The unseen foe

The world and all that is in it was made by God, people believe. Yet, for ages, the world of invisible microbes has been at war with humans, snuffing out lives and pushing millions of families into misery. Although ultimately man has been winning, this time, COVID-19 has taken mankind unawares. Already, about 2 million have fallen sick, and over 1,47,000 have lost their lives, every case being heart-wrenching. In most places, people cannot even have a last look at their loved ones; their bodies are being taken for disposal straight from isolation wards. In Ecuador, dead bodies are being abandoned in boxes and bags. In New York, they are being buried even in public parks. Crematoria are overworked; even mobile ones employed. Yet, humanity is only trying to dodge the attacks, desperately waiting for the best brains to find the right weapons to fight with.

WHO has been constantly alerting and updating the world about COVID's dangers – its highly contagious nature, it's transmission as droplets in the air across 13 feet, survival on metals, papers, textiles, from 2 to 8 hours, etc., and the precautions to avert said droplets from the sneeze or cough of the infected by wearing masks and consulting a doctor in case of symptoms of breathing congestion, fever, etc., as well as on aspects of sanitisation. While these are being strictly followed, a doctor from Vizag, Dr Surya Rao, has even suggested that using black umbrellas in open places would not only automatically maintain the required social distance but would also kill the virus with the heat absorption characteristics of the umbrella. IIT Ropar has even created a trunk fitted with ultraviolet germicidal irradiation technology. Costing only Rs 500, it can sanitise everything from groceries to currency notes.

Thus, while strictly following social distancing and the suggestions for sanitisation, with a fear of the unknown, people are also giving serious thought to every remedy being suggested – those on social media and by the Ayush Ministry, without verifying their veracity. The propaganda of the untested claim of having methods of COVID-19 prevention and cure by Ayush has, however, been banned by PIB after experts began emphasising that there is no cure or vaccine so far.

In the meanwhile, doctors are trying a combination of drugs to keep the patients healthy during the isolation regimes so that the natural immunity they develop ultimately takes care of the virus. It is even said that, unlike advanced countries, our 'herd immunity', acquired through our lifestyle of cohabitating with germs and dirt, like stray dogs, is also coming handy in preventing the spread. Yet, as cases are rising, like the rest of the world, we are also frantically groping for targeted treatment or vaccine.

At this juncture, thanks to Professor Praful Chander Rey, who invented the anti-malaria drug, Hydroxychroloquin, in 1901 and also our capacity to produce a whopping 20 crore 200mg tablets a month, India has taken centre-stage. However, its efficacy is yet to be proved. ICMR has only cautiously allowed its use as a preventive treatment (prophylaxis) for high-risk people since it can also cause cramps and a loss of peripheral vision. And, being in deep trouble and desperation, simply hoping that it would be the game-changer, US acquired a large supply for the same drug from India, even at the cost of having to accept our conditions for free-marketing in the US, lifting of relevant bans on Indian pharma companies, etc.

There is yet another ray of hope in plasma therapy, which has been experimented with since 1890 for several viruses. Tentative evidence reveals that those who are critically ill or even those who are at high risk of contracting the virus can benefit from the infusion of blood plasma collected from recovered-patients, that too after 14 days of complete recovery. Clinical trials are still in progress in China, US, etc. Now, ICMR has also approved such trials on critically ill patients.

While all these efforts are to meet emergent crises, a long-term solution lies in finding the vaccine. The world looks towards India in this regard for two reasons. With all the talent and infrastructure available, India may have a quick breakthrough. Then, once found, it requires mass production, for which India has a strong manufacturing industry with a capacity to produce a billion vaccines a year. India already supplies 70 per cent of vaccines used around the world. But, finding a vaccine, and then rushing it to production is time-consuming.

Beginning with the generation of the antigen, vaccine production has several stages. Viruses are grown either on primary cells such as chicken eggs (e.g., for influenza) or on continuous cell lines such as cultured human cells (e.g., for hepatitis A). Likewise, a recombinant protein derived from the viruses can be generated in yeast or cell cultures. After the antigen is generated, it is isolated from the cells used to generate it. Then, there are processes like adding adjuvant for enhancing the immune response of the antigen; stabilisers for increasing storage life; preservatives for allowing multi-dose vials, etc. Furthermore, several techniques are used for greater productivity and low incidence of contamination and side-effects. It is all a long process.

In the meanwhile, like the successful case of South Korea, we are also using 'Testing, Tracking, Isolating and Treating' as the mantra, and are faring better as compared to the US and others. Strict enforcement of lockdown is resulting in good signs.

The much-awaited flattening of the curve has begun in Kerala. WHO has also curbed its earlier alarm of India being in stage 3 with community spread, now saying it only has clusters of cases, while cautioning that any laxity now would push it to stage 3 of quick spread, when tracing the source would be difficult. As such, 400 of the nearly 600 districts in the country are unaffected and governments are fully vigilant in the 133 hotspot-districts.

However, one matter that still worries people is the vulnerability of doctors and other health workers and hospitals emerging as high-risk hotspots. When a patient hides their history or symptoms, it leads to more infections and situations like what happened at Ganga Ram where over 100 doctors have been quarantined. Already, over 50 doctors and other health workers in India have tested positive in two weeks, although many were not connected with the fight. The death of two doctors in Indore has a telling effect on others. Notwithstanding the ESMA in force, 50 intern- doctors, appointed for three months to handle COVID cases in MP, have resigned, citing lack of essential PPEs and families being affected. Unless these supplies are provided quickly along with attractive financial incentives, the situation may turn worse in these testing times.

Further, in view of episodes like that of Tablighi Jamaat, cases in Dharavi slum and a dhobi's positive case in Surat, rapid testing has to be done. But the serological test kits are yet to arrive. Even the order of the SC for free-testing of the poor by private labs is yet to be implemented, with the alibi of financial constraints. Corporates have to step in to help the labs and deliver on their corporate social responsibility. This is the most opportune time to fruitfully share their wealth with society. Birthday bashes, like that of some BJP MLAs and picnics of the rich as is the case in Mumbai can wait for the future.

Battles have been won by Taiwan and South Korea and India is on the verge of winning, while others are still struggling. Ultimately, in this war, humanity will conquer the invisible world of COVID-19.

The writer is a retired IPS officer and a former Member of Public Grievances Commission, Delhi. Views expressed are strictly personal