India is battling on two fronts over the coronavirus disease (Covid-19) pandemic: one, to restrict new infections and keep the fatality rate low; and two, to handle post-recovery complications.
In the last week of October, India came down to the third spot in terms of new infections over the world as France slipped up to the second position, and the country’s fatality rate dropped to 1.5%, lowest since March 27, according to health ministry data on October 26. As a matter of fact, India has one of the lowest fatality rates in the world. But these should not be reasons for complacency and we must continue to wear masks, maintain physical distance and do everything else to prevent getting infected or spreading infection. Awareness about wearing masks has become a social campaign across the country with some states such as Rajasthan planning to bring a law to ensure this, and others have announced penalties for violators of the Covid-19 guidelines, which includes compulsory wearing of masks. This, because the numbers may be rising slowly but they are rising. The fatality rate may be low but Covid-19 is still claiming lives. No one, absolutely no one, can afford to take this virus lightly. Some people argue that most of the infections now are in the mild category and require only home isolation and some medication for symptoms but the fact is, people are still getting into the ICUs (intensive care units) and choking on oxygen.
Then there’s a category of people who are hoping against hope for an early vaccine. That, unfortunately, may not happen as early as they hope. Every day there are reports about trials of new vaccines but a vaccine doesn’t seem in sight before mid-2021. And before that we have the festival season and the winters to handle. Experts have raised concern over chances of rise in infections as the winter sets in. Air pollution, they add, will exacerbate the pandemic in India. It is therefore more important the people don’t throw cautions to the winds and continue to keep their guards against the virus.
Another fact about vaccines is that even when India has a vaccine, it will take at least eight months to completely inoculate the one-billion-plus population. According to a report, India plans to vaccine 25% of its population by July 31. By that speed, the whole of India will not be vaccinated before the end of 2021, and this means, we have at least one year to be careful, extremely careful. There’s no word on whether the vaccine will be administered free of cost or not, election promises in Bihar and Odisha notwithstanding, so there’s an issue of affordability also linked with the vaccine.
So much for keeping infections and fatalities under control but people who have recovered from the diseases are also facing a slew of post-Covid complications and reporting symptoms such as fatigue, cough and difficulty in breathing. Experts are calling symptoms of Covid-19 persisting weeks and months after recovery as “long Covid”. In Rome, after a study found that 87% of 143 patients in a hospital had at least one symptom nearly two months after recovery, convalescent clinics have opened to handle recovered patients with symptoms of cough, fatigue, diarrhoea, joint pain, muscle aches, and lungs, heart, and kidney damage. Fatigue is the most common symptom, with more than half of the patents with “long Covid” in the Rome study reporting chronic fatigue, according to JAMA, the Journal of the American Medical Association.
In Rajasthan, the state government has announced post-Covid clinics at all district hospitals to tackle “long Covid”.
According to a BBC News report, which quoted a yet-unpublished research at King’s College London to say one in 20 people are sick for least eight weeks, older people, women, overweight and obese people, asthmatics and those who have more than five Covid-19 symptoms in the first week are at higher risk of “long Covid”.
There is evidence that suggests that even people with very mild or no symptoms can also develop post-recovery symptoms with the winter cold and rising pollution worsening post-recovery symptoms.
A Hindustan Times report quoted Delhi All India Institute of Medical Sciences director Dr Randeep Guleria as saying this: “With rising pollution, falling temperature and increasing crowding during the festival season, everyone at risk and those with ‘long Covid’ must get vaccinated against the flu to lower severity of post-recovery symptoms and also protect against flu infection.”
In the same report, Dr Rajesh Chawla, senior pulmonologist and critical care specialist at Indraprastha Apollo Hospitals in Delhi, said, “Hundreds of Covid-19 patients have been treated at Apollo Hospitals and what we’ve found in large follow-ups is that patients who had pneumonia on chest X-ray, needed oxygen or respiratory support have persistent symptoms beyond recovery, such as a nagging cough, breathlessness while walking, fall in exercise tolerance and chronic fatigue. Older adults and people on oxygen support are at maximum risk, but it doesn’t happen only to people in ICU. I recommend an annual flu vaccine to all recovered Covid-19 patients and a pneumococcal vaccine to protect against pneumonia to people before the age of 65 to protect them from chronic respiratory diseases when the weather turns cold and pollution level peaks.”
Doctors said it was best for the people having “long Covid” and those at risk to be in constant touch with their doctors.
Meanwhile, a study has found that countries where hygiene is poor, along with low-quality sanitation and water, seem to have a low Covid-19 fatality rate (CFR) as compared to countries that are well sanitised. The study was carried out by researchers in India that extended the support to the “hygiene hypothesis” which claims that areas having high levels of background infections are likely to witness less Covid-19 deaths.
The research revealed that within India, Bihar, one of the poorest states on socio-economic parameters, kept the death rate at 0.5 per cent, one third the national average.
The paper has been published by the CSIR, the National Centre for Cell Science in Pune, and the Chennai Mathematical Institute. It was published in the journal MedRxiv.
The study reinforces the common belief that people in India have high immunity because of poor hygiene and sanitation facilities.
