in administering the oral polio vaccine in places like India. An entire campaign was built around that. In the build-up to the vaccine, Covid-19 cases continued and the immediate focus has been to contain that. The year has seen a welcome decline in the death rate even as availability of hospital beds and respiratory facilities were stretched beyond capacity. More and more cases have fortunately been confined to homes with palliative measures becoming more successful and death rates falling. 

However, there have been mixed results in symptomatic treatment. In India, various absurd suggestions revolving around cow's urine have been scotched pretty fast. Various types of disinfectants came into play with desperate migrants trekking home being sprayed with these. Trump, eagerly followed by Brazil's Bolsonaro, had energetically advocated the ingestion of disinfectants to disastrous consequences earlier. Bleach had often been advocated earlier, but has fortunately fallen by the wayside. On a more serious note, three therapeutic options have been suggested and used: corticosteroids, such as dexamethasone that is still in use, monoclonal antibodies based therapy such as Regeneron's product that Trump endorsed after his treatment, on which the jury is still out, and finally, hydroxychloroquine, an old anti-malarial drug that's finally been consigned to the dustbin. However, in sum, while awaiting the vaccine, the medical fraternity worldwide rose to the occasion finding effective symptomatic treatment, avoiding ventilators and other respiratory alternatives as far as possible and still ensuring that less and less people died.

In the meantime and until more people are immunised than otherwise, controlled public behaviour is clearly the way ahead in 2021. There can be no one way to enforce such things. The UK is just one example: the UK's coronavirus crisis has reignited one of the country's most bitter political debates: can the United Kingdom of Great Britain and Northern Ireland survive as a union of four nations? One Sunday night in May, Prime Minister Boris Johnson addressed the country from 10 Downing Street in a recorded message, announcing his plan for the UK to emerge from lockdown. He called on millions of people to return to work, and gave a rough outline of when schools and shops might reopen over the coming months. He also shifted his government's core message from the simple "Stay Home, Protect the NHS, Save Lives," to the more ambiguous "Stay Alert, Control the Virus, Save Lives." As the National Health Service looked close to collapse at the end of the year, Johnson performed a sharp U-turn, imposing a lockdown on most of England's population (the other three nations of the UK had imposed restrictions much earlier).

In India, Modi has pretty much handed over the handling of the pandemic to the provincial governments and the more effective of those in turn to the local district and municipal administrations. This is how it works and will work when it comes to delivering the vaccine as well. 

The efficacy of command and control measures depends very much on the underpinnings of people at large. Japan, for example, has always had an inclination towards masks way before the pandemic, the Japanese always bow rather than shake hands in greeting others. In India, people greet each other with a "namaste" instead of shaking hands (now being rapidly adopted elsewhere in the West). In Nepal for example, people leave their shoes behind at the door and there are often "house slippers" provided for use inside. However in India, for example, spitting in public, at least in the North, is a way of life like nowhere in the West apart from football matches. To expect a sudden and uniform change in such habits overnight is well nigh impossible. Perhaps the pandemic 2020 will begin doing this in 2021. 

And for the year ahead, 2021, there is of course a deep downside to the changes in the fortunes of the world at the end of Annus Horribilis: nine out of ten people in 70 low-income countries are unlikely to be vaccinated against Covid-19 because the majority of the most promising vaccines coming on-stream have been bought up by the West, campaigners have said. As the first people get vaccinated in the UK, the People's Vaccine Alliance is warning that the deals done by rich countries' governments will leave the poor at the mercy of the rampaging virus. Rich countries with 14% of the world's population have secured 53% of the most promising vaccines. Canada has bought more doses per head of population than any other - enough to vaccinate each Canadian five times, said the Alliance, which includes Amnesty International, Frontline AIDS, Global Justice Now and Oxfam. The missing point in this is that faced with a pandemic, no one is safe until everyone is safe. It happened with other global blights like polio and smallpox that finally ended with global immunisation and it'll happen again with the current pandemic. No one can be completely safe if 30 or more percent of the global population is unsafe. It's been proved by the case of both polio and smallpox. And that's going to be the story of 2021.

Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi