Health, not tradition

Across the border in India, things are awfully hard and do not seem to be getting any better. The images of people suffering are heartbreaking. Things there are harder for those who are poorer and marginalised. A former student of mine from India, whose father is in charge of a hospital, told me that for her, if there ever was a disease that was both undiscriminating in its individual impact and yet discriminatory because of who can afford care it seems to be this one.

The situation in India is (presumably) driven in part by a new variant. The development of new variants is not particularly surprising. Virus, unlike bacteria, need living hosts (cells) to replicate. Every time a virus invades a cell, it hijacks its machinery to make copies of itself. The genetic material in the copies, in most cases, is identical to the invading virus. But every now and then, there are some errors in the copying process leading to mutations. Most mutations are benign, some might even make the viruses less effective, but occasionally a mutation could make the virus more lethal, either in making it easier to spread, or making it evade prior immunity or vaccines. The mutated viruses can mutate further and become more dangerous. The Indian variant is less well-studied than the one from the UK (and South Africa) but early indications from Maharashtra suggest that it is the dominant variant there. As more people get infected, viruses get more opportunities to mutate, and mutate further as the disease spreads.

While mutations and variants are getting plenty of news, the reality is that the coronavirus causing Covid mutates relatively slowly — perhaps as much as four times slowly compared to influenza. It is therefore not just the biology, but behaviour and policy that is wreaking havoc in India. Large gatherings with minimal social distancing, poor compliance of appropriate health practices and slow vaccinations have all led to the collapse of infrastructure with tens of thousands critically ill grasping for air.

India may be the epicentre, but this could happen in many parts of the world. In Pakistan the conditions are ripe for a catastrophe like this. General compliance of SOPs remains abysmally low. Private gatherings and those in the mosques rarely comply with guidelines. There is — in many circles — a complete denial of the disease. Vaccination rates are also among the lowest in the region. There may already be some local strains as well, but surveillance in general is weak, and unlikely to change in the near future.

While vaccinations need to pick up rapidly, and a stronger approach to compliance of SOPs is indeed needed, we need to also not undermine our precarious situation further. With what little time we may have, we need to act fast to prevent a complete collapse of our system. First, it is likely that we will need a continued supply of oxygen for the near future. In India, the challenge is not just in production but also in distribution. We ought to think about transport and access in not just large cities but in all hospitals across the country. The demand for oxygen can come in quickly and inundate the system almost immediately.

Second — we need to have a clear policy and serious enforcement around Eid shopping. It is not OK to have malls and shopping centres work at full capacity. Similar clarity in policy is needed for indoor gatherings for Eid prayers.

Finally, in-person exams are a disaster waiting to happen. I have yet to hear one cogent argument about why in-person exams (for Cambridge or Matric/ Intermediate) need to go ahead. All I have heard is insistence of the federal education minister, with no substance or facts. It seems to be an issue of ego, not health.

We have done certain things in a certain way (in-person exams, large gatherings at mosques, mingling and shopping for Eid). This is not the year to stay true to tradition. Saving lives is more important.

Published in The Express Tribune, April 27^th, 2021.

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