Corona Daily 409: The Year of the Midwives

In May 2019, when WHO decided to declare 2020 as the “Year of the Nurse and the Midwife”, it had no idea how fortuitous the choice was. (The decision was based on the 200th birth anniversary of Florence Nightingale).

Since March, midwives are in great demand everywhere. Many pregnant women are terrified of delivering in a hospital. Women in the second and third trimesters are seeking alternative birth options.

In this matter, developed countries may be backward. Between 2000 and 2017, the maternal mortality rate has become worse only in 13 countries of the world. United States of America is one among them, in the civilized company of countries like Syria and Venezuela. Sweden has a 300-year tradition of professional midwifery. India has over two million qualified nurse-midwives and another million diploma midwives. The world is still short of 9 million midwives.

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Currently, the fear is mutual. Pregnant women are worried they may catch the virus in the hospital. The midwife is worried the pregnant woman may transmit the virus to her. During childbirth, social distancing is not possible. In New York City, one out of seven women admitted for delivery tested positive. Most were asymptomatic. Still, they reported a feeling of being shunned by the hospital staff. Their babies were taken away from them at birth, and given back a few days later. Some midwives offered help only through Facetime or Zoom. Initially, the expectant partner was not allowed in the room. Later, Governor Cuomo issued an order allowing the partner or any uninfected substitute.

The pandemic has reshaped the delivery process. Women in labour pain wearing masks, being looked after by midwives in protective gear is a bizarre if not a grotesque experience.

In parts of Scotland, home births were banned, but can now resume from 29 June. A woman wanting to deliver at home must sign an agreement promising a series of safeguards for the attending midwife. If the house has two toilets, one must be reserved exclusively for the midwife. (About toilets and virus, tomorrow).

Netherlands is more civilized. In the last two months, births were allowed to happen in empty hotels where midwives could get enough space to feel safe.

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WHO says safe and effective midwifery can prevent 83% of maternal deaths, stillbirths and newborn deaths. Experienced midwives can handle most low-risk women through labour, leaving only the most complicated cases to obstetricians. Even a non-professional midwife (called doula) is a great comfort for the pregnant woman.  

The medical profession, however, is commercial in many places. Modern doctors are trained to advise medical intervention every time. A C-section has become fashionable. In the USA, 35% of deliveries are C-section. WHO thinks the rate should be between 10% and 15%.

Caesarian is a major surgery that increases the risk of infection, hemorrhage and blood clotting. That risk has to be weighed against the risk of delivering at home.

Birth, a fundamentally natural process, may go back to become natural. A sustained trend of natural birthing will be a great positive contribution of the pandemic.

Ravi  

Corona Daily 410: Eight Hospitals in Fifteen Hours

Thirty-year old Neelam Kumari Gautam worked on an assembly line producing electrical wire. She was happy the lockdown had started during her pregnancy. Her husband Bijendra Singh, 31, serviced machines at a printing press. Their joint annual income of Rs 6 lakh ($8000) was enough to take care of them, their six-year old son, and the baby that would arrive sometime in June. The family lived in Ghaziabad, Delhi’s satellite city.

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On 5 June, Neelam woke her husband up at 5 am. Her excruciating labour pains were accompanied by rising blood pressure and breathlessness. Fortunately, her brother-in-law, Shailendra, owns an auto rickshaw. He took the couple to the ESIC model hospital. Neelam had an ESIC (employee insurance) card that qualifies her for cashless treatment there. The first thing the doctor said to Neelam: ‘I will slap you if you take off your mask.’ He then asked the couple to move to another hospital.

By 7 am, the rickshaw reached Shivalik Hospital, which had given Neelam pre-natal care earlier. Doctors feared she had coronavirus, and abruptly asked her to leave. Later, its director Ravi Mohta said: ‘We are a small mother and child hospital. We did what we could.’

In the rickshaw, Neelam was panting, sweating, holding her husband’s arm tightly. Fortis hospital is a health care giant. Neelam went in at around 11 am. Fortis would issue a statement two days later: ‘Due to unavailability of rooms in the ICU, she was given oxygen in the waiting area. The husband was counseled and explained the need for transfer to another hospital.’

Their next stop, the Jaypee hospital, later issued a statement. ‘She had covid-19 symptoms like fever and breathlessness. According to government instructions, we referred her to GIMS, where covid patients are treated.’

Sharada hospital in greater Noida treats covid patients. Its spokesperson, Dr Ajit Kumar later said: ‘We had no space in the ICU, and ICU allotment happens through the CMO office. So, she was referred to a higher center.’

It was eight hours since they had left home in the morning. The temperature was hovering around 38 C. At 1330, Bijendra called the police. Two police officers met them at the entrance of GIMS (Government Institute of Medical Sciences), a large public hospital. Police tried to persuade the doctors, but couldn’t get the patient admitted. The family paid Rs 5500 for a private ambulance which took them to the Max Super Specialty hospital, 25 miles away. It had no beds. Later, Vaishali, the hospital’s spokesperson said: ‘As per our records, no such patient was registered in our emergency.’

The ambulance carried them back to GIMS. In the ambulance, Bijendra repeatedly pleaded with his wife to keep her spirits up. She did not respond. At GIMS, they tried to resuscitate her, but it was too late to do anything. At 08.05 pm, fifteen hours and eight hospitals since leaving home, Neelam was pronounced dead. Her baby also died.

Dr Rakesh Gupta, director, GIMS, later said, ‘yes, they came to us, but we didn’t have a bed. And the second time they came, the woman was dead.’

Atul Garg, the minister for medical, health and family welfare said, ‘I will inquire and get back. Since I am on visit to districts in western UP, I had no information about the case.’

A preliminary government investigation said: ‘Hospital administration and staff have been found guilty of carelessness.’

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Ravi

Corona Daily 411: Pandemics and Hollywood

How long will cinemas remain shut? When will we see Avengers-type movies again? Will the pandemic affect Hollywood in any way?

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Ironically, Hollywood – as we know it today - was an outcome of the Spanish flu pandemic (1918-1920). The credit for that goes to Adolph Zukor, the founder of Paramount Pictures.

At the start of the 1918 pandemic, movies were silent. Filmmakers were independent, artists and distributors were fragmented. Family owned movie theatres were known as mom-and-pop theatres. Once the pandemic began, 90% of those theatres were closed for six months or so. The closing of cinemas disrupted everything, movie-watching, making and selling. Los Angeles studios imposed a ban on filming crowd scenes. From October 1918, all film productions were shut down for over a month.

Mary Pickford and Lillian Gish, the top lady stars, were infected but recovered. Mask-wearing was voluntary. Male stars were reluctant to wear masks. It diluted their invincibility and manliness. The leading star of that period - handsome, blond Harold Lockwood, 31 years old, had already featured in forty films. On the sets of shadows of suspicion, he fell ill and died in a few days.

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Adolph Zukor was a visionary. He wanted to control the entire chain – make movies, distribute them, and decide how they were shown. Exhibitors and mom-and-pop theatres were ruined by the pandemic. Zukor began buying the movie theatres. If someone was unwilling, he threatened to build a theatre across the road. In 1919, he bought 135 theatres in the southern states. That guaranteed his films would be shown.

Paramount is still one of the “Big Five” Hollywood studios (along with Walt Disney, Warner, Universal and Columbia). The studio system also began with the 1918 pandemic. Studios locked up stars, directors, technicians to work for them. Zukor developed the film rental concept, whereby the distributor charges the exhibitor a percentage of the box office receipts. That practice is still prevalent in many countries. He also introduced the concept of ‘block booking’ whereby a studio could force a movie theatre to sign an annual contract to exclusively show movies made by that studio.  

Just as supermarkets, hypermarkets and shopping malls gradually killed the mom-and-pop retail stores, Zukor’s tireless enterprise put an end to the family owned theatres. He succeeded in achieving vertical integration and complete top-down control. An unfortunate side effect was the disappearance of independent filmmakers. Women and non-white filmmakers went out of business. Hollywood essentially became a white male studio-driven industry. The so-called golden age of Hollywood started. Post-pandemic feature films became longer, with bigger budgets.

We see the Zukor model adopted today by streaming services like Netflix. Netflix wants to produce films/web series, distribute them around the world, and bring them to your small screen by charging a subscription fee.

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Hollywood’s consolidation by establishing a studio system shows what can happen in a pandemic. Not only to a movie industry, but any business. Small fish face financial ruin, and either die or are eaten by the big fish. The big fish take over that industry, and become more powerful than before.

This consolidation is not a short-term effect. The model Adolph Zukor created one hundred years ago is still the backbone of Hollywood.

Ravi

Corona Daily 412: Lockdown Shoots

Franck Riester, France’s cultural minister, last week confirmed actors kissed for the first time on French film shoots. L’amour is not dead. Both actors had tested negative before kissing, he added.

Around the world, less than a handful films/TV series were shot in the last three months. Katla, a sci-fi series, directed by an Icelandic director Baltasar Kormakur was shot in Reykjavik.

On arrival, all the 80+ crew members were tested. Every morning, temperatures were measured. A colour-coded armband system was used. Yellow for those near the camera. Black for actors, makeup and costume professionals. Red for producers, script supervisors and visual effects. Blue, very rare, for people like the director with access everywhere. Each colour pod had not more than twenty people. Colour pod mixing was discouraged on sets and off-sets. All costs were financed by Netflix.

All meals were in individual boxes. Every hour, a special team sanitized all doorknobs, toilets and other surfaces. Except for actors facing the camera, everyone wore masks. Makeup artists and production designers wore gloves. In the four weeks of shooting, no intimate scenes were included. Only two crew members who felt feverish were sent into isolation for two weeks. Nobody else was infected.

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Harvest of the heart, a romance was perhaps the only film shot in America. It was shot for 16 days starting 27 May. “Covid coordinator” is a new title in the credits. This person was responsible for set sanitization, and ensuring no visitors, no restaurants, no gyms, no gatherings. People lived in Airbnb apartments to avoid hotels. The 14 cast and 22 crew worked outdoors all the time. The script was altered to exclude love scenes, even handshakes. (Spoiler alert: A single kiss at the end of the film). Actors were given the option of doing hair and makeup themselves.

Insurance was a big problem. No insurance company wants anything to do with coronavirus. The film producer found a single company that excluded coronavirus, and charged an exorbitant premium.

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Australia’s long-running soap Neighbours is reported to be the first TV series that has resumed production. The shoot started on 21 April.

They follow a four square meter rule. This is the personal space nobody else should invade. A trained nurse is present on the sets. Male actors shoot without any makeup. Again no kissing, no handshakes, no intimacy. The cameraman and editor are expected to use trick technology to bring actors together. Cell phone sharing is prohibited.

On the entire set, offices and bathrooms have swinging doors. You can gently kick the door to enter.

Keeping abreast of the news is discouraged for both cast and crew.

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Hollywood has come up with two white papers offering guidelines for safe shoots.

Cast and crew should be quarantined for two weeks before the start of the shoot. Locations and sets should be covered for three days or more for the viruses on all surfaces to die. Scripts must be modified to get rid of extras – crew members to replace them as needed. Reduce action and increase special effects. Sweden recommends not taking actors above 70.

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Many Netflix/ TV watchers have expressed a strange feeling of discomfort when watching large families dining together, people shaking hands or an old rugby game. It may be a 1980s movie, but hugging and kissing on screen is making viewers cringe. Real life and cinema always follow each other. If social distancing becomes an on-screen norm, and requires a corona test before every shoot, the French kiss may soon disappear from the screen.

Ravi  

Corona Daily 413: Blockbuster of the Month

Eric Tabach, utterly bored and frustrated by the lockdown, had an idea. Eric is a small time actor and YouTuber. For a few years, he had worked as a viral video producer at BuzzFeed.

He spoke to Christian Nilsson, one of the little known film makers in New York. Christian liked Eric’s idea. Yes, he would be happy to make the film with Eric. Inspired, on 9 May, Christian sat in front of his laptop, and by midnight, had completed the script. A horror film, its title was “Unsubscribe”. The plot was lockdown friendly. A sinister internet troll tricks a group of YouTubers into joining a Zoom call. The killer stalks the characters on camera.

Eric started speaking to everyone who bothered to answer his call. He explained his idea, and shared the plot. Apologetically, he admitted it was a zero budget movie. Surprisingly, some well known actors agreed to act for free. They were utterly bored themselves. Charlie Tahan (Ozark fame) would play the killer, Michelle Khare, the other lead. A few other well known YouTube actors joined in.

The whole project was shot in a week’s time in May. Of course, all the actors performed on Zoom, without ever leaving their homes. Eric needed a couple of weeks to edit. A composer friend obliged by making an original score for the film. The horror film was now ready for release.

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From his BuzzFeed days, Eric knew an industry practice called “four-walling”. A filmmaker buys the entire cinema theatre for a fee. Cinemas are happy to let the filmmaker collect money from tickets, if any. Four-walling is like self-publishing. It is a loophole that allows a filmmaker to claim an official release. If lucky, the film can get reviews in reputed newspapers.

Eric contacted the Westhampton Beach movie theatre in New York, and rented it for a whole day. The theatre owners were surprised but happy to get a client.

On the night of the screening, Eric and Christian wore tuxedos, groomed their hair as well as they could, and asked a passerby to take their picture in front of the theatre. “Unsubscribe- Sold Out” in the background made them truly proud.

They sat with large cups of popcorn, and saw the film again and again. Five times in total. They were the only two spectators in the entire auditorium.

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Now Eric started calling IMDb.  IMDb is the owner of Box Office Mojo, the company that audits and publishes the American box office rankings. They didn’t believe that the film existed, and that people like Charlie Tahan played in it. Finally, Eric sent them a copy of the film. IMDb called Tahan and the other actors, they confirmed they had actually acted in Unsubscribe.

The total revenue of Unsubscribe was $25,488. On 10 June, it became the #1 movie of America, the blockbuster of June 2020. Eric Tabach, as he had planned from the outset, joined the illustrious list of Stephen Spielberg, James Cameron, Ridley Scott and Christopher Nolan.

Ravi

Corona Daily 414: The Model Mouse

Jackson laboratory, Maine (JAX) specializes in breeding laboratory mice. It also has facilities in China. On 3 February, Qiming Wang, a researcher in the Shanghai office emailed the American lab and described the situation in China. Every weekend he would take a bullet train to be with his family in Wuhan. Some people in his building had tasted positive. Scary time. How could JAX help?

The Jackson lab researchers discussed ways to develop new mice to understand the novel coronavirus. Someone remembered Dr Perlman’s mice. During the SARS epidemic, Stanley Perlman had genetically engineered mice. In a 2007 paper, he wrote SARS was unlikely to be the last coronavirus. His mice might be useful in future.

Since that time, Dr Perlman had cryo-preserved (stored at extremely low temperatures) vials of sperm from these mice. In February, he emptied his freezer, and sent the entire semen stock to Jackson labs. In a few weeks, with an IVF treatment for mice, hundreds of Perlman mice were born.

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For animal trials, mice are less expensive, easy to maintain, and multiply quickly. Before trying a drug or vaccine on humans, it is usually tried on mice.

Our bodies have an enzyme called ACE2. Mice don’t have this human enzyme. In 2003, SARS virus couldn’t infect them. Dr Perlman had genetically modified the mice to add the human ACE2 receptors in them. SARS ended too quickly for the Perlman mice to be used widely.

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ACE2 serves as an entry point for the novel coronavirus. With its spikes it clings to the ACE2 receptors. The 2020 Perlman mice refused to get ill with Covid-19. Scientists found out why. The human ACE-2 was added in the mice, but the mouse ACE-2 was not deducted. Also the human version of the gene was wrongly placed.

Dr Wang Youchan from Beijing succeeded in removing those shortcomings. The latest genetically modified mice have only the human ACE-2 in the exact specific location on the X chromosome. Dr Wang used a state-of-the-art gene editing technology that did not exist in the times of the Perlman mice. As far as the virus is concerned, the Dr Wang mice are almost human.

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Dr Wang’s tests show the virus attacks the mice’s lungs, tracheas (windpipes) and digestive systems. Older mice are getting more ill than younger ones. One surprising thing is that the virus is replicating in the brains of the mice. In humans, that is not detected so far, except the loss of smell in some patients. Covid-19 has not been fatal to mice, but they get sick, lose weight and develop lung damage.

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There is a huge demand for genetically modified mice. Drugs and vaccine creators order custom-made mice for diabetes, cancer, blood disorders or any other disease. China sells a pair for $17,000. Currently the market is worth $ 1.40 billion. The pups of those mice may not inherit those (artificial) traits. In other words, they may be born natural, with no human genes.

In the last three months, many universities, and research labs had to euthanize (in simple language, kill) their colonies of lab mice, because nobody could look after them. But sperm vials of the important or rare mice are usually cryo-preserved.

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Not all rodents are a menace. Lab mice sacrifice their health or life so that the human race can save itself.

Ravi

Corona Daily 415: The Pied Piper Effect

Do you miss going to a restaurant? Ordering more than necessary while chatting happily? A waiter clearing your unfinished dinner plate? Someone else misses it more than you do. The rats.

The last three months have been cataclysmic for urban rats. Rodentologists (such a profession exists) have noted their unusual, aggressive behavior. Rats are essentially nocturnal, but now they can be seen any time of the day. They are moving in parts of the cities not visited ever before. The British pest control association saw a 51% rise in rat call-outs since March. Two miles north of my house in Mumbai, rats have ravaged law books in the Small Cause Court library.

Rats are social animals. Living in colonies, their territory is generally limited to a 150-200 foot diameter. The colony outside a restaurant will be very loyal to it-a rat can spend its entire 2-3 year lifespan eating kitchen waste and night trash. Now with the closure of restaurants, cafes, and delis rats experience a famine. They are migrating en masse in search of food and water. They are so hungry and desperate; they are roaming during the day, unafraid of humans and traffic.

And rat cannibalism has begun. Rat colonies have a class system, and a complex hierarchy. Alpha male rats eat first, and have the first mating rights. They also get the best burrows and nests. Beta males and others may sleep outside a nest or burrow. The alpha rats are now killing other rats and eating the newborns. Landmark pest management in Chicago captured 19 rats between 20 April-20 May, but only two in the next two weeks, making them believe in rat cannibalism. Recently, I have come across a couple of wounded rats in my neighbourhood.

Rats are intelligent. They are usually wary about entering traps. Pest control associations report it is becoming easier to catch them. Rat baits with peanut butter, bacon and oats are trapping rats in a matter of minutes.

Does this mean the rat menace will go away? Not at all. A female rat can deliver litters of ten pups every few weeks. Cities like Chicago and New York have never managed to solve the rat problem. New York City has 2 million rats. Each of the 109 mayors of New York has had plans to snuff out the scourge. As NYT pointed out, their collective score is 0-109.

No matter where you live, check the space under your doors. If more than half inch, seal it. Plug up any holes in the house. Store food in safe locations. Clean plates thoroughly soon after eating. Don’t eat pizza in bed, in the toilet, on the couch, in the garden. Carefully dispose of garbage. (Remember rats chew through plastic bins). Set rat traps. Except in China and Vietnam, where they eat rats, coronavirus has not been found in rats. But they can very well transmit plague and leptospiriosis. We can do without those. If the situation becomes unbearable, contact your local pest control.

Rats can’t order takeaways, nor online. For their sake, we must look forward to the day when restaurants reopen, produce lots of night trash outside, and rat colonies resettle in their original homes.

Ravi

Corona Daily 416: Presidential Theatre

Unlike the Putin pandemic, the Trump virus has a time limit. But the lust for power is common.

Trump begins his grand campaign to once again make America great on Saturday, 20 June at Tulsa, Oklahoma. The boisterous rally will take place at a center packed with over 19000 people. Trump has tweeted a million supporters have shown interest in attending (the population of Tulsa is 400,000).

Media reports point to the advisory issued by Trump’s government: The highest risk of Covid-19 transmission is posed by large in-person gatherings where it is difficult for individuals to remain spaced at least six feet apart and attendees travel from outside the local area. Trump criticizes the media’s double standards by pointing out the ‘Black Lives Matter’ rallies that happened in Democrat states.

The difference is those rallies were spontaneous, and held outdoors. Like with passive smoking, the risk of virus transmission is high indoors. Pence, when asked, pointed to the freedom of speech and right to assemble enshrined in the first amendment.

Tulsa and Oklahoma are heavily Republican. Tulsa is known for the race massacre (1921) where dozens of Blacks were killed and their property destroyed by White mobs. Initially, Trump had announced the rally on 19 June (Juneteenth), the day that celebrates the end of slavery in the USA.

After protests, Trump agreed to push the rally by a day. Anyone wanting to register for or attend the rally must sign a waiver: By attending the Rally, you and any guests voluntarily assume all risks related to exposure to Covid-19 and agree not to hold Donald J. Trump for President, Inc.; BOK center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury.

The BOK center, Tulsa, the place of the event, has so far cancelled or postponed concerts by Bon Jovi, KISS and Justin Bieber. Except Trump’s rally, no event is scheduled there until 30 July. On Saturday, the gates will open at 3 pm; the event begins at 7 pm. More than 19,000 people will be crammed with the man on the stage refusing to wear a mask. Encouraged, most supporters will unmask themselves. An average Trump speech runs longer than an hour. His audience, warmly close to one another, will shout slogans and chant. The 300 toilets in the center will be shared by the 19000 people. Coronavirus is neither Republican nor Democrat. But if it needed a stage and an arena for a grand impact, a better recipe couldn’t be conceived.

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Donald Trump, now 74, is the oldest first term US president in history. He is obese, his medical conditions not known, because Trump is a master of not disclosing.

Joe Biden, 77, has survived two brain surgeries, takes blood thinners and medication for acid reflux, cholesterol and allergies. If elected, he will become the oldest president in US history.

The craving for power makes politicians blind. In 1991, Rajeev Gandhi wanted to regain India’s Prime Ministership. And Benazir Bhutto Pakistan’s in 2007. Both were given repeated specific advice not to mingle with crowds. Their lust for power made them ignore the advice, and both were blown by suicide bombers weeks before the election.

Trump and Biden don’t run the assassination risk. But if they start holding rallies, mixing with crowds and shaking hands, coronavirus may decide who will reach the finish line.

Unfortunately, just like Gandhi and Bhutto, reckless politicians take away many other lives along with them.

Ravi

Corona Daily 417: Constitutional Autarchy

Vladimir Putin is in a tearing hurry. He is bored in his Novo-Ogaryovo residence outside Moscow. Three special disinfection tunnels have been built to protect him. The virus has disrupted his grand, visionary plans, but being Vladimir Putin he will have the last word.

This is the 21^st year of his ruling the world’s largest country. When the USSR collapsed, and nascent Russia finally wished to live freely, the constitution limited the president’s power to two terms of four years, like in the USA. But an anonymous mischief inserted a word “two consecutive terms”. Since 2003, Putin has proclaimed he respects the constitution, has no lust for power, and he certainly wouldn’t dream of extending his rule. However, while saying this, he found a marionette called Medvedev. On completing eight years, Putin swapped places with Medvedev. The world knew the difference between de jure and de facto, but oil prices were high, relations with Ukraine were peaceful, so everyone ignored the charade.

In Dec. 2008, Putin provoked the marionette to extend the next president’s term to six instead of four years. Nobody asked why; in Putin’s Russia, you don’t. Using the non-consecutive loophole, Putin officially re-sat on his throne in 2012. He is now allowed to continue his autarchy till 2024. By then, Russia’s most masculine man, a black belt judo champ will be only 72. (Trump is already older). Surely, for Russia’s benefit, Putin must continue for at least another two terms, till 2036.

Putin respects the constitution. If the constitution doesn’t allow something, he gets it amended. In 2024, Putin wants to reset the clock to zero, meaning despite serving for 25 years, he hasn’t served as a president yet. A national referendum asking people to approve this change was planned on 22 April (Lenin’s 150^th birthday, a nice touch), but this goddamned virus came in the way.

Russia is now third on the list in terms of the number of cases. Moscow is a hotspot. Moscow’s April statistics suggested at least 1000 covid-19 deaths were not reported. The lockdown has been strict. Mayday had to be cancelled. Workers have been sent on mandatory leave. The risk of contagion remains high. The only news worse than the pandemic is that Putin’s popularity score is at a record low of 59%.

Like a chess grandmaster, Putin visualizes the endgame before making his moves. Before his rating goes below 50%, he must conduct a referendum to be in power till 2036. He ignores the concerns of the local leaders, the Moscow mayor, and announces a national vote on 1 July.

To boost the votes, he also announces Victory Day (normally 9 May) will take place on 24 June. Presumably, Putin will cross the disinfection tunnel, and appear without any protective gear. The grand display of power will make Russians proud. Muscovites have been asked to watch it on TV, but the president knows the streets will be full. Hopefully, that orgasmic feeling will last for a week until voting time.

On 1 July, Russians will go to vote to keep Putin in power until 2036. Each voter’s temperature will be measured. Disposable masks, disposable gloves, individual disinfected pens and sanitisers will be available at the booth. The largest country will exercise its constitutional right to let its autarch continue to rule over them for ever.

Ravi

Corona Daily 418: Anatomy of the Novel Coronavirus

The SARS-C0V-2 baby is now more than six months old. Epidemiologists, scientists and frontline doctors have described it in variety of ways.

Like all viruses, it is not a living organism. It can’t reproduce itself unless it enters a living host. Once the viral code, like a burglar, breaks into a human body, it uses the body’s genetic machinery, and instructs it to produce a new code - new virus. Some medical writers compare it to a microscopic Xerox machine.

Out of the trillions of viruses that exist, a few hundred thousand are known. Only 6828 virus species have names. Only about 250 of them, including the novel coronavirus, can infect humans. It is twice the size of a flu virus, and 50% larger than the Ebola virus. Still, it is 10,000 times smaller than a millimeter, one thousandth the width of a human hair. A wonderful NYT article says: If a person were the size of earth, the virus would be the size of a person.

SARS-C0V-2 has been called a genius. During the SARS pandemic, symptoms were visible immediately. The current virus infects, and waits. The infected person, feeling healthy, infects dozens of others, and only then starts feeling ill. SARS-C0V-2 can use something as basic as the human voice for transmission. People talking energetically, loudly, or singing, can spread it beyond the social distance boundaries.

Genome analysis has concluded it is a nature-made virus, not born in any human lab. A virus that can quickly spread to two hundred countries, infect prime ministers, princes, and paupers, lock down millions, and bring the world to its knees is too potent to be made by humans.

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Once SARS-C0V-2 enters, it resides in the nose and throat for 2-3 days, before descending into the lungs. Air sacs in the lungs get inflamed and are unable to gather oxygen as they should. Symptoms can differ. Dry cough, low fever, shortness of breath, loss of sense of smell or taste, toes becoming red and inflamed, even something similar to a heart attack, delusion and disorientation.

An important fact is 35% of the infected people feel nothing, but they continue to spread it. (If it is a microscopic Xerox machine, not all photocopies are the same). The others can get pneumonia, internal drowning sensation and can become desperate for oxygen. One doctor describes its ferocity as breathtaking and humbling. The novel coronavirus can damage the walls of the heart, attack the lining of the blood vessels, induce strokes, seizures, inflammation of the brain, and damage kidneys.

Some patients experience the cytokine storm. When the virus invades the body, the immune system becomes alert and starts the fight. The frontline soldiers are protein molecules called cytokines. Usually a strong immune response defeats the intruder and the immune system is supposed to sheathe the sword. In young healthy patients, this is what happens. But in some serious patients, the immune system is over reactive and keeps fighting, even when the virus is gone. That misguided zeal attacks multiple organs, including the lungs and liver. In those patients, it is the storm that kills, not the virus.

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After reading the cytokine storm description, I wondered whether it can apply to our response to the pandemic. Will the protracted lockdowns, simultaneous crushing of demand and supply, promising disproportionate fiscal and monetary stimuli turn out to be cytokine storms – an overreaction that can kill even when the virus is gone?

Ravi