The Covid pandemic is a reality of multi-dimensional proportions. It has exposed our fragility on several fronts. It concerns our health. It expects us to learn new ways to treat our planet. Community life is experiencing a vigorous resurgence. The pandemic expects us to prepare ourselves and make personal sacrifices for the benefit and the welfare of society. “Self-isolation and social distancing are not about you; they’re about protecting the especially vulnerable people. In short: Your behaviour changes the system. Your mindful behaviour is needed to avoid a breakdown of the system.”
Coronavirus is a naturally occurring pathogen. It has no restrictions to travel to any country. Its genetic structure is known. Its proteins are being characterised. It can be bioengineered. It can be used as a bioweapon. More than attacking the lives of its citizens, it can attack citizen’s most prized possession, its industry, its economy. It can change warfare strategy. It can make humans morally more vulnerable. To live in a menace free world we will need to create a new order. We will have to form a new normal to live in a better world. And as they say, life science is too important to be left alone in the care of a few. It needs the care and supervision of many. Let us join hands in creating the new normal. The post-Covid world will have too many contradictory expectations. We want remote digital learning, and at the same time, we want to keep student mobility and interaction. We want ‘open access publications’ without causing much agony to ‘blue-sky funding’.
Covid has put us in a difficult situation. Some think we should have known the arrival of viruses long before they arrived. Virologist Peter Piot of London School of Hygiene and Tropical Medicine and the co-discoverer of Ebola says, “I hope the lesson will be that we can’t afford as a society to create the fire brigade once the house is on fire. We need that fire brigade ready all the time hoping that it never has to be deployed.” This can be said so easily but is so difficult to implement. Many things we desire to do but many times but we find them so difficult to do. Few things are easier said than done. Covid prediction is one such thing.
In the Covid world, there is a tussle between living and livelihood. There is a tussle between ideology and reality. There is a loss of employment in several areas, gain in a few areas. There are issues related to subsidy and charity. There is a war of priority – health over wealth. There are questions - what organizational concept is better suited to deal with the pandemic? The worst is that with any new invention or strategy there is a major overhaul in predictions and proposed strategies. Economists and planners are not ready to deal with the ‘black swan’ or ‘grey rhino’ situations. They are in deep trouble. They are expected to walk the extra mile and that too ahead of time.
Think of another scenario. If Newton had not escaped
the disease-ridden city to rural loneliness during the great Plague, how could we have known that prism did not create colours, but merely separated colours. As they say, Newton thrived in isolation. What about Charles Darwin? His was not a case of pandemic isolation, but isolation due to chronic health. He writes, “Ill-health, though it has annihilated several years of my life, has saved me from the distractions of society and amusement.” Byron’s forced quarantine at Malta made him furious, but in the 40-day lockdown, he wrote Farewell to Malta. Milton at the time of the bubonic plague of 1626 was cordoned off to his home in London, away from Cambridge. During this time what he wrote showed his flair for comedy.
Henry David Thoreau experimented with self-isolation. He wrote, “Walden; or, Life in the Woods” in a rural setting in a state of semi-self-quarantine. It was not enforced isolation. “And his apartness was far from total. He went into Concord several times a week to catch up on gossip and have dinner with his relatives.” Thoreau created from it constructive solitude. Social distancing came naturally to him. In his retreat (a refuge from “the noise of my contemporaries”) he found “a place of opportunity where he could do what he could not easily do in the everyday world: namely, concentrate, focus,…” He thought, “To some extent, and at rare intervals, even I am a yogi.” Thoreau wanted to live in Nature with raised antennas, writes Holland Cotter.
Covid Biology, Technology and Atmanirbhar Bharat
Different people have different experiences with coronavirus. It can produce cough disrupting taste and smell. It might work its way down to the lungs and debilitate that organ. Most infected people create neutralizing antibodies that are tailored by the immune system to bind with the virus and block it from entering a cell. But some people seem unable to make them.
Genetic evidence suggests that the virus SARS-CoV-2 has been hiding out in nature possibly for decades. Coronaviruses are big (125 nanometres in diameter) and have the largest genomes of all RNA viruses, having 30,000 genetic bases. (The human genome is over 3 billion.) The latest coronavirus genomes are more than three times as big as those of HIV and hepatitis C and more than twice as influenza virus. Scientists have identified genes for as many as 29 proteins, which carry out a range of jobs from making copies of the coronavirus to suppressing the body’s immune responses.
The complete genome of a coronavirus causing a cluster of pneumonia-like cases in Wuhan, China, was posted online on 10 January 2020. “Within 24 hours, a network of structural biologists around the world had redirected their labs towards a single goal — solving the protein structures of a deadly, rapidly spreading new contagion. To do so, they would need to sift through the 29,811 RNA bases in the virus’s genome, seeking out the instructions for each of its estimated 25–29 proteins. With those instructions in hand, the scientists could recreate the proteins in the lab, visualize them and then, hopefully, identify drug compounds to block them or develop vaccines to incite the immune system against them.”
On 11 January 41 confirmed cases of COVID-19 worldwide were reported, on 13 January 42 confirmed cases, on 26 January: 2,014 confirmed cases, 1 February: 11,953 confirmed cases, 18 February: 73,332 confirmed cases, 16 March: 167,515 confirmed cases, 22 April: 2,471,136 confirmed cases, 14 May: 4,248,389 confirmed cases.
How does the Coronavirus act? Coronavirus uses its surface spike protein to lock on to ACE2 receptors on the surface of human cells. Once inside, these cells translate the virus’s RNA to produce more viruses. The process has been explained in the following 5 steps: 1. The virus enters the body. 2. Virus enters the cell. 3. Virus fuses with the vesicle and its RNA is released. 4. Virus assembly. 5. Virus release.
How the Immune System Works? The antigen-presenting specialized cells engulf the virus and display a portion of it to activate T-helper cells. T-helper cells enable other immune responses: B cells make antibodies that can block the virus from infecting cells, as well as mark the virus for destruction. Cytotoxic T-cells identify and destroy virus-infected cells. Long-lived ‘memory’ B and T cells that recognize the virus can petrol the body for months or years to provide immunity.
Testing Covid cases and developing a vaccine for treating Covid cases are the two important ways to curb Covid menace. Nature examined the tests that are currently available and the status of a new diagnostic test that is being developed. Most tests are based on reverse transcription-polymerase chain reaction (RT-PCR) using material from nose and throat swabs. The method amplifies a specific gene sequence in the virus. Primers are used for copying purposes. Different labs use different primers for targeting different sections of the virus’s genetic sequence. PCR-based tests have often given false positives, due to contaminated reagents used in the tests. Key requirements for conducting the test are appropriate lab space, reagents and tools and trained people. Often trained people are in short supply. Most countries were not prepared to take up the test, due to various reasons. Therefore, barring a few countries, the pace was slow in adopting and conducting the tests. Scaling of test facilities is one of the reasons for the slow development of testing facilities. Another option is the serological test. This test looks for antibodies in previously infected people to detect infection. Several groups are working on this option, no test as yet been broadly validated for clinical use. Some groups intend to use CRISPR that takes advantage of the popular gene-editing technique to improve testing. “The techniques use the CRISPR machinery’s ability to recognize specific genetic sequences and cut them. In the process, it also cuts a ‘reporter’ molecule added to the reaction, which reveals the presence of viral genetic material relatively quickly,” writes Nidhi Subbarama . She adds, “The key advantage is that a CRISPR reaction is incredibly specific and can be done in 5–10 minutes.”
How does the Vaccine work? Vaccines provoke an immune response that can block or kill the virus in an infected person. Based on the current status as more than 125 vaccines are at different stages of development (Jonathan Corum and Carl Zimmer, Coronavirus Vaccine Tracker, New York Times, June 10, 2020). Out of which 7 are in Phase I, 7 in Phase II, 1 in Phase III, and none is finally approved. Following strategies are being used for the design of a vaccine.
1. Virus vaccines – weakened or inactivated form, as used in many existing vaccines, to provoke an immune response. One company in the US is working with a company in India using weakened viruses by altering the virus’s genetic code so that less effective viral proteins are produced. The virus is made ineffective using chemicals or heat in the inactivated form.
2. Genetic Vaccines – DNA and RNA are used for genetic instructions that prompt an immune response. Inserted nucleic acids churn out copies of the virus protein that encode the virus spike protein. The status of their development as on June 10, 2020, is as follows: Moderna’s mRNA vaccine is expecting Phase III trials in July and hopes to have vaccines ready by early 2021. BioNTech in collaborations with Pfizer and Fosun Pharma is developing their mRNA vaccine, and hope to have a few million doses for emergency use in the fall. Inovio’s DNA-based vaccine produced antibodies in mice; safety trials in humans are underway. Imperial College London researchers have developed a ‘self-amplifying’ RNA vaccine.
They have partnered with Morningside Ventures to manufacture the vaccine.
3. Viral-Vector vaccines – a known disease-producing virus is genetically engineered to produce coronavirus proteins in the body. These engineered viruses are weakened. Two types are available: those that can still replicate within cells and those that can’t. Replicating viral vectors are safer and provoke a strong immune response. However, previously existing immunity could blunt the vaccine’s effectiveness. Non-replicable viral vectors need boosters for long-lasting immunity. Viability of this method is yet to be proven. The status of some potential candidates, as on 10 June 2020 is as follows: AstraZeneca and the University of Oxford are developing a vaccine based on a chimpanzee adenovirus. The vaccine has gone through Phase I testing and is beginning Phase II/III testing. The project may deliver emergency vaccines by October this year. CanSino Biologics is testing a vaccine based on an adenovirus. They published
Phase I trial data in May 2020. Beth Israel Deaconess Medical Center are testing an adenovirus in monkeys. They would start Phase I/II trials in late July in association with Johnson & Johnson. Novartis will manufacture a vaccine based on a gene therapy treatment developed by the Massachusetts Eye and Ear Hospital. Phase I trials are set to begin in late 2020. Merck is partnering with IAVI to develop a vaccine from vesicular stomatitis viruses, using the approach that produced the only approved vaccine for Ebola.
4. Protein-based vaccines – injecting coronavirus proteins directly into the body; the focus is on spike protein or receptor-binding domain. Virus-like particle mimics the virus structure but is not infectious. They can, however, trigger a strong immune response. They seem difficult to manufacture. The status of the vaccine, based on this strategy, as on 10 June 2020, is as follows: Novavax started a Phase I/II trial on a vaccine made up of fragments of coronavirus proteins. Clover Biopharmaceuticals is developing a vaccine containing a protein from coronaviruses, to be taken in conjunction with an adjuvant made by GSK, to further stimulate the immune system. Because the coronaviruses that cause SARS and Covid-19 are very similar, the Baylor College of Medicine researchers are reviving their earlier project on SARS epidemic in partnership with the Texas Children’s Hospital. A vaccine in development by the University of Pittsburgh is a skin patch. When placed on the skin, the needles dissolve and deliver virus proteins into the body. GSK is providing an adjuvant to further stimulate the immune system. Sanofi’s strategy is to use viral proteins using engineered viruses that grow inside insect cells. GSK will supplement these proteins with adjuvants that stimulate the immune system. An oral tablet containing different virus proteins, a concept of Vaxart, is preparing for Phase I trials in summer 2020.
Any new vaccine before it comes to the market for public use goes through a process called a clinical trial. It aims to establish the safety and efficacy of a vaccine before it is licensed. The most essential point in the clinical trial is that it respects human dignity. If life has logic, disease and health also have logic. Logic is a necessity. Ethics is permissibility.
There was a time when doctors offered themselves for the inquiry. There was also a time when human beings were used as guinea pigs; they were used without their consent or well-being. The need for ethics in clinical practices arose because of the creation of false data, altering data to suit a purpose, appropriation of another’s ideas, and gifting of authorship for fear or favour. Good clinical practice was thus needed to ensure credibility of the data and to protect the rights of participants. This necessitated the introduction of bioethical principles.
The underlying principles related to clinical trials are:
(i) Howsoever useful the technology is if it doesn’t respect human rights or carry risks that outweigh the potential benefits, that technology should not be carried forward.
(ii) Listen carefully to those who are concerned about the implications of biotechnology and respond to their concerns.
(iii) Educate the public about biotechnology, its benefits and implications.
(iv) Regulation by government agencies to safeguard health, ensure safety and protect the environment must be respected.
(v) Protect confidentiality, and at the same time see that medical information is not used to promote intolerance and discrimination.
(vi) Sensitivity to ethical and social issues regarding genetic research is addressed appropriately.
(vii) Conservation of precious biological diversity is essential.
In the preclinical trial, the vaccine is given to animals such as mice or monkeys to see if it produces an immune response. The successful candidate is sent to Phase I Safety Trials. Here the vaccine is given to a small number of people to test safety and dosage as well as to confirm that it stimulates the immune system. In Phase I parameters such as pharmacokinetics (PK) and tolerance in healthy recruited volunteers are studied. The studies include acute and chronic dosing studies including initial single-dose, a dose-escalation, and repeated-dose studies. In the Phase II trials continue to evaluate the safety and PK of the biologic and also to evaluate the efficacy and possible side-effects in a small set of people (commonly 100 to 200). The trials are given in groups, such as children and the elderly. Phase III studies are large-scale clinical trials for continued safety and efficacy in thousands of people. During this phase, the final process is determined and a gap analysis of the process to support process validation is conducted and any gaps or risks are addressed. These trials determine if the vaccine can protect against the coronavirus. Phase IV marketing prepares the vaccine for commercial manufacturing and launch. Biologics manufacturing requires the use of good manufacturing practices (GMP) to ensure that adequate history is maintained for each product run. In a pandemic situation, a vaccine may receive emergency use authorization before getting formal approval. It is possible to combine phases, like Phase I/II trial.
Vaccine design is the priority of many R&D institutions, universities and companies. India is not lagging. According to a report, substantiated by the Department of Biotechnology and Department of Science and Technology, Government of India, several big government-backed projects — in both private firms and academic institutions — are leading the country’s Covid 19 vaccine hunt. When we have so many vaccines in the race, it is difficult to choose the winner. Developers and fundraisers are laying the groundwork for efficacy trials to only a handful of vaccines. Then there is ‘human challenge’. Large trials are necessary to determine safety and efficacy.
In addition to vaccines, dozens of coronavirus drugs are in various phases of development. Remdesivir (previously used for Ebola virus) is the most talked-about drug. Trials indicate a reduction in recovery time by a few days. Familiar generic medications, such as hydroxychloroquine, are repurposed for coronavirus treatment. Antibody treatments have also been used to “tamp down the body’s immune response when it becomes destructive.” According to a recent report, a commonly used steroid dexamethasone has shown positive results in randomized controlled clinical trials. According to the trials, the effect of dexamethasone was most striking among critically ill patients on ventilators requiring oxygen. The steroid did not affect people with mild cases of Covid 19; those not receiving oxygen or ventilator. Use of steroids to treat viral respiratory infection has been controversial. WHO has cautioned against treating people with coronavirus with steroids. The trials suggest that the benefits of steroid treatment may outweigh the potential harm.
India took Covid challenge ‘very seriously’ from the start. WHO chief scientist Soumya Swaminathan calls for an ‘open mind’ and says, ICMR data can be believed. She thinks that ‘Asia contained Covid-19 better than European nations’. Soumya Swaminathan expressed support for using traditional medicine to boost immunity. Traditional medicine, she said, should be given a fair chance in either preventing Covid-19 infections or for treatment.
Atmanirbhar Bharat, among other things, is one of the pillars suggested by our PM Narendra Modi to deal with the present crisis. Atmanirbhar Bharat is ‘non-economic and non-materialistic’ in character, thinks Soumya Kanti Ghosh. Ghosh, Chief Economic Adviser, SBI writes in Times of India, “the approach to growth had truly turned towards internal strength with the slogan, vocal for local to make it global, which should not be misconstrued as protectionism.”
India intends to give a major thrust to agriculture and MSMEs. “The government now wishes to create a unified market in agriculture commodities, pushing investment in the agriculture supply chain through the Agriculture Infrastructure Fund, better price realisation for farmers and bringing modern technology in agriculture,” writes Ghosh. Indigenisation of defence hardware is another opportunity the government sees for domestic manufacturing. The migrant labour dislocation and disruption in domestic transport have impacted the agriculture sector significantly. Ghosh expects loss to the economy to the tune of one-quarter of GDP growth. “Opening up of space and atomic energy for the private sector also entails a positive spillover effect of technology.” He adds, “the issue of reverse migration assumes significance in the context of supporting agriculture through MGNREGS.” He hopes the government will look into the possibility of gainful employment of migrant workers and their up-skilling soon.
In such situations, diversity of opinion is expected. Here Ghosh refers to the works of Friedrich Hayek and Gunnar Myrdal (both were awarded economics Nobel in 1974 for contrasting economic views) to stress upon the point that economic views may differ to arrive at the economic solutions for Atmanirbhar Bharat. Unity in diversity is always possible. To become Atmanirbhar, Bharat will require a double-digit growth rate over a long period (at least 10 years) to regain its lost ground.
The book ‘Economics in the age of Covid 19’ by Joshua Gans is very timely. While writing the review of the book in Nature, Philip Ball makes a very vital statement: “There has never been a harder time to be a political leader.” He is so right. The consequences of the choices made are hugely important for the post-Covid world. Of course, “With situations and knowledge changing daily, unfurling events will always render some aspects of such an analysis obsolete.” Interventions and financial handouts doled out by the politicians will have greater chances of attracting criticism. Job patterns will be continuously changing. People are groping in the dark. Lockdown of this magnitude is a new experience. There is the risk of trial and error due to inexperience. Politicians will be required to make some decisions in a hurry. These will lead to transparency issues. One important issue Gans raises is “how innovation in vaccine development can be motivated without reliance on market forces and patenting of what is so clearly a global public good.”
Ashutosh Sharma, Secretary, Department of Science & Technology (DST), Government of India, speaking at the Rajasthan STRIDE Virtual Conclave, an initiative of Government of Rajasthan organized on May 30, 2020, stressed on the need to examine and strengthen the knowledge chain end- to- end to see how Science & Technology will lead to Atmanirbhar Bharat. Ashutosh Sharma feels happy seeing the progress post-Covid crisis. This, he thinks, is due to a clear understanding of our needs and priorities. To meet the emerging challenges DST initiatives include Cyber-Physical Systems with focus on the convergence of communication, computing, Artificial Intelligence, autonomous machines, etc. A mission on Quantum Technology & Devices is also being formulated. Connecting Science with the Society is one of his Department’s priorities. This is possible if there is a willingness in both Industry and Academia, he thinks.
The recently launched Centre for Augmenting War with Covid 19 Health Crisis (Cawach) programme of DST seeks to identify and support start-ups and technologies related to Covid 19 challenges. The programme is expected to come out with market-ready technologies and products at the end of this year. These include screening, diagnostics, sterilisation, disinfection, information management, ventilators and personal protection equipment (PPE).
Covidonomics and the New Normal
Covidonomics is like Godonomics. God is invisible. No one has seen his footsteps. Some think god, the miracle man, is the projection of the mind. Some consider his belief in hope beyond reason. We may doubt the existence of god, but we can’t doubt the existence of Covid. It is real. The crisis is not a product of our mind. We have created a crisis. It is our responsibility to resolve the crisis. God is omnipotent and omnipresent. He believes in fair distribution. Let us hope Covidonomics and Godonomics go hand in hand.
What should we do at the individual level, at the group level, at the country level, and the global level? We are facing problems and we are trying to get rid of the problems. We are predicting future problems, and accordingly preparing ourselves. How different the post-Covid world will be? Some people blame ‘modernity’, and go away from nature for all our ills. Some say we have to learn to live as ‘humble wanderers’ and not as the ‘conquerors of the world’. They think by unlearning modernity we can resolve many of our problems. Are we too afraid of the crisis? Are we reading too much from the wall? Is the present crisis so powerful that it can change the world so much that we will have ‘new normal’? Some hold pollution of the inner self-responsible for the crisis. They think we have to free our inner slaves from bondage. It is not easy? Only Zombies are free from bondage. History says we are experts in facing catastrophes and disasters. Backed by a strong technology base why can’t we do it this time also.
Wherever there are challenges there are also opportunities. Future of education seems to lie on both sides, depending upon how we are looking at it. This pandemic has the potential of worsening the situation unless we are extra alert. We must act before it is too late. The good thing is that a lot can be done to reduce the impact of the crisis, but that will require, besides infrastructure, a lot of efforts of the society, the government, and of course the major stakeholders. All the strata of the society will be affected, middle-income and poor-income groups more. If we are careless we will allow inequalities to amplify. We must minimize the differences in opportunities, as much as possible.
It is time we put our dysfunctional strategies behind. The other side says that the crisis is a major threat and there will be “catastrophic shortfalls in university revenue, which will lead to massive job cuts and severe disruptions to learning and research.” Both sides are saying the truth, depending upon how the truth is interpreted. Some analysts believe “most public universities look more like bloated conglomerates than focused intellectual-capital and information-dissemination institutions that can help the economy and society navigate the future.”
Running an education system costs money. On the other hand, expectations from it are much more than ‘making money’ and ‘students getting jobs’. There is nothing wrong in filling the beds in a hospital provided one is careful about the treatment. There is nothing wrong in a student’s expectation to get a lucrative job. And definitely, there is nothing wrong if the job giver expects worthy job seekers.
Higher education has always been a matter of concern. There are issues of content, investment and output. There are problems of expectations from this enterprise. The understanding of cost control is a matter of opinion. Variation in understanding between the cost controller and the implementer can be so wide that the working of the enterprise may lose its primary focus.
Accountants can’t run an academic enterprise. Imparting education and maintaining account books are two different spheres of activities. Piecemeal efforts make sense only in the short term. ‘For the lambi race ka Ghoda’ short term fixes often become long-term addictions, and as we know they do what addictions do. They lead to long-term structural problems. Mushrooming of low-quality engineering and business schools give rise to long-term structural problems.
Starting a business school and an engineering school are two entirely different situations; one doesn’t need capital resources, while the other needs a lot of it. The requirements to teach at these schools are also different. Too much focus on the specialization at the undergraduate level needs slight tempering. Matters of red tape can be resolved amicably only if that smoothens the process of working.
Another question is who should govern an academic institution – an academic, an accountant, or a manager? If ‘one is three’ that is the best solution. But that seldom happens; their ways of governance, due to the nature of their training, are so different. I have often seen that an academic at the peak of excellence is offered the position of the head of the institution. The problem is that we all want a ‘corner room’. We deserve it in some senses, while in many other senses we are so undeserving. For the sake of occupying the ‘corner room,’ we often ignore this fact. Can’t we have more corner rooms?
Accountant sees only one colour. Administrator’s job is to run the shop. He has to fight with the authorities with one hand. He has to keep the other hand ready to fight with the government. Leadership roles need to be redefined. One must not spend time on an activity one has proven to be a misfit.
Students will willingly pay only if the education provided is of expected quality. Students have known what good quality education can be. Students think that they have the right to know what they are getting. More than the number of students, it is the quality of the students that is bothering many educators.
We need to train the ‘locals’. Like in many other countries, we can’t depend upon the foreigners for revenue resources. As they say, buying education and buying meat are two different things. The meaning of ‘learning’, per se, has changed. We need to train students for jobs they don’t know they would be getting, because of the uncertain future of the ‘future’. According to one report, 85% of the jobs in 2030 have not yet been invented. We are observing a change in our attitude. Thanks to the crisis, an attitude of help is coming back. During a crisis, it is good to observe a massive spike in the energy of our workforce.
We are social species. Social distancing, therefore, is not a natural phenomenon for us. Quarantined, we are expected to avoid large gatherings and close contact with others. We are expected to suppress our ‘evolutionarily hardwired impulses for connection’. It is not easy. But it is the requirement of the time. As George Miller writes in Science Journal, ”Social distancing prevents infections, but it can have unintended consequences.” Social isolation can increase the risk of a variety of health problems. At the same time, social contacts buffer the negative effects of stress. Ability to handle social isolation and stress vary among individuals. “Someone who is already having problems with, say, social anxiety, depression, loneliness, substance abuse, or other health problems is going to be particularly vulnerable.” ‘Collective effervescence’ (sharing emotional excitement with people) magnifies the sensation that you’re something larger than yourself.
LANCET has reviewed the psychological impact of quarantine and has pointed out a few important issues. General psychological symptoms include emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms), anger, and emotional exhaustion. Low mood and irritability stand out. After quarantine avoidance behaviours, both inpatients and healthcare workers have been seen. Stressors include longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Longer durations of quarantine were associated with poorer mental health, specifically, post-traumatic stress symptoms, avoidance behaviours, and anger. Confinement causes boredom, frustration, and a sense of isolation. Shopping and social networking exacerbated frustration. Besides, inadequate basic supplies can be the source of frustration, anxiety and anger. Shortage in public health supplies and inadequate information from public health authorities are some reasons for dissatisfaction. Lack of clarity, lack of transparency about the risk, clear guidelines and quarantine protocols are some of the predictors of post-traumatic stress symptoms. Financial problems and loss of work are key post-quarantine stressors. Financial reimbursement is an issue that doesn’t make anybody happy. Work-from-home is still not an acceptable concept in many countries. The stigma of quarantine is reported to be an issue. Participants in several studies reported that others were treating them differently: avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments. General education about quarantine helps in the reduction of stigma. Restricting the length of quarantine to what is scientifically reasonable given the known duration of incubation periods, and not adopting an overly precautionary approach to this, would minimise the effect on people.
“The biggest psychological experiment in history is running now,” is how Covid crisis has been described by Lydia Denworth in Scientific American. The pandemic's effect on mental health is unprecedented. Lockdown has put people under house arrest. The emotional and financial reverberations are audible. The metaphor being used to describe the state of the people is ‘twisted out of shape’. We are hoping that it does not break and soon comes back to shape. There is the threat of disease, the loneliness of isolation, loss of loved ones, repercussions of job loss and ongoing uncertainty about when the pandemic will end. “The deaths by suicide of health care professionals who had been on the medical front lines are powerful reminders of the risks,” writes Denworth. Every individual is different. The impact of the crisis is different for each individual. Their time of return to a normal state from the disturbed state is going to be different. Their capacity for resilience is different. Studies made by resiliency experts show that around two-third will maintain relatively stable psychological and physical health, one-quarter will struggle temporarily, and around 10% will suffer lasting psychological distress. People who have a history of suffering from anxiety will be affected more. It is sad, studies indicate, the strength of emotions in older adults diminished during the Covid. This is perhaps due to the likelihood of higher chances of getting sick and of losing loved ones, scientists say. "Uncertainty tends to make things worse." Leading a normal life helps. Belief in the self helps to cope better.
This pandemic has forced us to face ‘new normal’. Pandemic has shown us a new sky. Care is not easy but pandemic has shown us its relevance. It has inspired a new reverence for the human spirit. Technology is finding new ways of binding us. Schools are finding new ways of educating us. Businesses are finding new ways of reaching us. New business models are emerging. There is renewed zeal for collaboration and cooperation.
In a short span, after the outbreak, we have developed a large number of diagnostic tests and are running clinical trials on a reasonable number of candidates and there are more than a dozen potential vaccines. We are better prepared for the next crisis. This is our finest hour to be a part of an essential industry. We are aware of our responsibilities. We are aware of economic consequences, unemployment, industry extinction, supply chain redesigning, unprecedented fiscal deficits. Pandemic will happen again. Bats are not extinct. 8 billion people will not stop moving. What we need is a system to be in place to stop it. It will depend upon sharing our responsibilities honestly. Alarms have been raised before also. We can’t miss them now. We don’t want to fail collectively. Rather, we can’t afford to fail collectively. Our people have given us hope that we can fight the menace together. Milton Friedman said, “There is one and only one social responsibility of business – to use its resources.” Before arriving at the ‘new normal’ we will have to return to the ‘old normal’ or bypass it. Those who made ‘old normal’ made it based on the requirements of the time. When they will make ‘new normal’ they will make it as per the needs of the present time. ‘Normal’ changes as time changes. While making ‘new normal’ the scope of ‘collective’ will be expanded.
Anti-science has no place in ‘new normal’. The ‘new normal’ will require more inputs from the scientific community. Life technologies have faced several challenges before and have also amicably resolved them. This time also they will not fail humanity. “Our biotech industry’s new normal must feature political activism in favour of those who support policies grounded in science, not ideology, and social justice.” There can’t be a better sum up than that of Steven Holtzman.
Maintaining strict social distancing (until a proven vaccine emerges) will extinguish the virus crisis, but that seems unreasonable, due to the high economic cost of a long shutdown. Parts of the world have already started to reopen some activities despite the risk of a second wave. The contagion will stop only when the herd immunity is reached. Relaxing social distancing with strict measures is a necessity. But society is not prepared to remain under lockdown. On the other hand, reopening leads to resurgence. Testing the contagion will be the key to reopening. Resources of testing are limited. Due to limited resources, there is a vast underestimate of actual cases. Identifying new cases will be crucial for the containment of this menace. Testing capacity must increase. According to an estimate, 100 million molecular tests worldwide by 2021will be required; a large proportion of it will be in India. The ‘new normal’ we are talking about will vary from country to country. It will be driven by testing availability and hospital space.
The pandemic has touched each of us in different ways. It has reaffirmed the importance of community, emotional and professional connectivity and a sense of belonging for our wellbeing. It has renewed our interest in self-growth, reflection, and refocusing on new ideas and strategies. It has once again emphasized the need for finding time to reconnect with families. For some spending time with the family has been enjoyable, while for some it has been whimsical and challenging, for some stressful and isolating. Large events will not take place in the immediate future. High-risk population (elderly people) will remain isolated and low-risk population will proceed cautiously. This will require flexibility, adaptability and individual commitment among the people.
Yaron Weber writes in Biotechnology in the time Covid 19: Commentaries from the front line: “SARS-Cov-2’s mutation rate suggests that each successive vaccine will need to account for future variants of the virus in the same way that flu vaccine attempt to address the emergence of new variants each season.” The appearance of the new variant, however, appears to be considerably slower than the flu and is expected not to drastically shift within each season.
Our collective behaviour must change. We are different when we are in a crowd than when we are alone. We have to move from “ignorance, hate, and fear” to “curiosity, compassion, and courage.” If there is a need to maintain social distancing, there is also a need to open the heart and mind. Denial worsens the situation. The blame game doesn’t help. Trust is essential for any healing. Don’t feign blindness. Coordinate and collaborate. False propaganda is dangerous. Shift from ego to eco.
We have noticed that many things can be done from home, and for that will and discipline are required. We have to take a relook at ‘essentials’ and ‘non-essentials’. We have to be careful not to delete some ‘non-essentials’ from the list. We have a few challenges before us, such as planetary healing and societal renewal, reshaping learning and leadership structures, premortem and post mortem approaches in planning and execution, changes in platforms and scale-up approaches. We need to build schools of transformation technologies with focus on not only to design but also to build. We must take responsibility for the situation we are in. The outbreak of new infectious diseases is not new for us. In future, we will face more such situations. This is because we are undergoing significant change in land use pattern. We are disturbing wildlife habitat due to aggressive agriculture, forestry, mining and oil exploration activities. This pandemic will follow another one soon unless we change our living pattern, and that includes trade in animal products. If we don’t do that we can’t stop ‘jumping of viruses from animals to humans’. It is not easy, and definitely, it is not cheaper, but we will have to do it.
How long will the lockdown continue? How long will we allow this weird virus to disturb our daily routine? How long will this ‘cytokine storm’ reside in our bodies and minds? Many things kill, why worry so much about this virus? Someone made a remarkable statement: The relatively low lethality of the novel coronavirus is the reason for its pandemic spread. If the virus had been rapidly lethal, it would have died along with its victim, preventing further spread. This virus, being new, will take time to develop immunity, like any other virus. Are not precautions enough for preventions? Good quality supportive care based on an understanding of the pathophysiology of the infection is what saves most lives.
Social media have to play a more positive role. Don’t create panic even if ‘death’ sells more than ‘life’. Reduce irrationality. Don’t take the responsibility for what is not your competence. Half-truths are worse than complete lies. Use scientific intelligence and rationale to deal with the pandemic. Desperation and the urge of self-promotion do not lead to solutions we are looking for. Hastier than thou is only good for the menace and not for humanity. Too much pessimism makes one incurable. Optimum optimism helps, as it always keeps some space for pessimism. The arrival of ‘magic bullet’ takes time. ‘New normal’ will come, but it will take time. Let us remember that we are only as strong as the weakest health system in our interconnected world.
Many predictions have indeed gone wrong. One of its consequences is that the necessity of lockdown is being questioned. Scientists are blamed for both ‘too much lockdown’ and also ‘too ready to relax restrictions’. Why don’t we realize that good science requires time? Moreover, good science doesn’t create Frankensteins.
(From the book Algorithms of life and the window of hope by Purnendu Ghosh)