CORONAVIRUS: REALITY CHECK
Health, World Affairs / By adityapimple1
When the outbreak of SARS-CoV-2 or Covid-19 began in China in December 2019-January 2020 and went on to spread around the world, Governments and Public Health authorities struggled to come to grips with this unknown virus. As the virus spread through Europe next, with Italy and Spain being the worst hit, Italy became the first Country in the World outside of China to announce a stringent lockdown of its citizen. 5 Months on, we have learnt much more about the virus than we did when the pandemic began, with the most reliable date coming out of Europe and the United States which have borne the worst of the pandemic. But what has also come to light are the extremely divergent views on the virus and the means of dealing with it, not dictated by the available scientific information, but by pre-existing biases focusing more on anecdotal instances than on actual numbers and science. The reality of the virus, and the manner in which it is to be dealt with, lies somewhere in the middle, between extreme paranoia or blatant and irresponsible carelessness.
To understand Covid-19 virus properly, one needs to look no further than the Bergamo Province in the Lombardy Region of Italy, which was the first to be hit by the virus and resulted into the harrowing and scary images flashed on TV screens around the World showing the enormous humanitarian and economic damage that the virus could cause. An important factor for using this region as the best pool for analysing the virus is because it was the first to be hit, and the behaviour of the virus, for a long period was not stopped by timely and necessary preventive measures like physical distancing or masks till the time the localized lockdown in the region was imposed on 21st February 2020, followed by a nation-wide one on 9th March 2020. It is safe to assume that by this time, the virus had spread considerably without any obstruction.
Bergamo, Lombary Region, Italy
In the Lombardy region, there have been 89,442 confirmed cases of Covid-19, with 16,174 confirmed deaths, and a mortality rate of 18.12%. In the first-hit Bergamo province of the Lombardy region alone, there have been 13,224 confirmed cases with 2,060 deaths, with the mortality rate of 15.57%. Most deaths were amongst people of advanced age or other people with co-morbidities. These mortality rates coming out of Italy were alarming and most of the World followed Italy into imposing stringent lockdowns to stop the spread of the virus and the resultant deaths on such a large scale. Even the figures coming out of China at the time seemed to suggest that the actual mortality rate, taking into account some unconfirmed cases, would be around 3%.
However, now that the first wave of Covid-19 in Italy has subsided, serological studies have started to be carried out in the region to find out the true extent of the spread of the virus. Serological tests look for anti-bodies in a person’s blood to find out if a person had been infected in the past with the virus. On 30th April 2020, the local Health Protection Agency of Bergamo announced the results of a serological survey carried out on 1,054 citizens and 1,527 health workers. For this survey, the following three categories of persons were excluded,
- past confirmed cases,
- symptomatic contacts of confirmed cases and
- asymptomatic contacts of confirmed cases.
Therefore, the survey was carried out on a small sample of citizens and health workers not figuring in the official confirmed numbers of cases in the region. The results among the citizens showed that 652 out of 1,054, a positivity rate of 61.9%, were found to have antibodies showing that they had been infected in the past without them knowing it. The positivity rate among health workers was much lower, at 355 out of 1,527, viz. 23.2%, most probably owing to the protective measures such as masks and PPEs. Therefore, what the serological survey demonstrates is that about 61.9% citizens of Bergamo province has already been infected.
Applying this to the entire population of the Bergamo Province, 1.1 Million as of 2016, the total number of actual infections would be somewhere around 6,80,000 actual infections in the Bergamo province alone. Of this, with 2,060 deaths, the actual mortality rate would be around 0.30% and not 15.57% as the figures suggest. Even assuming the deaths to be under-reported, and taking the number of deaths to be double, the mortality rate would be about 0.60%.
New York City
Even other serological studies carried out in other highly impacted places like New York City show the same. On 23rd April 2020, New York State Governor, Andrew Cuomo announced that a serological study carried out in New York State showed that 14.9% percent of persons tested were found to have antibodies to the virus, showing that they had been infected. For New York City, the infection percentage was even higher at 24.7%. Applying this to the larger population of New York City of 8.4 Million people (as of 2018), about 20,75,000 citizens of New York City may have actually been infected. However, the actual confirmed cases in New York City is only 1/10th of that at 2,05,000 confirmed cases with 16,877 confirmed deaths (8.23% Mortality Rate). Therefore, the actual mortality rate even in New York City would be much lower, around 0.80%.
Closer home, in India, the state of Tamil Nadu, which has done a good job at testing and identifying a large amount of actual infections, has confirmed 25,872 coronavirus cases with only 208 deaths, showing a mortality rate of around 0.80%. The mortality rate maybe even lower taking into account the unidentified infections not captured by the State authorities. The state of Kerala, which has done a great job, not only at testing and identifying actual infections, but also at stopping the spread of the virus within the state, also shows a mortality rate of around 0.80% with 12 deaths out of 1,495 confirmed cases.
Further, figures relating to covid-19 deaths coming out of other Cities and Countries show that around 60-75% of the confirmed deaths have co-morbidities, many a times making it difficult to confirm whether the death occurred due to complications caused by Covid-19 or not. The deaths are also mostly in people of advanced age, with children and young people with extremely low or no risk of fatality from the virus.
These figures suggest that the Covid-19 is not as harmless as the Flu, which has an actual mortality rate of 0.1%. But neither is it a mortally endangering disease, so as to justify the continuing paranoia and stigma attached to it. What is crucial is to protect the Public Health systems around the World from crumbling under the stress of the infected Patients requiring critical care coming into Hospitals. Based on the actual mortality rates being deduced on the basis of serological studies, assuming 1% of the infected persons requiring Hospital or critical care in a short duration of time, it would be an impossible load for Public Health systems to handle if the virus is allowed to spread unchecked. Further, based on the actual mortality rates coming out of these serological studies, if virus is allowed to spread unchecked around the world, 0.30% of the World’s 7.59 Billion people dying is a horrifyingly high number which would overshadow all the natural and man-made disasters and wars known to Man put together.
Therefore, what is required is not mortal fear or paranoia of the virus, but remedial measures to slow the spread of the virus. Lockdowns, when imposed by various Nations, in the absence of full and clear information was understandable and even required at the time. But now that more accurate and critical information about the actual nature of the virus becomes clearer, it’s becoming more and more apparent to Governments around the World that it is impossible to pause the entire World and its economy and keep its people locked up in their homes in the hope of a vaccine. The focus of the Governments should now shift, as it rightly is, to slowing the spread of the virus so as to never overwhelm their respective Health systems and to protect the high-risk persons from contracting the infections, while allowing the young and healthy to go back to work by observing the necessary preventive measures.
Even though it looked like an extremely irresponsible and careless answer to deal the pandemic two months back, in the absence of an impending safe and effective vaccine, a slowly acquired ‘Herd Immunity’ seems to be the only and most realistic way to end this virus.
Aditya Pimple is an Advocate practicing at the Bombay High Court.