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COVID-19 pandemic: Are we witnessing the first world war?

2020; Medknow; Volume: 64; Issue: 2 Linguagem: Inglês

10.4103/ijph.ijph_432_20

2229-7693

Sanjay Chaturvedi,

COVID-19 Pandemic Impacts

To think that politics, power tectonics, economics, market, conspiracies, propaganda, rumors, and above all, gossips are not part of epidemiology would be a phenomenal error. Nothing underscores this better than this first global war of known human history. Previous two mega wars of the 20th century, wrongly documented as World Wars, were fought within some big yet well-defined theaters of Europe, Asia, and Pacific Islands. The scenario and span of COVID-19 is the spectre ofFirst World War in true sense, and with all colors inherent in human situation. This also has ruthlessly exposed the inadequacies of scientific methods and epidemiology that inform disease prevention, control, and mitigation. Are we competent or even cognizant enough to factor the colors and domains listed above as attributes or independent variables in our war-game models? What we celebrate as the discipline of epidemiology or scientific methods is still far too formal, deductive, and cussed to accommodate all this. COVID-19 is screaming from rooftop that the science of natural reality or even that of human reality is way beyond our much-proclaimed epidemiology. Not that the train of events skipped the cameras of orthodox epidemiology this time. Our cameras were too slow to capture this roller coaster, and our films were blind to many colors. Let's count the conventional stations en route and list some cardinal "unknowns." The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has jumped many species, but we do not know much about those stories. It quickly turned to a human-to-human droplet-transmitted virus of zoonotic origin with low-case fatality but a very high pandemic potential. All this might have happened much before what is known to us, may be as early as in November 2019.[1] Asymptomatic phase in humans made voluntary quarantine impossible. Fever was the most common symptom but also had the potential to mislead the screening since 56% of initial patients developed fever after hospitalization.[2] There was neither a definitive treatment regimen nor an effective tool for active or passive immunization. Rapid emergence of surge situation at ground zero rattled the health-care system and outsmarted mitigation efforts. This was happening at parallel arms while a critical parameter, R0(basic reproduction number), was yet to be substantiated and validated. But the biggest catch lies elsewhere. We have been trained to believe that if "wise and responsible" people know something that must be shared with people, it will be told to the world. Although science teaches us to be skeptical till proven, we never question this belief. This leaves us perpetually unprepared to face the chasm between "what is known" and "what is told." When some inquisitive minds start pursuing the spirit of enquiry beyond the domain of "schooled science" and start bringing this "chasm" on the radar of research questions, they are ostracized as conspiracists. Some of them may be but not all. Moreover, even if they are conspiracists, their questions need to be answered. It is difficult to believe that the agencies of United Nations were unaware of what was going on at ground zero in November–December 2019. Why didn't they show same level of professionalism they started showing from February 2020 onward? What was going on between them and the ruling classes of China from November 2019 to January 2020? Did Chinese rulers know what was coming, well in advance? And, did they start placing themselves, as early as in October–November 2019, to a position of advantage in a postpandemic World? All such rumors, gossips, and questions were buried under the carpet. Meanwhile, all our models were fed with half-truth. Pneumonia of unknown cause was reported to China Office of the World Health Organization (WHO) on December 31, 2019.[3] The WHO conducted field visit to ground zero, after 3 weeks, on January 20, 2020.[4] People hate to entertain a thought that the agencies of United Nations could be complicit in all this. Hence, they believe that these agencies were either unprofessional or gullible. To confound this noise furthermore, the global response has been largely political instead of being scientific. Then, there are wonderfully articulate voices of lobbyists, analysts, thinkers, ideologues, and propagandists muddling in the muddied waters. They cannot see beyond their viewpoint and for that all they need is a high optics event – not any data. Selective data are used though as a quasi-scientific garnish after the narrative is set and script is finalized. Some enthusiasts use this devastating tragedy to push their ideological agenda. When the humanity is holding UN agencies accountable for not holding Chinese government accountable for alleged deceit, some amazing intellectuals are peddling this alleged suppression of evidence and acts of ruthlessness toward their own people as the great success of socialism.[5] A new religion is being sold as social science. You just cannot beat a committed mind. Media, with their instant experts, are also having their daily sorties of carpet-bombing left, right and center. Celebrities of all shapes and sizes, who have an opinion on all topics ranging from cinema to plasma physics, are invited to opine on disease causality, prevention, and mitigation strategies. Unfortunately, the celebrities in the market of knowledge and healthcare are no different. What is offered to people is neither validated nor regulated. For example, an international broadcaster invites a cardiothoracic surgeon, also a corporate medicare leader, on a COVID-19 debate who in turn tells the world that Bacillus Calmette–Guérin is a smallpox vaccine. This may be a momentary lapse of reason or attention but an immediate "on camera" retraction was needed. What followed was a played-down damage control. Glamour takes it all. The damage was done. Public health stays in the background and is likely to be forgotten in postpandemic phase again. Governance in health is up against an unprecedented challenge and so are the people. Ordinary citizens living under dictatorial regimens are caught between rock and a hard place. Democracies are caught between restrictive or prohibitive public interventions and ethics of liberty. Noisy democracies are facing organized groups working for disruption and subversion. Alarmingly frequent violence against doctors, frontline workers, and security personnel in some parts of the world is emerging as a threat to healthcare systems. Sections of social media groups are fishing in troubled waters. Quick attrition of trained health-care functionaries as a result of higher infection and mortality rates among them is also a serious concern. In low-resource settings, these workers are caught in a cleft stick. Decades of political, administrative, and budgetary neglect are manifesting at the worst possible time. Asking for good quality personal protective equipment is perceived as indiscipline in a work environment where basic infrastructure is a luxury. Draconian orders have been issued against health workers testing positive by some top authorities. They were asked to face enquiry along with COVID-19. Even if such orders are kept in abeyance, this is victim blaming of a pervert kind that has gone unpunished. Diagnostic and screening exercises are heavily dependent on a costly test – Real-time polymerase chain reaction, but there are issues about its sensitivity even after two swabs. Antibody-based tests are not showing much promise. Poor quality of rapid antibody test has a potential to erode public confidence. Hasty media-announcements about the efficacy of hydroxychloroquine in chemoprophylaxis were heavily based on in vitro and some observational data initially. They may prove to be correct but the enthusiasts forgot that the apparent effect could well have been part of natural history. Then, there were some scandalous counters and course corrections as well. The virus and the syndrome may change their behavior or complexion across and within continents. Finally, the gastrointestinal symptoms have also emerged as marker of poor prognosis. This would be a huge challenge in the context of countries with poor environmental conditions. In South Asia, social challenges may be enormous, but the pandemic challenge is relatively less alarming as of now. Force of infection might be comparable, but the case fatality appears to be a bit muted. Quantum of civil aviation between China and South Asian countries was sizeable in November 2019 through January 2020. It is hard to believe that SARS-CoV-2 failed to reach South Asia much earlier than what we know. This might have actually occurred in November–December 2019 and would have been nationwide within weeks because of busy domestic aviation. If this assumption is true, then why didn't we witness a surge in South Asia? There are no concrete answers – only postulates. We can only guess that with passage of time, the virulence of virus, and the severity of disease may come down slowly. There is also a possibility that the virus may resurrect postmonsoons, and stay with us, may be as a seasonal SARS-CoV. Whatever be the course of pandemic, avoiding unnecessary assemblies and a curb on nonessential travel are going to be the game changers for a long time to come. Human-animal-environment interface is not statistical and may not follow laws of probability. Models may fail again to inform the program and mitigation activities on the frontline.[6] Some base-case riddles and resulting interventions continue to haunt Ground-Zero and rest of the world. Humanity would learn the hard way that ignoring zoonoses and One Health approach would keep us perpetually unprepared for newer pathogens with pandemic potential.[78] Although this has been the decade of vaccines and an efficacious vaccine against SARS-CoV-2 may be available very soon, we tend to forget the cardinal role of social mobilization and community-based delivery systems to address vaccine hesitancy and cultural resistance against vaccination in some highly populated areas of the world.[9] Like it or not, this is akin to a low fatality nuclear war where a biological fissile material is exploding in nearly every human habitation in successive phases. Case fatality may be low, but the threat of attack and spread potential is very high. Unfortunately, the rich and powerful (in each of these micro-theatres of war) may end up paying the least in terms of "net cost." Or, the "low resource living" as immunity booster for war preparedness may play as a great leveler. The big picture would only be clearer after 2 years (two seasonal cycles). This is the first global crisis in true sense. And, we all need to be prepared to pay our bit of cost. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.