Dr Ravindra Godse shares a letter musings about the pandemic

Most countries think that they are unique. To paraphrase Animal Farm, some countries are more unique than others. India has some specific set of tools and challenges that are uniquely unique.

India can certainly learn from the experiences of other countries, but Indians need not be endlessly fascinated by news in other countries; the circumstances are vastly different. Hearing a car honk in Tokyo is as rare as seeing snow in Mumbai. California’s GDP is much higher than all of India’s. Milan has a much older population than India’s. However badly Britain is losing the battles, she will win the war (she always does). Regarding China, if we don’t see the data, what we know would be incomplete and nonsense. If we see the data, it would be complete nonsense. So even with regards to the pandemic, India can just focus on India.

Experts know nothing. How it started, where it is going, when is the vaccine coming, how it is treated. Nada. Zip. Zilch. Nothing. We know more about this virus than we previously did but that’s not saying much. Let us see what we can make of these, expert opinions or educated guesses.

India’s peak was predicted to be later than USA’s but India’s lockdown started only 8 days after USA. That seems to have helped, so far. BCG vaccination may offer partial protection. It might not, but it might. We don’t know what we don’t know.

Lockdown has helped. We think. But we must start talking about re-opening. Imagine a solution for another problem: family planning. I have a solution that is cheap, easy, one hundred percent effective with no adverse effects. Not having physical relations!

If lockdown continues for months, there will be nothing left for the virus to destroy. The people who are stridently asking whether you want to choose between lives and the economy may not be able to save you, but they will ensure that you will die poor!

Simplicity is the ultimate sophistication”, Leonardo Da Vinci used to say. Let us think of some practical steps.

• Isolate and quarantine mildly symptomatic patients. Assume they have it. They don’t all need to be tested.
•  We don’t have to obsess about the number of tests per million, compared to the rest of the world. It is more important to keep people alive rather than knowing what they might be dying from.
• Asymptomatic patients can transmit too, hence the lockdown that was more than the twice the incubation period of the virus already.
• 90 percent of people diagnosed with COVID will likely be okay, 5 percent will be very sick and get better, and up to 5 percent may die. But remember, if for every diagnosed patient, there are 10 to 100 asymptomatic patients walking about.  Then the total number of cases will soar, but the mortality rate should also be divided by 10 or 100 and could be between 0.05 and 0.5 percent.
• Try and use experimental drugs under protocols to keep moderately symptomatic patients from getting serious.
• Try and use plasma under research protocol for serious patients. Start collecting the plasma today, if we need it in the future.
• Rather than troubling the recovered patients for the plasma, we can try and see if the antibody titer of the healthy asymptotic patients is better. (Remember, they did better than the patients who ended up in the hospital)
• Keep waiting for the vaccine, hoping for it be early and effective, and preparing for it being neither.
• Take politics out of it. If the American President says that a drug is good, that doesn’t make it good, but that doesn’t make it bad either. And remember, what is true in the US may not apply in India.
• Find the most accurate antibody test and use it by the thousands.
• Do random sampling genetic testing on people who are antibody positive, to see if these people are getting re-infected. If they are not, release these antibody positive patients into the work force and open the economy and life itself.
• When you open up, there WILL be new cases. Don’t panic. Do contact tracing.
• Stop circulating videos of police beating people. If they stop beating people, even better.
• Numbers are important but not more important than common sense. The total number of patients with corona does not matter as long as they are not dying, tying up a ventilator, or infecting others.
• Many people die daily in the world due to many illnesses, if they happen to have COVID and test positive for it, their death may be attributed to COVID. So while we are breathlessly talking about the underreporting of mortality, there also could be overreporting.
• This is an RNA virus so it can mutate (change). That could be tricky. But it may change for the better.
• The new normal is anticipated. This new normal will be more palatable if it is less new and more normal. Recommending a mask is reasonable, mandating it would be harder. Most people wouldn’t want to spend the rest of their lives behind a mask. This is not a choice between safe and sorry, but between sorry and sorry.
• The virus started in 2019, but remember the always-correct infallible hindsight is called 20/20. This is the year we conquer it. Only thing worse than false hope is false doom.
• Try and use experimental drugs under protocols to keep moderately symptomatic patients from getting serious.

 Dr. Ravindra Godse, MD, Internal Medicine, Pittsburgh.
Director of Discharge Planning, UPMC Shadyside