Corona Daily 086: Miscarrying Cows

In the beginning of the twentieth century, USA had an epidemic among cows. A bacterial infection called brucellosis was spreading through the cattle, causing spontaneous miscarriages, known as “contagious abortion”. By the 1910s, the miscarriages threatened livestock across the USA.

Worried about the disease, farmers would kill the diseased animals, to try to eradicate bacteria from their herds. George Potter, a vet from Kansas had an epiphany: a cow getting brucellosis may lose its calf, but at the same time acquire immunity to the disease. An immune cow was more valuable than an uninfected one.

In a 1918 article in the Lancet, Potter compared the miscarriage disease to a fire, which unless new fuel is constantly added, dies down. “Herd immunity is developed, thereby retaining the immune cows, raising the calves and avoiding the introduction of foreign cattle. This was the first known use of the term “Herd Immunity”.

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In the 1920s this concept made some scientists curious. They began deliberately infecting mice to see how the disease spread through their colonies. They discovered that above a certain threshold, the infection couldn’t find new hosts, and stopped spreading.

In 1923, a British pathologist Sheldon Dudley studied a diphtheria outbreak at a crowded navy school. One thousand children of naval officers ate together in a dining hall, and slept in cramped military-style barracks. Dudley found that every time new students joined the school, the diphtheria bacteria would attack the newcomers, and an outbreak would start again. In 1924, Dudley applied, possibly for the first time, the term “herd immunity” to humans.

Now in covid times, a semi-literate person uses the expression. Equating us to cattle may sound offensive. But the term’s origin was in the herd of miscarrying cows.

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While Dudley was studying diphtheria, a diphtheria vaccine was developed. He began wondering: What is the best way to reach herd immunity: natural exposure or vaccination?

Last year, several heads of states thought of reaching herd immunity through natural exposure. To be fair, there were no vaccines then. Johnson started with it in the UK. Trump’s advisor Scott Atlas, who called himself anti-Dr Fauci, recommended it. (Trump was so unengaged; he often called it herd mentality). Sweden took it as an official state policy. And Russia adopted it without an official pronouncement.

All these nations were heavily punished. The UK and USA had to rethink. Sweden acknowledged the unnecessary loss of thousands. Russia has unofficially lost more than half a million to covid.

It is possible to opt for mass natural exposure if the virus is not deadly. Without vaccinations, Indians develop herd immunity against the flu every season. Because flu is not so deadly. Covid virus kills and maims. Such a plan inevitably leads to catastrophic loss of lives and suffering. We usually look at the death count. But many infected people suffer long covid, with damaged organs. They may take years to recover, or not recover at all.

Herd immunity against covid through natural exposure is rejected by scientists as unrealistic and unethical. Vaccination is the only ethical road.

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The formula for calculating the required herd immunity percentage is 1- (1/R0), which in simple language means the more transmissible the virus, the higher is the %. For example, measles, an extremely infectious disease, has an R0 between 12 and 18, which translates into a herd immunity threshold of 92-94% of the population.

Looking at this number on a national basis is a mistake. In large countries like the USA or India, some places may be vaccinated enough to reach immunity, but less vaccinated pockets may still be vulnerable.

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Finally, when the USA or UK currently say their R0 (spreading rate) is low, it is low because of the lockdowns, masks, handwashing, and distancing. When human behavior changes; people start throwing masks away, and hugging; the R0 can go up, and with it the herd immunity % required shoots up. Coming months will show whether the joy of these nations was premature.

This is why fully vaccinating an entire nation and the entire world may be the only effective way to achieve herd immunity.

Ravi   

Corona Daily 087: Inseparable

In 1997, when Joefred and Ralfred were born with a gap of three minutes, their parents couldn’t tell them apart. Along with an older brother, they grew up in a one-story house in Meerut, a satellite town of New Delhi. Their parents were teachers in a Christian school. In their neighbourhood in Meerut, there were not many Christian families.

Joefi and Ralfi as they were called went to the same school. Identical twins tend to share a special bond; they cooperate more and are usually gentle with each other. It is also a norm that as children, twins wear identical clothes. What was a little unusual was that Joefred and Ralfred continued this habit in teens and beyond. They dressed the same at parties, weddings and community functions. They wore matching clothes, and trimmed beards to the same length. Next door neighbours confessed they couldn’t tell who was who. Both were around six feet tall, with similar muscular build.

 The parents, in their defense, said they didn’t raise the twins to copy one another, it was their own initiative.

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Not surprisingly, Joefred and Ralfred went to the same college. This was away from home, in Coimbatore. The committed pair graduated in computer engineering from Karunya University. Neither Coimbatore nor Meerut had big international companies that would give them suitable jobs.

Both applied to companies in India’s technology hubs, and managed to get their first jobs in Hyderabad. Not in the same company, though. Joefred joined Accenture, while Ralphred was recruited by Hyundai Mubis. With substantial research, the twins had mapped out their future path. They wanted to move first to South Korea, and after working there for a few years, to Germany. Had the pandemic not happened, they could have already left for Seoul, and their life story would have taken a different turn.

However, once Hyderabad went into lockdown, the brothers started working from home. They spent a few months working from home in Hyderabad. When everyone understood the pandemic would last for more than a year, Joefred and Ralfred decided they should move back to Meerut and spend the locked up time with their family. For computer engineers working for software companies, it doesn’t really matter where they are located. Had they not taken that decision, they would still be working from their Hyderabad home.

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Last month, on 23 April, both celebrated their 24th birthday quietly with their family. In 2020, stuck in Hyderabad, they had sought their parents’ blessings over the phone.

The following day, on 24 April, both Joefred and Ralfred tested positive. After a week of fever, and discomfort in lungs, the family decided to move them to Anand Hospital, a reputed private facility. Realising their oxygen levels were low, the doctors put them on ventilators in the intensive care unit, a few beds apart, Joefred in bed 10, and Ralfred in 14.

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A week ago, on the morning of 13 May, Joefred, the twin older by three minutes, had his oxygen level fall to 48. The twins’ mother was sat outside the ICU. The doctors requested her to go home. In the afternoon, they broke the news of Joefred’s death to the parents.  

When the parents went back to the ICU to check on Ralfred, he kept asking: “Where is Joefi? Where is Joefi?”

“He has been moved to a bigger hospital in Delhi.” Said the mother. The parents had agreed that’s what they would tell Ralfred. They thought his condition would get worse if he was told what happened.

“You are lying, mom. You are lying.” Said Ralfred as loudly as he could through the oxygen mask.

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The next morning, Ralfred died. The depression on suspecting the news about his twin probably hastened his death.

His father told the Times of India he intuitively knew both sons would come back home, or both wouldn’t. “Whatever happened to one, always happened to the other.”

Under a young Neem tree, Joefred and Ralfred are buried in two coffins, but a single grave.

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Ravi   

Corona Daily 088: Truck Drivers Wanted. Pay $100,000

Many of us visit the nearby supermarket or mall to buy dozens of different items. We don’t see their journey from the factory to the supermarket. In large geographies like the USA, Canada, Australia; truck drivers drive thousands of miles to bring the products closer to the household. In the USA, more than 70% of goods hit the highway at some point before they reach the shopper. Coca-Cola, the world’s best distributed brand, owes its success partly to the trucks that distribute the drink. (One may add distribution of vaccines now. With few manufacturing plants, vaccines travel long distances.)

Driving an 18-wheeler truck requires a special license and prolonged training. Working hours are long, some of them not paid for. In many countries, when loaders are loading the truck, the driver stands next to it, or helps with the loading. However, his clock and payment generally starts only once he begins to drive. He may have to drive for days alone, stay away from his family for weeks. A cigarette may be his only companion on the journey. Truck drivers suffer from sleep disorders and sleep deprivation. Their eating habits are poor, irregular, the food junk. With no exercise, a sedentary lifestyle and lack of access to care, 86% of American truck drivers are overweight or obese. Despite all this, they are treated like dirt and are the lowest rung in the economic caste system.

It is also an ageing profession in North America, because the young are not willing to join it. 94% truck drivers are male. Desperate young men from Eastern Europe, some staying illegally in the US, work as truck drivers. Because the shortage is huge, and continued, the pay is good. $73000 per annum is the average, but $100,000 is possible for the Class A drivers.

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Last year, most driver schools were shut since the first lockdown. As a result, the new inflow stopped. As luck would have it, just before the pandemic, in January 2020, USA had fired 60,000 truck drivers for drug or alcohol violations. Since April, many aged drivers opted to retire instead of driving in these challenging times. In April 2020, turnover of drivers was 70%.

The Pandemic forced them to work longer hours. The scheduled truck stops became very crowded. It was difficult to find food. Though the driver is isolated most of the time, when he comes out of the truck, he is using common public bathrooms and restaurants. Because of poor health and obesity, the risk of catching the virus and taking it home was high. Drivers were no longer allowed to use personal mugs for coffee, but use disposable cups. Lounges where drivers typically gather to watch TV were closed. Sit-down meals were banned. The driver, after a long drive, had to sit in his truck and eat the takeaway.

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Carrying gas (petrol) in America has been a bigger issue. Now 20-25% of the tank trucks are idle for want of qualified drivers. Many drivers left the business when gasoline demand ground to a near halt during the shutdowns. Some transport companies shifted their drivers to work for Amazon, simply to not lose them. The elderly drivers were not keen to follow what they considered draconian shutdown protocols.  

Some of the drivers who worked during the first months shared their stories. One driver said somebody came up alongside, blew the horn, and asked him to roll the window down. Then he was asked whether he was carrying toilet paper in the truck.

Another driver, who has been working for 40 years, had a few people thanking him for working during the pandemic. Truck drivers had made sure people locked up home were able to get all essential goods.

Driving trucks for thousands of miles was termed a patriotic duty. The pandemic was the first time many truck drivers, in their long career, received thanks for their thankless job.

Ravi 

Corona Daily 089: That Pandemic and This Pandemic

This week, the USA and UK are kind of celebrating the end of the pandemic, in their respective countries. America has allowed people not to wear masks, both outdoors and indoors, provided one is fully vaccinated. However, since vaccination doesn’t create a visible tattoo for others to see, the maskless mingling is based on trust. In Britain, since yesterday, people are madly hugging, a revenge for year-long missed hugs.

In Brazil and India, systems are overwhelmed and broken. Far more patients than hospital beds. Far more bodies than pyres at the crematorium.

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When will the pandemic end, I mean truly end in the whole world and not specific parts of it? The 1918 Spanish flu pandemic may offer some lessons.

Laura Spinney, the author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World lives in France. In France, she says, there are 170,000 monuments to World War I, but not a single one to the pandemic. Despite the pandemic killing 50-100 million globally, many more than the world war. Wars produce enough material for novels, films, have good and evil, and plenty of human drama. (Think Mahabharata or War and Peace). Spanish flu apparently produced fewer stories. In that book, the author says that wars destroy both infrastructure and people. Pandemic usually kills only people, so it is easier to rebound once it is over.

Covid-19 Pandemic has offered enough human stories, I think. Not having experienced a world war, for most people this is the first experience of a global shock.

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One key difference is that in 1918, infectious diseases were the major killer anyway. Until last year, cancer or heart disease is what would kill modern people. Alzheimer’s worries people more than measles.

The other thing is the 2020 media: Television and internet have ensured everyone in the world fully understands the global nature of the pandemic. One hundred years ago, in the absence of visual media, the perceived impact was essentially local.

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John Barry wrote: The Great Influenza: The Story of the Deadliest Pandemic in History.

He says the 1918 pandemic began in spring, with its first wave not deadlier than influenza. A more contagious and more lethal variant caused the deadly second wave. Then it also seemed to disappear. In March 1919, another variant triggered a third wave less deadly than the second, but more lethal than seasonal flu. First wave illness protected against the second wave (meaning people who were infected in the first wave were spared in the second). But neither the first nor second wave infections could protect against the variant in the third wave. In the absence of vaccines, the immune system of the survivors kept improving, and turned the virus into an ordinary seasonal flu virus.

That is expected to be the best case scenario this time as well. Coronavirus turning into an annual flu-like virus that kills, but doesn’t require any lockdowns.

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As far as society was concerned, in the USA, only during the second wave were schools, theatres and salons shut. Masks were introduced. One big difference was the duration of the restrictions and lockdowns. The 1918 disease usually affected a given community for 6 to 8 weeks, and restrictions lasted 3-5 weeks. The working people’s behavior didn’t alter significantly.

This time, the world has accepted the Zoom way of working, and at least partially it is likely to remain longer than the virus.

Spanish flu was more active in winters. That had triggered a naïve hope of safety in summers. Brazil and India have shown there is no real correlation this time.

On 28 September 1918, Philadelphia organized the Liberty Loan parade to celebrate the soldiers returning from the WW. Intellectuals opposed that gathering. Ignoring them, the patriotic event gathered 200,000 people. Within the next few days, 47,000 fresh cases were reported and 12,000 people died. The second wave was particularly deadly for the 25-35 year olds.

The world would be a better place if Presidents and Prime Ministers were students of history.

Ravi 

Corona Daily 090: A Paradigm Shift

When I worked for a tobacco company, I came across research that said the smoke exhaled by a single cigarette is roughly the size of a golf ball. Now if you were to stand next to the smoker in a park, that golf ball dissipates into the vast open space. The risk of secondhand smoke is almost non-existent. However, if you were sharing with a smoker a table in an office or a restaurant, the passive smoking can be a risk factor. That learning can be applied to the coronavirus.

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Three days ago, on 14 May, 40 scientists from 14 countries presented a policy paper called “a paradigm shift to combat indoor respiratory infection”.

“We expect to have clean water from the taps,” said Lidia Morawska, the group’s leader and an aerosol specialist.  “We expect to have clean, safe food when we buy it in the supermarket. In the same way, we should expect clean air in our buildings and any shared spaces.”

In 1842, a landmark report on sanitation by Edwin Chadwick highlighted the shocking plight of poor urban residents suffering from diseases caused by contaminated water. It led to a major investment programme to supply clean water and to better handle sewage. A similar effort is needed now to clean indoor air, say experts.

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Current WHO guidelines on indoor air quality cover benzene and carbon monoxide, but there are no standards for bacteria or viruses. We know air pollution affects our health. But air quality inside the offices or other closed spaces is invisible, so we ignore it, though it may affect us on a daily basis. Experts are now proposing the public places should have “ventilation certificates” like those for hygiene.

Adding filters to existing ventilation systems, using portable air cleaners, and UV light to kill bacteria are some suggestions. Something simple like opening the windows, where possible, can also help. These are not expensive suggestions. In-room air filters are priced at 50 cents per square foot, UV lights incorporated in the building’s ventilation system cost $1 per sq foot. Those installed in individual rooms would be more expensive, but may be still worth it when compared to the cost of the pandemic.

We live for years with cold and flu and accept them as a way of life. One expert says we don’t really have to.

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This month, for the first time, CDC acknowledged in large, bold letters that airborne virus can be inhaled (indoors) even when one is more than six feet away.

Lancet has published a paper offering enough evidence that the virus can be airborne. (a) Superspreading events, such as choir concerts, cruise ships, care homes. (b) People in adjacent rooms in quarantine hotels got infected without meeting one another. (c) Asymptomatic transmission. (d) The virus was found in the air in lab experiments. (e) Found in air filters and building ducts in hospitals. (f) Caged animals got it from other caged animals.

The WHO had long held that the coronavirus is spread by large respiratory droplets expelled by infected people in coughs and sneezes. The organization was, unfortunately, relying on an outdated concept of airborne transmission. It believed an airborne pathogen, like the measles virus, has to be highly infectious and travel long distances. The droplets can hang in the air, drift down streets, and find their way to people’s homes.

Experts agree coronavirus doesn’t behave that way. Prolonged contact at close range indoors allows aerosol transmission. That is where cleaning indoor air, and building special ventilation systems become critical.

To bring indoor air on the same platform as clean water and safe food is indeed a paradigm shift. Our current life has made us understand the importance of this initiative for the future.

Ravi 

Corona Daily 091: Micro-weddings and Mini-moons

Worldwide, the wedding industry is estimated to be worth $ 300 billion a year. USA’s share is some $73 billion.

The USA wedding numbers are now out. 2.13 million (2018), 2.13 million (2019), 1.11 million (2020). The wedding ceremonies that took place were sharply shrunk, budgets lowered, guest lists curtailed. The micro-weddings were followed by mini-moons instead of honeymoons. Instead of travelling abroad, couples settled for moving domestically, sometimes to a resort only a few miles away.

In 2019, the average wedding in the USA cost $25000+, most of it going to the reception ceremony. In the pandemic, nuptials took place in the family house backyard or online. The expense came down substantially, and wedding industry vendors had to adapt.  Hotels are offering elopement packages, bridal gown designers are creating shorter dresses and bakers are baking miniature cakes to be individually served.

Though there were fewer marriages, reportedly there were more than usual engagements. Couples found themselves locked in the house, or isolated away from one another; both were susceptible to realize love and get engaged. Pre-pandemic engagement rings had 1 carat stones. Now a standard engagement ring comes with a 2.5 carat diamond ($6000-$9000). Larger and more novel cuts of diamonds, including pear and heart shaped stones, are in heavy demand.

Some redirect the saved money on flowers. Instead of 200 guests, they are allowed 20. They are spending on expensive flowers, specialty arrangements and hanging installations.

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Newspapers had published scary stories of traditional weddings held courageously. In August 2020, a 55-person wedding in rural Maine spread infections across more than 200 miles, landing seven in hospital and killing seven in total. A 300-person wedding in Washington resulted in 61 cases, and 15 deaths.

When traditional wedding bookings dried up, Caroline Creidenberg began offering planned Zoom weddings. She bought a few dozen tripods, microphones and lights. There are virtual group dances, toasts and breakout rooms separated by virtual tables. The package costs $1200 excluding photo guest book ($100) and slide shows ($200).

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The Association of British Wedding Businesses reports that 36% weddings were cancelled or postponed. The £10 billion industry suffered a loss of £5.6 billion.

Nearly 80% of the world’s wedding gowns are stitched in China. Those made outside China also rely on Chinese fabrics and materials. Last year, when China closed its factories to curb the coronavirus outbreaks, brides in America and Europe were suddenly dress-less.

Next week, on 20 May, China celebrates its own Valentine’s Day. This year, more than 200,000 Chinese couples have registered for marriage licenses on that day.

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India holds 12 million weddings every year. Some couples don’t want to postpone because the auspicious date set by the family astrologer may not return in future. In Gujarat, reportedly 30,000 wedding ceremonies were cancelled. Those determined to abide by the date either married in a private ceremony or online. Shaadi.com is a popular matchmaking site. It now offers a “weddings from home” (its own form of WFH) service that provides a qualified pundit (Hindu priest), and tutorials for bridal make-up. Some Indian weddings have had hundreds of attendees online, and a live stream for thousands more.

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New York’s Governor Andrew Cuomo went one step ahead in the online wedding business, and issued an executive order named “project cupid”. This for the first time allowed couples to apply for marriage licenses online, and not turn up in person as required by law.

In parts of Asia and Africa, weddings are ruinously expensive. Some shrewd young men and women are hurrying up to marry to save on expense. They can avoid falling in debt over their weddings.

It is an excellent thought to arrange a wedding cheaply, in the backyard or online with only the immediate families present. Postpone the reception ceremony to a few years down the line. That way, money wasted in marriages that don’t last long can be saved. Wise couples would do well to follow this wedding-reception distancing practice even after the pandemic is over.

Ravi 

Corona Daily 092: Babies in Trials

This week, USA has started vaccinating 12-15 years old, just in time for their summer camps. Pfizer has received an emergency approval. There are 50 million children in America below the age of 12. What about vaccinating them?

In fact, Pfizer and Moderna have started clinical trials among younger kids. Moderna has three age groups: 6-11 years old/ 2-5 years old/ 6-20 months old. The youngest participants for either trial are six months old.

The doses for 12-15 age group are the same as for adults. This stage of trial for the younger children is about finding the right dosage. Pfizer is giving one third of an adult dose to the babies, and scaling up age-wise. The side effects will be monitored, and development of antibodies measured. The objective is to find the optimum amount that doesn’t produce too strong a reaction, but is able to protect.

Participation in the trials is competitive. More than 3,400 have applied for the Moderna trials, but only up to 200 will be accepted. The later bigger trial where kids will be given either a vaccine or a placebo will have 7,300 kids for Moderna and 4,000 for Pfizer. If you live in the USA and have young children, you can still apply for either.

Families monitor the children’s health and side effects, are required to keep an electronic daily diary of any symptoms, and commit to one year of follow-ups either by phone or in person. They must take the children to the sites for blood draws to measure antibody response. So far, apart from sore arms and mild temporary symptoms, Moderna participants are fine.

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Parents and legal guardians must give consent. Children capable of understanding are required to agree as well. They have spent a whole year living in a pandemic; even four-year olds have given verbal consent and the reason why they want to. (e.g. They saw the grandparents take the vaccine).

Unlike adults, children’s concerns are immediate. “How much will the injection hurt?” They also worry about the blood draws. Health care workers are usually enthusiastic about their children taking part in vaccine trials.

The larger trials will begin in late summer, and continue into winter. Last year, pharma companies were lucky. A wave started, and as a result there were lots of cases among the trial participants. The trial closed early. If the USA is corona free, the trials will take a long time. If there is no virus, the vaccine receivers and placebo receivers both have the same reaction, making any conclusion impossible.

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There is a debate on the ethics of America vaccinating its youngest. Of the 583,000 corona deaths in the USA, around 300 were children under 18. Some children have suffered from long covid. Concerning as those facts are, the number of cases, hospitalizations and deaths remain small.

In flu or pneumonia, children play a large role in transmission. That doesn’t appear to be the case with covid. Studies in Iceland and Israel showed children below 10 didn’t usually get infected or transmit to others.

Instead of giving 100 million doses to the 50 million American children, the same vaccines could probably protect 50 million adults in vulnerable countries where the contagion is surging. Once the vaccines are established as safe and effective in the current trials, USA can give them to the small group of children with medical conditions, who are at higher risk. And the remaining vaccines can go to people who need them most. That is the argument of the ethicists.

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Early results available show that fully vaccinated 12-15 year olds developed substantially higher level of antibodies than 16-25 year-olds. Scientists wonder if the youngest children may produce the same or greater immune response with a lower dose.

Currently, it is correct to debate the ethics of vaccinating the youngest Americans in times of global vaccine shortage. However, as I wrote in an earlier article, a coronavirus vaccine becoming a routine childhood vaccine may be the long term solution to prevent pandemics. From that point of view, the baby trials are a welcome step in the march of science.

Ravi 

Corona Daily 093: Ten Million and Counting

Yesterday, a Russian friend from Moscow’s Ballet on Ice called. Once upon a time, I had worked as the Russian interpreter with that group. The former ballerina told me about the death of a ballet dancer, our common friend. She has been hearing about so many untimely deaths. Everyone she talks to tells her about three or four people they have lost.

I could relate instantly with her. In Bombay, every day on average I hear about someone dying from covid, a relative’s relative, a friend’s friend, my mother’s student. If 4000 Indians are falling victims to covid daily, and I know one of them, my network has to be fantastic. (Mathematically, I should know 350,000 Indians). The dark possibility is the gross undercount of deaths, both in India and Russia.

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The Economist has been systematically tracking the excess mortality data from the pandemic’s start. It has now completed a robust analysis using available reliable data. For other countries, the model uses 121 different variables to come up with the best estimates.

First the headline numbers. The total number of pandemic deaths are somewhere between 7.1 million and 12.7 million, the central number being 10 million. That is more than three times the official count.

If you look at worldometer, parts of Asia and Africa appear to have escaped the brunt of the virus. Not true according to the Economist. In poor and middle income groups, under-reporting is huge, giving a deceptive picture.

In the USA, the difference between official data and the model output is only 7%. In Romania and Iran, the deaths are more than double the government figures. And in Egypt, excess mortality is 13 times bigger. Peru’s pandemic, even today, is 2.5 times worse than India’s. Nepal and Pakistan also have a suppressed covid count.

For sub-Saharan Africa, the estimated death rate is 14 times the official number.

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What sort of intelligent estimation has the Economist model made?

As a rule, in places where lots of tests come back positive, it is safe to assume that the testing focuses on those seeking medical treatment or have symptoms. Lots of infections are missed in those countries.

Serosurveys show the percent of population with antibodies.

Other indicators are the steps the governments take to curb the pandemic; the extent to which people move around physically (satellite pictures or phone data); systems of government; media freedom, demographic factors; and geographic location.

Russia, where media is controlled by the state, has excess deaths that are 5.1 times greater than official covid deaths. Instead of the 100,000 deaths that Russia reports, more than 500,000 Russians have died. That is why the Russian ballet dancer was surprised at every Muscovite knowing someone who has died.

Closure of schools is a good indication that the actual picture is worse. Indian schools have been shut for over a year. In January, when PM Modi declared victory over coronavirus, he would have reopened the schools if it was a genuine victory.

Demography matters. If two populations have the same level of health care, the one with more elderly people sees more deaths. The risk of dying from covid is 13 times greater in Japan (median age 48) than Uganda (median age 17).

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As per the model, India is seeing between 6000 and 31000 excess deaths daily, not 4000 as reported. It is in line with the epidemiologists’ estimate – between 8000 and 32000. Only in 2021, around one million Indians have already died of covid.

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The methodology of the Economist model is here. The raw data is here. You can check your country’s data here. (Sorry, India is missing).

Under-reporting for whatever reason is a menace. It means not enough ICU beds, not enough ventilators, not enough medicines, and bodies thrown in rivers.

The under-reporting countries, including India and Russia should closely look at the Economist model, and either scientifically refute it, or try to budget medical stocks for the higher figures.

Ravi 

Corona Daily 094: Indian Crisis is Global Crisis

In the last financial year, the Indian economy contracted by 8.5%. In the last twenty five years, this was the first time India plunged into recession. 2021 was expected to offer recovery; those hopes are now dashed by the onslaught of the second wave. For more than forty years after independence, India had quasi-communism, and a so-called Hindu Rate of Growth (3.5% and stagnant). Following the collapse of the USSR, India, to an extent, embraced market economy and globalisation. The pandemic threatens India’s ambitious growth plans. Not even the Hindu nationalist government would want to revert to the Hindu rate of growth. A CNN article this week points out why a crisis in India can be a global crisis.

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First, the supply chains. 80% global trade by volume happens on ships. India is a quality human resource provider for the shipping industry. Currently, couple of my neighbours, friends, and a nephew are sailing on container ships. They are either captains or chief engineers. Out of the 1.7 million seafarers, more than 200,000 are Indians. In terms of ranking, education and skills, the Indian percentage is high. Shortage of seafarers leads to disruption of supply chains. When countries outright ban flights from India, the Indian captains or chief engineers are unable to reach their ship. Alternatively, many can get stuck for months because the replacement doesn’t arrive. Last year, those cargo ships were called floating prisons. It can happen again this year.

Currently, UAE, Singapore, Hong Kong, and China have already imposed strict quarantine restrictions on vessels arriving from India.

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Second, generic medicines. The world by now knows India produces 60% of the world’s vaccines. Serum Institute of India was expected to export 200 million doses to 92 countries, the plan now blockaded by the domestic surge of cases.

India is also the largest supplier of generic (unbranded), cheap medicines. A prescription by an American doctor has 90% drugs made in India. One out of every three pills taken by an American is from India.

Now, there is a catch. India may be the world’s pharmacy, but 70% of the medicines’ raw materials come from China. For USA to get the Indian medicines, the China-India, and India-USA supply chains must function.

Two weeks ago, China’s Sichuan Airlines suspended cargo flights to India for fifteen days. Worried, India’s pharma community has written to the Indian ambassador in Beijing urging him to resolve the issue.

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Third, financial services. If other than medicines, India is not great at exporting goods, it is a powerhouse for export of services. As many as 4.4 million Indians work in IT and business process backend, most working for American or European companies.

Banks are encouraging staff to work from home, shifting work out of India, and extending project deadlines. Work from home is complicated because employees are falling sick, or are looking after sick relatives. Security and data protection are additional challenges. Barclays employs 20,000 people in India. In India, banks fall under essential services. Stanchart CEO said the bank has suffered disproportionate share of cases among its branch staff.

The Big Four accounting firms (KPMG, PwC, EY and Deloitte) and Accenture together employ 350,000 Indians. Ernst & Young activated its contingency plans to shift work from India to other geographies. Accenture employs 200,000 people in seven Indian cities. They also have a plan to shift functions elsewhere if necessary.

In addition to the banks and accountancy firms, Amazon, Twitter, Google, Microsoft, Zoom and Indian IT giants Infosys and Wipro have donated money, medical equipment, opened covid care centers, and offered paid sick leave to their employees.

With vaccine nationalism and superior medical infrastructure, ordinary people in America and Britain may be able to celebrate a normal summer this year. However, those engaged in business will pray for India’s recovery. Front office loses its glamour without a well-functioning back office.

Ravi 

Corona Daily 095: The More People Die, the Less We Care

The Syrian war began in 2011. Bashar Assad and his government started mass killing protestors. By 2015, nearly 250,000 died in the Syrian war, most of them civilians. There was little international interest. Those who analysed Google searches for Syria or refugees found zero searches for four years. That changed overnight when the picture of the drowned Syrian toddler (above) Alan Kurdi went viral internationally. Suddenly, the Google search for Syria and refugees zoomed. Donations to the Red Cross were greatly boosted by that single picture. Why did a single photograph manage to motivate when the death of a quarter of a million people didn’t?

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Joseph Stalin was a disgusting genocidal butcher. But he has some memorable quotes attributed to him. “One death is a tragedy; a million deaths is a statistic”, he had said.

This feeling of indifference was named “Psychic Numbing” by Dr Robert Lifton, a psychiatrist who studied this phenomenon among Hiroshima survivors.

Dr Paul Slovic, the psychology professor at the University of Oregon has devoted his career to research on this subject. He finds that our brains process situations through gut feelings, not logic. We don’t necessarily feel twice as bad when two people die, as compared to one. And as the numbers grow, numbness grows as well. We don’t notice the difference between 80 lit candles and 81. Similarly, our feelings don’t register the difference between 80 deaths and 81 deaths.

Every year, more than two million children die from diarrhea and eight hundred thousand from measles. Stalin starved seven million Ukrainians in a single year, and Pol Pot killed two million Cambodians. Did the world blink? The official coronavirus death count has passed 3 million. Will we feel any different when it crosses 5 million or 10 million? We likely won’t.

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Our capacity to feel is limited.

Many of us are willing to help a single suffering child. Studies have shown that a picture of two children brings down the desire to help. And if it is known that the child is one among thousands or millions, the charitable motive disappears. One life is valuable, but that life loses value, perceptually, if it is part of a larger tragedy. This is technically called the “compassion fade” and the “compassion collapse”.

Charities such as “Save the Children” have recognized it is better to endow a donor with a single, named child to support than to ask for a bigger cause. No matter where we live, we have probably seen a television story where a child falls deep into a narrow well or an abandoned shaft, and the live coverage of the rescue operation is watched by millions for two days. Those millions celebrate the triumph of that rescue because it is an individual story.

There is nothing new about racism in America. But the story and a 9-minute video of a white police officer fatally choking a black man by pressing his knee on him added new life to the “black lives matter” movement.

Abel Herzberg, a holocaust survivor has a famous quote: “There were not six million Jews murdered; there was one murder, six million times.”

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If three million people have died in the pandemic, what is there for us to do? We think our efforts are so puny, we end up doing nothing. This is called a “false sense of inefficacy”. It’s not correct to assume we can’t help, we can.

Awareness of the concepts of psychic numbing and compassion collapse is important. It makes us focus on individuals rather than abstract masses. Since the start of the pandemic, I have picked up two individuals in my neighbourhood, a cobbler and a car-washer. Every month, I partly compensate their monthly loss of earnings. They are happy, and I am happy. The joy of giving is no less than the joy of receiving.

Millions affected by the pandemic is a numbing concept. But any of us can help an identified one or two people. When you want to, help as soon as possible. Compassion also has a shelf life and an expiry date.

Ravi