Healthwise: Cost of chasing the impossible

Thor, the god of thunder and lightning in Norse mythology, stood in front of the giant king. Pride was at stake. The king had asked a drinking horn to be placed before Thor, challenging him to empty it. Thor picked up the goblet and took one long gulp after another but no matter how deeply and how much he drank, he found his breath running out and the drinking horn still almost full. He kept on making fast and furious attempts to drain the goblet but all in vain. The level did sink in the vessel but he could not empty it.”

Thor was perplexed. But what had been handed to Thor was not a simple goblet. By trickery the horn was connected to the nearby ocean. And Thor had come close to draining the ocean! Unknowingly, he was attempting the impossible.

This story is from ancient mythology. Are we too, in trying to drain the novel coronavirus from the globe, attempting the impossible?

Our country is an ocean of people and most have recovered from natural infection with the coronavirus. The recommended strategy of test, trace and isolate have hardly made any dent on the spread of infection and only a fraction of infections have been identified by these methods which are still being continued to “break the chain of transmission”.

The fourth round of serosurvey conducted by Indian Council of Medical Research (ICMR), showed that 67.6% of Indians had antibodies. What can be inferred is that a staggering 92 crores plus Indians have developed immunity either due to natural infection, mostly, or due to vaccination. Around the time of the survey less than 5% of the population was fully vaccinated and around 20% had taken both doses of the vaccine. So, we can assume that around 75 crore people in our country had acquired immunity from having recovered from natural infection.

The cases identified by the “test, treat, isolate” strategy stood at a minuscule of around 3 crores. So, by intense contact tracing efforts of Herculean proportions (or Thorian proportions!) we have been able to detect only 4% of the cases in the country.

The novel coronavirus is the don of all viruses, not only difficult but impossible to catch up with. And like all successful dons, it is ruling more by fear. The panic and fear are also contributing to deaths from this virus, as brought out in a recent peer reviewed original research paper published in the July 2021 issue of Public Health Research, Practice and Policy by Kompaniyets and colleagues.

Among 540, 667 adults hospitalised with Covid-19, the researchers tried to identify the risk factors for severe outcomes and deaths. To their surprise the investigators found anxiety and fear-related disorders to be the second highest risk factor after obesity, leading to death from Covid-19. Scientists advising the government lost the plot early. Testing and tracing are important in the early stages of an outbreak when it is a localised stream and has not merged into the ocean (of humanity), or at the end of the pandemic when it has reduced to a puddle, i.e. if the public health problem associated with the disease still demands eradication. Else the puddle can be left alone.

We have so many un-cleared and bigger puddles in our country such as Tuberculosis which kill over 1200 every day, child deaths – over 2000 daily, typhoid which does not have a proper surveillance and counting system in place, and so on.

What about the costs of these futile measures when the stream has merged with the ocean of community transmission? What about the opportunity costs? What about the fear, stigma and harassment of quarantine among those randomly picked up in the goblet while the bulk of those harbouring the virus were in the ocean of humanity in our densely populated country?

First, let us consider the futility and utility of testing and tracing. From the scientific perspective, testing and tracing do not make any sense once community transmission has set in. Even if the number of tests had been increased by 10 times, we would still have missed the bulk of positive cases which occurred in our country as revealed by the latest serosurvey.

On the other hand, aggressive testing and tracing and quarantining have great utility to increase the case counts and generate panic and fear among the people.

People harbour innumerable viruses and bacteria in their throat, gut and skin, some of which cause far more serious diseases than Covid-19. But never before in the history of medicine were people labelled as cases on the basis of disease-causing pathogens isolated from them without any symptoms as is being done for Covid-19.

The ensuing panic of rising case counts is exploited by vested interests to promote dubious treatments and preventives all assured of over 99% success rates, given the low Infection Fatality Rate of 0.3% of the “lethal” virus. What about the cost?

It has been estimated that the cost of contact tracing in the USA was 3.6 billion dollars. India’s population is three times that of the USA so the approximate cost of contact tracing and quarantining in our country would be about 14 billion dollars. Can we afford this type of money when our public health infrastructure is in shambles?

Had we used this to bolster the public health infrastructure to manage moderate to severe cases our mortality rates would have been lower in the second wave.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal).