COVID-19: Causes, Concerns & Way Forward

COVID19 Causes

The COVID-19 pandemic has gripped the world with as many as 212 countries and territories affected. It is an ongoing outbreak triggered in response to the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). It is sweeping through the globe with the tally of confirmed cases standing at more than 65.2 million and more than 1.5 million deaths reported as of December 4, 2020.

Officially, the World Health Organization (WHO) recognized the spread as a Public Health Emergency of International Concern (PHEIC) on January 30, 2020, and a pandemic on March 11, 2020.

Exposure & Transmission

So how does the disease spread? Droplets produced during sneezing, coughing or talking by an infected person transmit the coronavirus to a healthy person if they are in close contact. A single human cough can produce up to as many as 3,000 droplets. However, owing to their heavy weight, the droplets mostly do not hang around in the air and fall off to the ground or onto surfaces. People catch the infection when they come into contact with these contaminated surfaces or potential carriers of infection and subsequently touch their face.

Lifespan of SARS‑CoV‑2 on Surfaces

The duration for which SARS‑CoV‑2 survives differs from surface to surface, depending on humidity, temperature and type of surface. Over time, the amount of the virus detectable on surfaces diminishes until it becomes totally non-infectious.

Research suggests that SARS‑CoV‑2 can survive for up to three hours in the droplets that an infected person coughs out. However, the smaller finer droplets between 1-5 micrometres in size can remain airborne for several hours if the air is still. Also, Sars-CoV-2 survives for up to a day on cardboards and up to 2-3 days on stainless steel and plastic surfaces.

Contagiousness

Following the onset of symptoms, the first three days are critical for spread as the disease is most contagious during this stage. Yet, note that the infection can transmit in the later stages or even before the symptoms manifest.

Fatality Rate

Globally, more than 42,248,499 people have recovered from COVID-19 as of December 4, 2020. The WHO Director-General Dr. Tedros Adhanom Ghebreyesus in his opening remarks on March 3 media briefing had estimated the worldwide fatality rate to be around 3.4%, much higher in comparison to seasonal flu that “generally kills far fewer than 1% of those infected.” For India, the mortality rate was projected at around 2% in a press conference on January 29 and February 10 with the disclaimer that the prediction was an early and provisional estimate that might change in the times to come.

Common Symptoms

Typically, fever, fatigue, dry cough, loss of smell and shortness of breath have been observed as the signs and symptoms of COVID-19 in patients worldwide. Some people also report aches and pains, runny nose, headache, chills, nasal congestion, diarrhoea and sore throat as additional symptoms. However, the disease may produce different symptoms for different individuals, ranging from mild to severe.

Stage-Wise Symptoms Breakdown

The Centers for Disease Control and Prevention (CDC) notes that it can take anything between two to 14 days for the symptoms to appear following the exposure. Characteristically, the first signs to occur are cough, fever and difficulty in breathing.

Usually, the time between exposure and onset of earliest symptoms is around five days. Often, patients are not aware of their symptoms as COVID-19 shares many commonalities with the common cold.

Here’s a day-by-day progression of coronavirus signs and symptoms for better understanding:

  • Stage - 1 (Day 5): Patients report dyspnea or difficulty in breathing, if they are elderly or suffer from a pre-existing medical condition.
  • Stage - 2 (Day 7): Patients with signs of dyspnea are likely to be hospitalized. However, this is also the point for the majority of patients, around 85 percent, to experience a disappearance of symptoms and see hope of coming out of isolation.
  • Stage - 3 (Day 8): Patients with a severe condition experience symptoms of acute respiratory distress syndrome (ARDS) with the lungs increasingly failing to meet the vital organs’ demand for oxygen. As per the Chinese Center for Disease Control and Prevention, approximately 15 percent of the total cases reach this stage.
  • Stage - 4 (Day 10): Intensifying breathing difficulties may cause some patients to be admitted into an intensive care unit.
  • Stage - 5 (Day 12): An early coronavirus symptom, fever is likely to go away at this point although cough associated with the disease tends to stick around for longer.

The average time to death is estimated to be around 18.5 days whereas dyspnoea tends to cease in survivors after around 13 days.

Asymptomatic COVID-19

Research around the world has emerged as a fresh challenge to the medical professionals already grappling to contain the pandemic. It has been suggested that the coronavirus infection could spread through unidentified sources or “silent spreaders” who are more difficult to trace and isolate, hence posing a far more dangerous risk of transmission. Raman R Gangakhedkar, Chief Epidemiologist at the Indian Council of Medical Research (ICMR) has observed: “Of 100 people with infection, 80 do not have symptoms.” Public health experts have emphasized that these unknown sources of contagion must be factored in while considering when to roll back social distancing norms as part of government directives.

Complications

COVID-19 can develop into pneumonia or cause acute respiratory distress syndrome (ARDS).

Preventive Measures

  • Frequent hand washing: CDC recommends washing hands properly for at least 20 seconds with soap and water, particularly if they’re visibly dirty. Hands must be washed on a regular basis and especially:
    • Before cooking or eating
    • After coughing, blowing the nose or sneezing
    • After touching an animal, animal waste or animal feed
    • After handling pet foods
    • Before and after caring for anyone sick with diarrhea or vomiting
    • Before and after treating a wound or a cut
    • After visiting the toilet
    • After changing a child’s diapers or cleaning up the child who used the toilet
    • After coming into contact with garbage

    Use alcohol-based hand sanitizer containing at least 60% alcohol, if soap and water are unavailable.

  • Respiratory hygiene: Cover your mouth and nose with a flexed elbow while coughing or sneezing.
  • Physical distancing:Avoid mass gatherings, standing in groups and crowded places. Maintain a distance of about two meters or 6 feet (2 arms’ length) from people in outdoor settings. Stay at home and step out only for essential or unavoidable circumstances with full precautions.
  • Face mask: CDC recommends wearing homemade cloth face coverings when going outdoors. The face mask should have multiple layers of fabric, fit snugly against the side of the face and be secured with ear loops or ties. Select a fabric that can be laundered and machine dried without damage to its material or shape.
  • Self-isolation: It aims to separate an infected individual from those who are healthy in order to prevent the transmission of disease.
  • Self-quarantine: It is advised for individuals who suspect a potential infection due to close contact with a COVID-19 positive person. For example, people with a travel history to coronavirus-hit areas in the past 14 days.
  • Surface cleaning: SARS‑CoV‑2 can be inactivated by disinfecting contact surfaces with products containing at least 62-71% alcohol, 0.5% hydrogen peroxide bleach or household bleach containing 0.1% sodium hypochlorite. CDC recommends regularly cleaning high-touch surfaces like door knobs, phones, tablets, remote controllers, touch screens, light switches, hard-backed chairs, desks, sinks, toilets, keyboards, handles and tables.

Global Socio-Economic Disruption

The socio-economic disruption due to COVID-19 pandemic has resulted in the most significant global recession after the Great Depression. The International Monetary Fund’s Managing Director, Kristalina Georgieva has predicted a negative global growth eyeing "a recession at least as bad as during the global financial crisis or worse." She has warned that the world growth in 2020 would plunge below the 2.9 percent rate seen in 2019. Countries worldwide are tackling the coronavirus crisis by implementing lockdowns, facility closures, travel restrictions, quarantines, workplace hazard controls and curfews which has considerably brought economic activity to a standstill.

Timeline of Events

  • An unidentified pneumonia detected in Wuhan, China and reported to the WHO Country Office, China on December 31, 2019
  • WHO starts working day and night to analyze data, issue advisories, coordinate with partners, and provide all possible assistance to countries for preparing, improving supplies and managing expert networks
  • On January 30, 2020, WHO formally declared the outbreak as a ‘Public Health Emergency of International Concern’
  • On February 11, 2020, WHO decided a name for the novel coronavirus disease - COVID-19
  • The world tally crossed the 1,00,000 mark on March 7, 2020
  • WHO recognized COVID-19 as a pandemic on March 11, 2020
  • March 15, 2020 marked a notable statistical milestone as the tally of confirmed cases outside of China surpassed the Chinese total

Flattening the Curve: Containment & Mitigation

Essentially, the measures to control the spread of a pandemic involve the dual-pronged strategies of containment and mitigation. In the early stages, containment is undertaken that works by tracking and isolating the infected individuals, and adopting vaccinations and other infection control mechanisms. The target is to protect the uninfected population from potential community transmission.

On the other hand, the next step, mitigation, is undertaken when it becomes increasingly difficult to contain the transmission, and the goal rather becomes to slow the progression and mitigate its effects on the community and healthcare system at large.

Related to these strategies are efforts to delay and bring down the epidemic peak which is popularly known as – ‘flattening the epidemic curve.’ It aims to make more time available for the development of vaccines and treatments, and prevention of public healthcare services from being overstressed.

COVID19 Case Curve

Has India Flattened its Epidemic Curve?

As Indian states varyingly lift and extend the COVID-19 lockdown, let’s try to analyze the situation.

The Indian government’s endeavor from the beginning has been to embrace a “cluster containment strategy" to check large-scale transmission of the virus at the community level. Early detection of infections is coupled with a ‘break the chain of transmission’ strategy to limit the spread within a given geographical region.

As the crisis now stands, several studies have emerged from time to time predicting the trajectory of India’s COVID-19 caseload in future. Epidemiologists and scientists across institutes are divided on when the potential peak in the country will be reached and what shape the curve will take in its aftermath. As per a latest scientific study, the coronavirus outbreak was supposed to reach its peak by mid-August and plateau until declining ultimately at an indeterminate point. For Dr. T Jacob John, a reputed Virologist, Christian Medical College, coronavirus will achieve an endemic status in India by December 2020 or January-February 2021. However, he clarifies, “But we should note that the epidemic transitioning to endemic should not be mistaken for curve-flattening.”

Professor Gautham Menon, Ashoka University, a member of the Indian Scientists’ Response to COVID-19 Group (ISRC) sees the curve as likely far more complex than what was believed initially. The outbreak in various states has had different progressions due to which it makes more sense to look at a granular scale of districts, sub-districts and zones in cities to better understand the disease’s progression. As the spike in numbers is dominated mainly by a handful of states, country-wide numbers do not give a clear picture according to the professor.

As per the Times Fact-India Outbreak Report, India was inching closer to hit the pandemic peak towards the start of September. After this, the infections were predicted to plateau around mid-September, before beginning to show a steady downfall by the end of the month. Daily active case counts were projected to decline by November 17.

Confirmed COVID19 Cases Total Confirmed COVID19 Cases

India’s COVID-19 Recovery Rate

As per the latest data from the Ministry of Health and Family Welfare, India’s COVID-19 recovery rate stands at 94.2% with more than 9 million patients recuperated so far till December 4, 2020.

Government Measures to Control the Pandemic

Aggressively pursuing its aim of eliminating COVID-19 from the Indian landscape and providing maximum support to the affected people, the Government of India has taken several steps. Some of the major ones are:

  • Introducing the Aarogya Setu mobile app to educate citizens about the novel coronavirus and keep them protected amid the crisis.
  • Plan to set up a chain of 20 lakh retail shops known as ‘Suraksha Stores’ across the country to provide daily essentials to citizens while maintaining strict safety norms.
  • Launching a web portal (Young India Combating COVID with Knowledge, Technology and Innovation - YUKTI) to monitor and record the efforts of the Ministry of Human Resource Development to battle COVID-19. The portal covers the various initiatives of academic institutions, research (particularly related to COVID), social initiatives by institutions and the steps taken for the betterment of students’ well-being. It also allows institutions to share their strategies against various challenges posed by the unprecedented COVID-19 situation and other future plans. Likewise, YUKTI 2.0 was launched by the MHRD to ensure that researchers, teachers and students in higher educational institutions get appropriate support to meet the requirements to advance their technologies and innovation.
  • Doubling the amount of collateral-free loan for women in self-help groups to Rs. 20 lakh.
  • Hiking wages under MGNREGA to Rs. 202 from Rs. 182 to provide additional Rs. 2,000 to workers.
  • Under a special provision, allowing individuals to withdraw three months salary from Employees’ Provident Fund (EPF) account amid the crisis.
  • Disbursing Rs. 1,400 crore to nearly 2.82 crore old aged, widows and disabled people under the National Social Assistance Programme.
  • Extending the last date for filing ITR for the FY 2018-19 and slashing the interest rate on delayed income tax payment from 12% to 9%.
  • Providing medical insurance cover of Rs. 50 lakh per person to health workers battling the pandemic.
  • Providing eight free refills in three months to poor households using 5kg cooking gas cylinders as a relief from the disruptions caused by the outbreak. Under the Ujjawala scheme, free LPG refills were provided to more than 8.3 crore poor women.
  • Releasing the first instalment of PM-KISAN, amounting to Rs. 13,855 crore, which directly benefited more than 6 crore farmers amid the lockdown.
  • A relief package worth Rs. 1.70 lakh crore and Rs. 30,000 crore in assistance to various sections of the society in the wake of the pandemic.
  • Disbursing Rs. 3,066 crore as financial assistance to more than 2 crore construction workers under the Building and Construction Workers’ Fund.
  • Disbursing Rs. 500 each to nearly 20 crore women Jan Dhan account holders.