India is facing a massive wave of Covid-19. As about 1 in 5 people is Indian, this is a planetary problem as far as humans are concerned. Our survival depends on India. As a response, many conuntries have been closing borders with India. The US bans most travel to India with some extemptions for students, US citizens and permanent residents. Australia has been closed off for more than a year and continues with its strict policies. An Australian returning home from India can face 5 years in jail, if they don't cleanse themselves for 2 weeks in another country before joining the Australian quarantine. Will these new restrictions last? Let's look at the situation and then let's look at numbers.
The problem and the proposed way out?
As expected, despite having one year to prepare, India has failed to build sufficient capacity in the medical system to deal with the problem. Most other countries have done the same.
Several politicians, some rather prominent, have advised people to use readily available holy cow urine to treat COVID-19.
So, such statements beg the question, does cow urine kill people? Short answer: no! We routinely drink milk from cows, eat their meat, sometimes raw and we are generally safe. In India, people sometimes choose to drink cow urine or eat cow feces without notable negative consequences to their health. Thus, it is reasonable to assume that, when it comes to COVID-19, cow urine is a placebo. This means it will work just as well as holy water, a prayer, or a sugar pill. We know that, when it comes to common colds, we often have noting better. In fact, my father's favourite joke about the common colds is that they last a week without medication, and seven days with medication.
We do, however, have a lot of medicine that can do a lot of harm.
Especially now, I believe going to a hospital in India with Covid-19 can result in a lot of harm. Here's how:
Just like with common colds and flu, treatment for COVID-19 is largely supportive. It is used to temporarily relieve some of the symptoms. Doctors try to keep the patients alive and let the immune system take care of the virus. Most people -- and, when it comes to Indians, a lager fraction than in the West, will stay alive without any special measures when infected with COVID-19.
Supportive treatment starts with rest, warm tea and love. Just like with colds, the mind plays a big role in the evolution of the illness. Stress makes things worse. When we take someone to a hospital, we increase stress. The hospitals are stressful places in the best of times.
The hospitals are dangerous, dirty places. Sure, they look clean, but they are teeming with sick people and their germs -- a wide selection of viruses and bacteria that, when added to COVID, have the potential to make things much worse. Now, the hospitals are overcrowded, and require the patient and his family to put on a considerable fight to get in. Waiting doesn't help. All these make Covid worse. Thus, many people who would have survived at home die in hospitals.
If the lungs are affected, statistics show that changing position (i.e., turning the patient on their side or on their belly) increases survival more than being intubated. The former is more likely to happen at home. Doctors and nurses are overwhelmed. So, patients are often tied to their beds, which prevents movement and increases the probability of death and/or intubation. Intubation is a very sensitive process that can only happen in the hospital, but requires a lot of monitoring, which is simply unavailable in COVID times. Furthermore, hastily administered medication without monitoring its effects can be lethal.
The turning of the patient is called proning. It's a technique that has been used against respiratory infections for centuries. When we visited the Skansen museum in Sweden, I asked why their beds were so short. They said it was because respiratory infections were common, and if one laid down on a flat surface, they believed death would come. So, the bed was a short wooden structure on which there was not enough room to sleep lying flat like we do today.
Some people choose to go to a hospital when they have symptoms consistent with COVID, but are not sure they have COVID and not a normal cold or flu. If they don't have COVID, they will get it, and are more likely to die.
In some parts if India, hospitals only allow patients who bring their own oxygen. At home, one would get to use his oxygen bottle. In the hospital, it may get shared.
One should also consider the family. As hospitals are short of staff, often healthy family members are allowed to look after their loved ones. At home, these family members would be exposed only to the virus from their loved one. In the hospital, they have a wide choice of viruses and bacteria to get sick from. Added to this, is the stress that will make these people more vulnerable. Thus, going to the hospital may not kill only the patient, but his relatives as well.
So, to go or not to go to the hospital? It is a personal decision that should be taken by family and professionals on a case by case basis.
The Situation in India: From the beginning to now.
India had a relatively mild first wave of Corona, with mortality 20 times lower than the UK or 10 times lower than Germany. While in Europe, it looked like the virus stops after killing 0.2% of the population, in India, it seems to have stopped after only 0.01% were dead. While this is most likely an undercount, the numbers remain low. Furthermore, it looked like India had herd immunity and the decrease in infection rates and deaths was constant and solid -- until now.
In April 2021, a new wave of COVID infections sweeps over India. The deaths and incidence increase exponentially, as if there is no immunity at all. What could have India done wrong?
(1) The early, strict lockdown. While it did not seem to contain COVID-19, the lockdown lowered the incidence of the other harmless coronaviruses which are endemic in the Indian population. Infection with these harmless coronas provides a degree of immunity to COVID-19. This immunity isn't permanent. The longer the time since last exposure, and the lower the number of coronaviruses a patient was recently exposed to, the lower the immunity and the higher the potential of serious disease. Thus, by eliminating the harmless coronaviruses, the lockdown may have created the conditions for this new wave to take place and be deadly.
(2) Virus mutations. It could be that the COVID-19 has evolved in India in a way that it can evade immunity from the old version. The virus was under evolutionary pressure to do so. India may have been for a long time in a situation where COVID-19 was widespread and most people immune. Thus, if a variant of the virus evolves to be able to reinfect these immune people, it can have all of India and the world. The virus mutates randomly -- lots of infected people means lots of mutations. The Indian environment would then select the best variant that can cause an all-new pandemic worldwide.
I worry about (2). In this scenario, the whole world may follow India and experience a new wave of the COVID pandemic. This is common with other colds. The viruses mutate and reinfect. COVID-19 is more deadly and new, but should function on similar principles.
The Future as predicted by numbers
The new COVID wave won't last long in India. In a large part of India, 25-50% of tests carried out a positive. It can't last. The virus will run out of Indians soon. This new wave appears to have the dvcmic of New York or Belgium. The Indians no longer comply with lockdown rules and it doesn't appear to stop. Thus, in a short time, the entire population will be exposed to the virus. Rich people will be immunized by the vaccine, poor people naturally.
Given the structure of the Indian population, the overall mortality will remain well below Europe. Most Indians are young and healthy. In Europe, Corona generally kills people who are within about one year from their natural death. In India, these people have been killed a decade ago, by more deadly diseases that are endemic.
Sure, some people will die, but it won't be like Belgium or New York. I think it won't even reach Germany, or Sweden. May even stay below the most successful EU nations like Denmark and Norway.
India couldn't really hope for a better outcome.
Shockingly, it may even be that, overall, Indian life expectancy will continue to increase this year.
In 1900, the Indian life expectancy was only 22 years. It has increased almost every year since. The Spanish flu of 1918, which was about 10 times as deadly as Corona and it killed mostly young people, has lowered Indian life expectancy by 2.5 years from 23.5 in 1915 to about 21 in 1920. By 1925, it had recovered and increased to 25 and kept growing since. In 2020, it was the highest ever at nearly 69.27.
The current rate of increase in India's life expectancy is about 4 months a year. This rate was maintained since the Spanish flu.
In Europe COVID seems to kill 0.2% of the population one year earlier than normal. Thus, 2 lives and 2 years of life expectancy are lost for 1000 people. That amounts to a reduction in life expectancy by 1 day, for the entire population alive today. Indians are younger and less likely to die. Thus, a reduction of Indian life expectancy for of 1 day due to Covid appears an overestimate.
If we look only at the people dying tis year, they will be about 1% of the population dying of the usual causes, plus (at most!) 0.2% dying of Corona one year too soon. Thus, this year's deaths will be 20% more than last year and 2 months younger than they might otherwise have been due to COVID-19.
They are however, on average, due to be 4 months older than the people who died in India last year due to the normal increase in life expectancy seen for the entire past century. Thus, the people dying in India this year, will still be 2 months older than those who died last year.
It's not worth shutting the country down if people dying this year are only 2 months older than those that died last year.
Drinking cow pee may indeed be the best solution. Thus, India's politicians are right. I say this as a Caltech-educated scientist.
A fast moving and short pandemic is better for live and the economy than a deadly long lockdown.
The sun will raise tomorrow. The cows will pee. New babies will be born.
++++ Looking ahead: the problem of lower birth rates in India ++++
India has been through many pandemics. COVID-19 isn't the most deadly. The prospect of losing 0.2% of the population in addition to the 1% that die every year won't make India run out of people.
India will, however, be running out of people soon.
Indian brith rates have gone down just as living condition improved. Vast swathes of India a below replacement level and, India as a whole went below 3 children born per woman in 2005. They are under 2.18 today.
The lowest integer number of children a childless woman can aim for that is compatible with the existence of the human species is 3. Most Indian women aim for less and most don't reach this number.
If birth rates continue to drop at the same rate, they will reach replacement level within the next five years. It may temporarily settle after that at some value below two or it may continue to drop. If it continues to drop at the same rate, India will reach one child born per woman in the next 25 years and absolute zero in less than 50 years. Over time, the drop in birth rates should become a much bigger problem than diseases like COVID.
--------------------------------I thank Anja Bojds inspiring discussions.
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