On March 18, 2020, I arrived back from San Francisco in a 22-hour flight, with more than 150 Indians, and went through the screening process at the Delhi airport. I was shocked to see how a number of people, likely infected with COVID-19, were let go. Screening officials checked for three things:
- Self-declaration of 3 symptoms: Fever, Cough, or any Respiratory Distress.
- Travel history
- Thermal screening (To check for fever).
If a person had declared any symptom or had a travel history to a country with an outbreak, or was found to have a high temperature, they were held for further investigation. Otherwise, they were let go.
80% of the people infected develop only mild symptoms such as cough, fever and sore throat. Fever is easy to detect with thermal screening but fever doesn’t happen to all, and when it happens, it also varies from person-to-person. Therefore, thermal screening finds only a small portion of infected people.
Coughs and a sore throat require a deeper check-up, which the screening officials were not doing. They relied on self-declarations. Here’s the problem with that. I had counted 30+ people in flight who had a cough, including me. However, at the end of the screening, I saw only a handful of people being held for further investigation. This meant that a vast majority of people chose to probably be dishonest with their declarations.
These people, who were able to pass the screening, could have been exposed to Coronavirus, and therefore, they would become carriers and spread the virus.
The problem with self-declaration is that people do not self declare for whatever reasons. The person closest to me, who was coughing frequently, chose not to declare too because he had a connecting flight to Ahmedabad and he wanted to skip queues. When I tried to reason with him, he was dismissive of the threat from COVID-19. Screening officials should not rely on self-declarations. They should do deeper investigations.
It was also important to enforce self-quarantine for all 150 passengers. In a 22-hour flight, with people sharing a dense space and flight attendants being a significant source of mixing, even if 1 person was infected with Coronavirus, it is likely that they must have infected other people. To what extent? that depends on the number of sick people to start with.
Then, 3 factors could determine the spread of Coronavirus: in-flight mobility of people, hand and mouth hygiene, and how contagious a person is, which varies as symptoms get more severe. Worst case scenario is all 150 passengers were exposed to the virus. If this was the case, then all 150 will develop symptoms in the 14 days. If they are not quarantined then they start spreading it in the community as they come in contact with other people. The screening officials completely failed to even advise a 14-day quarantine to people who passed the screening. I had a mild cough and I was told that I could go. No one recommended a home quarantine or a test or social distancing. I was told to call the government helpline if I develop any symptoms and that’s it.
At the Delhi airport, no one had hand sanitisers or masks available for incoming travellers. No one advised people to keep a distance from each other. We were all cramped in the queue. This seems to be a common problem, where people on Saturday had to wait for 11 hours at the airport. All these factors add to the risk of spread in the country.
In India, the health system is not prepared for what’s about to come. Coronavirus is like a supercharged UV light and people are like flies, ignorant and under an illusion thinking that the Coronavirus can be dealt with easily. It is only when it is too late, when they are too close, they will pop, burst!
The fatality rate of the Coronavirus is about 3.4% on average. 15% of people will need some kind of hospitalisation because of being in critical conditions. It spreads exponentially and the coming weeks have the potential to devastate the lives of people. A lot of people could get infected instantly, overwhelming our health systems because of lack of beds, ventilators, masks and so on.
India’s population density is 3 times more than China and it is rampant with inequalities that make social distancing very difficult. The economy is slowing down, businesses are adapting by allowing people to work from home. This helps but there are people who will suffer the most. The daily wage labourers, the poor on the street, the maids, the poor who are reliant on everyday income (about 100 million). Without something to float their boat, they won’t be able to practice being distant. They will bear the unproportionate burden of survival. They will get exposed, and might just expose others.
Many will die, not because of a deadly disease but because of a deadly economic and social inequality that will leave them powerless to support themselves, helpless to seek healthcare in an already stressed health care system.
Then there will be health care workers who would be at risk from high exposure and fatigue. They are the ones who have the power to reduce the number of deaths. And the numbers can be staggering. Globally, 20% to 60% of people are expected to get infected. For India, this means 200 million to 600 million people. Estimates by an expert suggest that around 2 to 2.5 million people could die because of the healthcare system’s inefficiencies. If we improved the efficiencies and if we enforced people to stay away from people, stay at home, we could save 1 to 1.5 million people.
What is most important to figure out now?
- How to enforce social distancing and home-quarantine for people?
- How to support the most vulnerable, the economically weak, the health workers, and the elderly?
- How to innovate the health systems to reduce inefficiencies? That is, removing financial and medicinal constraints for people, reducing equipment limitations and helping health workers’ lives to remain stable, functional and healthy.
Please comment with your thoughts and recommendations on how to improve.
Get facts straight from WHO: http://bit.ly/who-covid-19-whatsapp
Resources to cope with Corona: https://www.google.com/covid19/
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