“Everything that has a beginning has an ending. Make your peace with that and all will be well.”Jack Kornfield, Buddha’s Little Instruction Book
During the last few months, COVID-19 pandemic has turned the world upside down. There is one question that bedevils every mind, ‘when will this pandemic end?’ or ‘when will we go back to normal life?’ Can we answer these questions with any degree of certainty with existing knowledge?
We all know that the culprit for this pandemic is a virus called SARS-CoV-2. It arose as a new virus from Wuhan (China) and is now possibly present in almost every country. We also know that coronavirus of a different type had earlier caused localised epidemics that were named MERS-CoV and SARS-CoV. This family of viruses has also been popular among fiction writers. In 1981, author Dean Koontz wrote a thriller called “The Eyes of Darkness” which mentioned a similar viral illness.1 The novel talked about a Chinese scientist who brought a biological weapon called “Wuhan-400” to the United States. It is uncanny that the current coronavirus pandemic started in Wuhan, China. Later in the book, the fictional virus was shown to be extremely dangerous with a kill rate of 100%. The reality of COVID-19 is different. Those exposed to SARS-CoV-2 start developing symptoms in about 5-15 days. Mortality in the young population is low (<1%) and most deaths occur in elderly and immunocompromised patients.2
SARS-CoV-2: A strategic bio-weapon?
More eerily, it is known that there is another (non-fiction) book authored by two Chinese Colenels in 1999, called “Unrestricted Warfare – China’s master plan to destroy America.”3 The book carefully explores strategies that militarily and politically disadvantaged nations might take in order to successfully attack a geopolitical super-power like the United States. Military strategists Qiao Liang and Wang Xiangsui argued that there was, in the American military doctrine, a blind spot with regard to alternative forms of warfare that could be effectively exploited by its enemies. Liang and Xiangsui focussed on the importance of alternatives to direct military confrontation. Unrestricted Warfare allows an innovative adjustment in strategy, using unprecedented ways to leave all opponents behind economically. Is SARS-COV-2 a bio-weapon that is a part of one such strategy?4,5,6
US officials believe that there is ‘enormous evidence that SARS-CoV-2 originated in China’s lab due to genetic manipulations.7,8,9 Several countries have asked for an independent investigation into the origin of this epidemic.10 When the existence of the virus was first detected and reported to the Chinese authorities by a Wuhan ophthalmologist Dr. Li Wenliang, their first response was to penalise him and also others who rang the alarm bell. Every attempt was made to suppress the reports and alarms in the most ruthless and savage manner. The Chinese authorities then had also categorically denied the existence of the virus.11
More than evidence, one should look at China itself. It displays habitual secrecy, big ambitions, and absolute disregard for life or the environment. Allied to that is the fact that bio labs everywhere have been a source of serious threats, with the big powers seeing them as potentially usable as weapons of mass destruction, proved by the large number of such facilities worldwide.12
Today we see that China has virtually recovered from Covid-19 epidemic and has started industrial production of material that the whole world needs due to this pandemic – like masks, ventilators and so on. The net worth of many of its companies has jumped over 400%. The question still hangs in air; was this pandemic by a novel virus a part of a deliberate but innovative biological/ economic warfare plan? A carefully thought out strategy? Many blame China for the pandemic. There has been a hot debate about the applicability of ‘Rylands vs Fletcher case‘ to hold China legally responsible for it.13
How China behaved after the virus breakout, also points to its culpability.14 Chinese ships have sunk or harassed ships from Vietnam, Malaysia and Japan in areas that those countries consider their “exclusive economic zones.”15 Recent threatening stance against India as well as Taiwan are other examples.43,16 Ignore the possibility at your own peril, that COVID-19 is a carefully orchestrated strategic plan for World domination by China. If China can do it once, they can also do it again! Brace yourself for the new normal, for a long haul.
Whatever be the cause, let’s look at how this pandemic will end. Epidemic dynamics are supposed to be governed by Farr’s law.17 It was originally developed after observations on smallpox epidemic in 1840, when William Farr observed that time-evolution behavior of an epidemic could be captured by a single mathematical formula that approximated to a bell-shaped curve.18 The time taken for the epidemic to die down will be somewhat similar to the time taken to reach its peak. Dynamics in New Zealand, where COVID-19 has been fully controlled can be studied.44 But for the rest of the world, two main factors will govern its natural course (a) how the virus behaves, and (b) how we react.
Virus is a small piece of genetic material wrapped in protein/lipid covering. It is inert on the inanimate surfaces but comes alive when it catches a living cell. It hijacks the living cells’ resources to create its own copies. One of the ways it protects itself from the host immunity is by undergoing repeated mutations. Viruses that trigger pandemics have enough novelty in its structure to begin with so that the human immune system does not recognise them as dangerous invaders.
The virus also has the capability of mutating its coat to escape antibodies made by human immune system against its earlier self. Some viral mutations will be beneficial to humans too. It may become less offensive and less injurious to humans, whence it may end up becoming another common cold. This may end the venom in the pandemic and we can stop worrying about it. Mutations in SARS-CoV-2 are already being reported.19,20 There is a hint that some unique mutations could weaken Indian SARS-CoV-2 strain.21 However, they may also delay vaccine development.22
Recognising SARS-CoV-2 as a ‘non-self’ particle, the human immune system prepares a defence, involving new antibodies and other immune system components that can react to and attack the virus. The human body gets disease often as a collateral damage, when the immune system tries to destroy all the infected cells. The lethal ‘cytokine storm’ described with COVID-19 is the human immune system attacking the virus. Ultimately, in most survivors, antibodies developed by the immune system fight off the invader and linger on enough to confer longer-term immunity. It will also limit person-to-person viral transmission, but the process can take several months/years. Before it happens, the havoc reigns.
If we could isolate every infected person right in the beginning, we could end the epidemic. It is not practical for COVID-19, because a significant proportion of those infected do not get symptoms severe enough for them to report to a doctor.23 Lockdown was not meant to end the epidemic. It was implemented to delay the peak so that we get some time to react and bolster our capacity to deal with it. Its unexpected adverse outcome was crippling the economy.24 As we come out of it, we know that the essential services will require nearly half the population to be on the move. That means more chances of spreading the virus.
We can delay the inevitable by social distancing and using public health measures as we are doing now and hope that an effective vaccine will be available very soon. The effort is on at a breakneck speed. There are 17 vaccine candidates under clinical trials and another 132 under preclinical trials.25 Some of the vaccines use newer technology (RNA vaccines), which has not been tried in humans earlier.26 India too is fast tracking its efforts to complete clinical trials in a time bound manner.27 Similarly, frantic efforts are being made to develop effective treatment of this disease. We already have several successful options available such as Remdesivir, Favipiravir, Tocilizumab, Dexamethasone, Convalescent Plasma and many others.28,45 Compared with flu viruses, coronaviruses don’t have as many ways to interact with host human cells. If that interaction goes away, (the virus) can’t replicate anymore, that’s the advantage we have here.29 Despite several ifs and buts, these endeavours are bound to bear fruit sooner or later.
Lessons from the past
The Pandemic of H1N1 influenza infection (1918–1919) is the most famous example in the modern history.30 In those days the understanding and scientific/computational resources were rudimentary as compared to what they are today. Only control measures were social distancing and school closures. Over two years and three waves, the pandemic infected 500 million and killed between 50 million and 100 million. It ended when the natural infections conferred immunity on those who recovered. Subsequently, the H1N1 strain became endemic, an infectious disease that was constantly with us at less severe levels, circulating for another 40 years as a seasonal virus.
It took another pandemic—H2N2 flu in 1957—to extinguish most of the 1918 strain. One flu virus kicked out another one. The scientists don’t really know how. Human efforts to do the same have failed. Nature can do it, but we cannot.31 Thus, if we do nothing, COVID-19 will burn through the World population, eliminating many sick and infirm from our lives, albeit also some young persons. As it ends, like the flu pandemic of 1918-19, it will leave behind enough immune survivors to carry on with the herd immunity. This scenario involves tremendous cost in terms of human lives, leaving behind millions of dead bodies and a devastated healthcare system.
A coronavirus, SARS-CoV, (older cousin of the present virus i.e. SARS-CoV-2) caused severe acute respiratory syndrome (SARS) epidemic of 2003. There are several known human coronaviruses, four of them circulate widely, causing up to a third of common colds. The culprit of the 2003 epidemic was far more virulent. That outbreak could be contained to a few locations such as Hong Kong and Toronto by aggressive epidemiological tactics including isolation of the sick, quarantining of their contacts and implementing movement control. This was possible because the incubation period was short and nearly all those infected had symptoms, like fever and breathlessness. Virus transmission occurred only after the symptoms developed. It stopped after causing a total of 8,098 SARS cases globally and 774 deaths.
There was yet another pandemic by a new H1N1 influenza virus (swine flu) in 2009. It was very similar to the 1918 killer pandemic but fortunately proved less lethal than feared. The pathogenicity of this virus wasn’t very high. But another important reason was that six months after the virus appeared, scientists developed a vaccine for it. Influenza viruses are slippery, mutating rapidly to escape immunity. As a result, the vaccines must be updated every year and given regularly. But during a pandemic, even a short-term vaccine is a boon. The vaccine was able to temper a second wave of cases in the winter. And the pandemic ended, as did 1918 pandemic, by becoming a widely circulating seasonal flu, from which many people are now protected either by flu shots or by antibodies from a previous infection.33
So how will COVID -19 pandemic end? Human efforts supported by nature will see this horrid spectacle die down in due course. COVID-19 has already pushed humans into several collaborations and joint efforts as never before and scientists are working on multiple fronts to develop tests/vaccines/remedies. Most estimates made in March/April had predicted that COVID-19 pandemic would peak around mid-july.35 Figure-1 above shows the incidence of new cases in various countries as on 13 July 2020. Each country seems to be following a different curve. Moreover, many curves do not appear to be bell-shaped at all. Figure-2 alongside, shows the trend of COVID-19 incidence in various parts of the World as on the date of this blog.36 Even different regions of India will show different curves too. It has been now been predicted that there may be multiple peaks in different regions or a longish plateau instead of a peak.37 An Operations Research Group constituted by the ICMR has been analysing these developments during and after lockdown period. They feel that the peak may now be seen by mid-November. (ICMR itself has distanced itself from these conclusions.)38 Some global experts believe that epidemic in India is in its early stages.39 Ultimately half the population of India is likely to be infected with SARS-CoV-2.40 It is during this peak period when the lack of health infrastructure will pinch most. We can still beat the odds if the vaccine proves to be safe and protective. Those infected in childhood, appear less likely to develop severe disease if they get reinfected as adults. The combination of vaccination and natural immunity will protect many of us. The coronavirus, like most viruses, will live on—but not as a planetary plague.
Let us accept that this virus is going to be nagging part of our life for over one or more years. You can not wish away the demon. Not only that, after the epidemic ebbs, there may be a secondary pandemic of mental health problems to follow. The MOHFW has been proactive with National guidelines, helplines and display of information.41 Knowledge can allay fears and can permit us to prepare for the worst. Mask, handwashing, social distancing and ‘namaste’ are here to stay for years to come.