This is an edited version of Rohini Nilekani’s conversation with Kiran Mazumdar Shaw, Anshu Gupta, and Theja Ram about how they coped with COVID-19 and what they learnt about the disease, the health care system, and society in the pandemic.
As of September 5, approximately 27 million people were confirmed to have been infected by COVID-19 globally, and there were around 880,000 deaths reported. In India there were 4.1 million people officially known to have been infected, with 70,000 deaths. To put these numbers in context, we had a crude death rate of 7.3 per thousand people.
When it comes to COVID-19, India’s case fatality rate stands at around 1.7 percent, compared with around 3.3 percent in the rest of the world. Of course, the numbers here are rising steadily and experts say we have not peaked yet as the disease is currently spreading more into the rural hinterland. In fact on September 5, we set a new global record of 90,000 cases in one day.
As it stands, we have a lot of work to do to contain this pandemic. Each death so far has been a tragedy, and family members no doubt are still grieving. But perhaps we need to put the situation in perspective. India is currently reporting about 50 deaths per million, while the USA, Spain, and others have 500-600 deaths per million. These numbers can change, of course, and we must assume some under-reporting on cases and deaths. We must also keep in mind that perhaps our lower death rate may be because we are such a young country, with half our population below 25 years of age, and this disease disproportionately affects older people and spares the young. However, it’s clear that our situation could have been a lot worse.
While the picture is far from complete, we also know much more about the virus and the disease it causes than we did in March. This does not mean we can be careless, in fact, it is quite the opposite. We must use the knowledge we have to act more responsibly. It is now clear that the virus will be contained if people take sensible precautions such as wearing a mask in public spaces. There is currently no evidence that you can get COVID-19 by eating or handling food, so simple hygienic practices will suffice to protect from transmission. What is also clearly established without reasonable doubt is that this virus spreads through airborne transmission.
Therefore, based on what we know, masks, hand-washing, and physical distancing are the three pillars for containing the virus, provided they are willingly and universally adopted. The fourth pillar is to try to be in well-ventilated spaces, even in the home. In addition, we know that exercise and nutrition always play a big part in maintaining good health and boosting immunity. But we must not forget the millions of people who are unable to sustainably maintain these simple protocols because of where they live or how they work, and this is why good therapies and safe vaccines are going to be absolutely critical in India. The good news is that there are currently dozens of vaccines in trial around the world. Never before has the scientific community, the state, and the market, stepped up so quickly to respond to a global public health emergency.
Today there are promises being made that at least one vaccine will pass the finishing line before the end of this year. While we will have to wait and see how accurate that is, one thing is certain – India will be able to quickly manufacture millions of doses of any vaccine, both for indigenous use for our people and for export to other countries. As my husband Nandan pointed out recently, we have to quickly plan for an efficient and equitable way of ensuring that the 1.3 billion people in India will be able to quickly take advantage of a good vaccine to protect themselves.
We are now six months into the pandemic, and it’s a good time to put some of our fears and our hopes into perspective. Can we discard some of our irrational fears? Can we recommit to personal responsibility? Can we throw off some of the new suspicions we have acquired of our neighbours and workers?
Understanding Our Fears
Earlier this year there was a lot of uncertainty about the virus and how it impacts health, because of which our fears were at an all time high. Especially for people who were living with senior citizens, or who were immuno-compromised themselves, there was a lot of doubt and anxiety. This is what concerned Theja Ram when her father, a senior citizen (64 years old), contracted COVID-19 in July. At the time of his infection Theja was writing an article about the death rates among people who have respiratory tract infections, which is the same kind of infection her father had. This only amplified their fears.
As a primary contact of her father’s, Theja got herself tested as well. As a cancer patient who had just met her father the day before she tested positive, Theja was doubly anxious. As Theja says, for both her father and herself, their biggest fear was whether they had already developed symptoms and got tested too late. According to her, her doctors tried to calm her by reminding her that she was young, so she needn’t worry about herself. Still, she talked to a counsellor who helped her calm her anxieties and get through it.
As a scientist, Kiran Mazumdar Shaw wasn’t as worried when she contracted COVID-19. Kiran says that for her, the symptoms resembled the flu, a mild fever and a cold, but because she lives with her 89-year-old mother and her 71-year-old husband, who is also a cancer patient, she decided not to take a chance and got her whole household tested. In addition, she immediately quarantined herself in one part of the house. When her test results came positive, Kiran wasn’t surprised, but she also wasn’t worried because her results showed that she had a moderate virus load, her SpO2 was good, she didn’t have difficulty breathing, and was in pretty good health. However, as a wife, a mother, and a daughter, Kiran says she was very worried – she didn’t want her loved ones to catch the virus, but being in quarantine herself, there was little she could do for them.
On the other hand, from the day he caught the virus to the day he tested negative, Anshu Gupta had to spend almost 26 days in isolation. In his experience, those days were full of unpredictable health side effects, including fluctuations in fever, severe gastroenteritis, and high blood pressure. For him, something that stood out during this time was the fear from his neighbours and community. Towards the end of May, when he caught the virus, the hospitals weren’t all open, and he had been advised to stay at home. But at the time, the fear of the virus was at an all time high and he noticed changes in how people around him were behaving. His neighbours wouldn’t allow the family to open their gate, and when his water filtration stopped working, their local shopkeeper sent them bottled water, with an additional INR150 charge per bottle as security. The shopkeeper has since refused to take back the bottles and return the money, even after a month of Anshu being COVID-free.
For Anshu though, his stint with the virus was two-fold, In July, he contracted it again, and this time it was much worse. On July 23, he began to experience a stomach ache, which was diagnosed as a severe acute case of pancreatitis. His liver, kidney, pancreas, were all affected. Anshu believes this was an after effect of COVID, but hasn’t found a doctor that will say that. Instead, doctors blame these side effects on drinking too much or having stones in the gall-blader.
According to Anshu, a lot of his fears were for his team. The Goonj team was placed across the country, working with migrants in remote parts, and like everyone else at the time, they had limited knowledge of the virus. Many people working in the social sector didn’t have the kind of insurance that would make them feel secure about their families, and didn’t have access to PPE suits. In addition, they had to redefine how they interacted with the communities they were working with – previously hugging people and shaking hands was the norm, but now they were creating systems to ensure physical distancing.
In an effort to deal with this, Anshu and his team created special WhatsApp groups where people talked to each other, shared pictures from the field, processed together and learned from each other. For example, people would share photos and others would point out things that needed to be corrected, like masks that were too thin or didn’t cover their noses. The group also spoke a lot about immunity, and measures people could take to maintain it. This, he says, is something all of us can do – create ways to support each other and learn from each other using science as a backing.
The Need for Increased, Affordable Testing
Based on her experience with COVID, Kiran says there is a need, first and foremost, for people to be able to get tested on demand. This is a public health emergency, and the government ought to be able to provide testing. The government also has to come up with a model based on antigen testing, antibody testing, and RT-PCR testing. It needs to have systems for pool testing and individual testing, because we need to know what the caseload looks like in every part of our city and state, so that we can predict where the next outbreak will be and where herd immunity is being built.
When talking about the importance of getting test results back in a timely manner, Kiran refers to an experiment that Bill Gates proposed for America, where he said, “Can we introduce a rule that says that if you don’t get your test results within two days, you get it for free?” If India were to follow this idea, we would get the private sector and all other testing labs to send test results on time. With this in mind, Kiran says that her recommendations to the government would be to make testing-on-demand available, to make tests free for people who have symptoms, and implement pooled testing as well.
Additionally, Kiran talks about the need for more effective tracking of the virus. As she explains, there are two phases of the virus. Most people experience only phase one, which is when your body develops the antibodies and T-cells required to fight it, and it goes away. But at least five percent of people experience what Anshu did, which is when the virus behaves like an autoimmune disease and starts attacking your own cells and organs. Given this, what we need today are systems that measure these things, and doctors to monitor them. Because even though everyone won’t need it, for those who do, it can be life threatening.
According to Anshu, as a country we need to be doing much more to make this virus manageable. For example, he talks about the affordability of getting tested. Today it costs more than INR 4,000 to get it done in some states, and that makes it unaffordable for most people, especially given that if one member of the family has symptoms, everyone needs to get tested. Many people are also afraid to go to hospitals to get tested because they believe their chances of contracting the virus are higher in those spaces. In his experience, even though he had access to a private hospital and doctors, the process to get tested was still very complicated. But what happens to the migrants he was working with before he contracted the virus? There’s no testing facility for them on the road, there’s no subsidy by the state for them to get tested, and each of them will come in contact with so many more people.
As a journalist, Theja has heard stories of how hospitals in India are severely understaffed and don’t have the resources to give patients the kind of care they need. She was fortunate enough to be treated in a private hospital where that wasn’t the case. To her, one thing that government hospitals need to do is ramp up their facilities. To begin with, they need to hire professionals who can handle the patients that are coming in, they need to increase their elements of hygiene, and they need more manpower because their doctors and staff are already overworked.
As someone who had previously been getting radiation treatment for her cancer, Theja did have medical insurance, which helped offset the total amount she had to pay. Despite this, her bill for COVID-related care crossed INR 2 lakh. With this in mind, she says it’s of the utmost importance that people get COVID insurance, regardless of whether they have regular insurance. Getting it can be hugely beneficial to people who don’t have immediate cash on hand, or don’t have the resources to get a loan, should they fall ill. According to her, a lot of insurance companies today have separate COVID-19 insurance, and once you have it, it’s fairly easy to claim it.
Living With COVID-19
As Kiran says, today society has a big role to play in keeping themselves and each other safe. It’s up to us to make sure we don’t infect anybody else in case we have it. So we need to make sure that we wear masks, maintain social distancing, and keep our hands clean. Globally, there is a lot of understanding of how non-linear this disease is, she says. There’s a much better understanding of what needs to be done, and people are learning how to handle patients much better than before. This is what we have to prepare for, because according to leading voices in biotech, a vaccine will not be launched before April 2021.
As Anshu points out, we also need to ensure that we are not paranoid. Checking your levels every half an hour is not necessary. As someone who had COVID, lived in a closed house, and didn’t spread the disease to anybody else in his family, Anshu emphasises the need to follow precautions, especially the wearing of masks. We need to take this virus seriously, but we shouldn’t be scared of it.
Kiran echoes this when she says that instead of getting paranoid, we should focus on getting better at treating this disease. What we need to aim for, is getting the mortality rate close to zero. For this, the government needs to take steps to manage it better, because what we need now is a collective effort towards tackling COVID-19.
As far as self isolating and staying at home goes, Theja acknowledges that being cooped up at home is not the answer. Referring to her own example, she says that working from home and following physical distancing norms isn’t a guarantee that you won’t get the virus. You can be perfectly healthy at home, but you do need health supervision, for which there are a lot of tele-health facilities, along with packages at hospitals aimed at providing supervision at home. With this in mind, Kiran recommends that people keep a helpline in mind, which connects them to a medical professional who can advise you if you have symptoms.
Importantly, Theja says that people need to stop stigmatising those who have got the disease. Referring to her father’s experience, she says that neighbours treat you as though you’re untouchable, and even after you have recovered, people walk away from you if they see you outside. This causes a lot of distress to the people who have gotten the virus. As Theja explains, we need to understand that people who got COVID-19 need to be sympathised with, not stigmatised.
Looking Forward
According to Kiran, we need to decentralise the management of this virus and delegate it right down to the taluk level. We have an army of healthcare workers, like ASHA workers who have been doing a phenomenal job of contact tracing. We know that the number of people affected by COVID-19 will keep increasing, but if we can reach a stage where there are more people who have recovered, and less who are dying, that will be a measure of managing this virus a lot better.
According to Anshu, as a country we need to understand that as of today, there is no “post-COVID” world because we are going to be living with COVID for a while. Importantly, he points out that this particular virus has been used in the country to spread communal hatred. This is extremely problematic because now more than ever, we need to stand with each other. We should be thinking about how we can help if our neighbour has COVID-19. They might need us to reach out through a phone call or some food dropped off at their doorstep. These are things we can do for each other even if we are afraid. As he says, we need to build support so that people know that they are not fighting this virus in isolation.
When talking about his learnings from the pandemic, Anshu mentions the importance of having patience and being cautious while fighting the virus. There is no need to panic or to call five different doctors and get five different sets of advice, as doing so will lead to more confusion and panic. Lastly, he says that he learned that it was important to keep busy, eat good food, and stay in contact with people through conversations or social media. We should listen to what our bodies are telling us and not exert ourselves too much.
