Coping with today, planning for tomorrow-COVID-19

Coping with today, planning for tomorrow

Part of: GS-I- CULTURE (PT-MAINS-PERSONALITY TEST)

(By Dr. Ramasubramanian is Consultant, Infectious Diseases, Apollo Hospital, and Director, Capstone Clinic; Dr. Aruna Mohan is Consultant Paediatric Dentist, and Director, Capstone Dental Care )

Quote for essay (Ethics)

“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm is all about” - Haruki Murakami.

Issues in tackling the COVID19 :

1. Does a negative PCR swab test rule out the infection? Even though the PCR test is currently considered the gold standard, it has only 60-70% sensitivity in picking up the infection.
2. Can patients become re-infected? Up to 10% of patients in China and South Korea who were discharged from hospitals after recovering from the infection subsequently tested positive by nasal swab PCR. The implications are unclear.
3. Do masks for the public help? With increasing evidence of transmission from asymptomatic persons with COVID-19 and the possibility that masks may partially help prevent viral transmission, cloth masks for all public is likely to be recommended.
4. Will an early vaccine release help the pandemic? Vaccines, if effective, will be a definitive answer to the pandemic. However, vaccines need to undergo safety and efficacy studies in an animal model followed by human volunteers, which will take up to 12-18 months.
5. Is plasma therapy an answer? It is too premature to expect that it will cure the infection. It appears less promising than it appeared initially.
6. Discipline of the community at large, in times like this, is an enormous challenge.

Issues after lockdown ends

• Purpose of lockdown: Lockdown has helped only to slow down the progression of the infection and has done precious little to eradicate it. Flattening the curve only gives the healthcare system a breather, to prepare for the onslaught of the virus.
• At present, infections are doubling every eleventh day in India. Once the lockdown is lifted and life resumes, there is bound to be a surge in the number of cases.
• The pandemic will end only when over 60% of the population is infected, leading to herd immunity, or if a vaccine is available, both distant options at this time.
• We will be in a position to lift the lockdown only if we have had no new cases for at least two weeks.

What can happen with increasing the lockdown period?

• This would wreak havoc on the economy of any country.
• Detrimental to the health of infected persons, and also deleterious in the management of non-COVID health issues.
• It will lead to massive unemployment and recession and ruin the economy.
• Even when the ban is lifted, several industries may not show revival for up to a year. So the current lockdown, however harsh it may seem, is our best option.

Stockdale Paradox (Accepting Realism is the key for survival)

• ‘Stockdale Paradox’, named after Admiral Stockdale of the U.S. Navy, who was imprisoned and tortured for seven years during the Vietnam War. The psychological duality of ‘balancing realism with steadfast optimism’ defined his endurance and survival.
• The implications of this crisis vary from financial catastrophe to emotional black holes. We are on different ships looking to survive, and survive we will. One has to be realistic, yet solid in the belief that ‘this too shall pass’.
• We need to face this period of turbulence with calm efficiency. “Maturity of mind is defined as the capacity to endure uncertainty” said John Finley, an English historian and mathematician.

Way ahead

• India needs to invest in community education and community participation.
• Trust in the government is an important component in any emergency health response.
• An increased expenditure in a robust public health system is important to building trust and confidence.
• Bolster infectious diseases surveillance.
• The media and the public health system should ensure that the correct messages reach the common man.
• Scientific and evidence-based information needs to be disseminated.
• Humans cope with trauma by repressing its memory. The temptation to forget COVID-19 and move on will be overwhelming. But India must let not let that happen. These crises create opportunities for innovation.
• We need a vision of a post-COVID-19 economy that is not ‘simply a return to normal’. A new normal can build upon what we have discovered under lockdown, about making a living and living well. Let us work on an economy that conserves earth resources, avoids future pandemics, and enhances physical and mental well-being.