Treat every person you meet as an asymptomatic coronavirus carrier, Delhi surgeon Dr Ambarish Satwik advised residents of his colony.

Allow me to state a few elementary facts. I don’t believe in divine intercession or any theory that accords inherent innate immunity to Indians. More importantly, as doctors, we’re in the thick of this and can see (in real time) the vector and the trajectory of these infections.

I urge you to read the following with a great deal of responsibility and disseminate as widely as possible.

1. We’re not getting a vaccine till next year, possibly not even for a year and a half. There is no evidence whatsoever that any medicine or therapeutic intervention can prevent or treat COVID infection. What can definitely and very effectively prevent COVID infections are non-pharmacological interventions that you’re all already aware of. But more of that in a bit.

2. In the absence of a drug or a vaccine, most of us are going to get infected over the next few weeks/months. To believe that we can dodge this would be a form of self-deception. That said, COVID isn’t the plague or Ebola. In about 80% cases, this infection would be completely harmless. Even in the elderly, getting COVID isn’t the equivalent of getting a death sentence.

There are scores of people in Delhi above the age of 65-70 who have been infected and have been asymptomatic or have had very mild symptoms and have fully recovered. But, of course, the elderly and those with co-morbid conditions are the most vulnerable and have to be protected.

It’s usually the young, the restless and the earning members who acquire the virus from their daily excursions and come back and give it to the home-bound elderly.

It’s entirely possible and probable that a few people [in our colony] have had a previous unsolicited encounter with the virus. It’s possible that a few of us are currently asymptomatic carriers, without having any knowledge of it. There’s no way of finding out unless we start extensive testing for antibodies, and that’s not going to happen for a while.

The trouble with all these statistics is that it gives you no information about whether you or your loved ones will be safe. It’s fundamentally a roulette. There’s no way of predicting who is going to fall. There have been instances of healthy, young people ending up in ICUs and even dying from COVID pneumonia and its sequelae.

3. The only way forward is to ride the storm. COVID isn’t going to magically disappear. About 70% of us will have to get infected for the community to acquire herd immunity.

4. Herd immunity isn’t real immunity acquired by osmosis: it’s a form of statistical immunity where the uninfected are protected by the previously infected (and cured) individuals around them. This really is the key to understanding how this is going to end.

As a crude example, consider all the people [in our colony] as a community. Imagine a time in September when about 70% of us have had COVID one way or the other and have acquired immunity against it. Thirty percent of us are still preserved and uninfected. The virus, remember, needs a human host to survive; it can’t survive outside humans for very long. When a new, uninfected individual now gets infected, the virus wants to move on, wants to jump to a fresh host.
This individual in [our colony] is now surrounded mostly by previously infected (and now immune) individuals. There is also a minority of uninfected individuals, but the statistical probability of the virus encountering an immune individual (70%) is much higher. It cannot infect (and thrive in) these immune individuals in its immediate milieu and withers way.

The uninfected minority in a community is therefore protected by a shield made up of a herd of the previously infected. The infected gentleman in B block is the first member of this shield. Remember this.

5. Now, some actionable things: no matter who you are and how old you are, do not step out without a mask. A simple mask is good enough, an N95 is even better, but please do not use N95 masks or Vogmasks with exhaust valves. The valve provides “breathability” when you exhale by releasing your breath and its contagion carrying respiratory droplets. These masks protect no-one. For the duration of the pandemic, these masks should be banned.

If you’re using a cotton or a fabric mask, make sure it’s not sieve-like or honeycombed. This leaks air and respiratory droplets. Make sure the mask covers your nose and mouth. It’s instructive to note that even if you’re in the presence of a COVID infected individual and they’re masked and not coughing and you are yourself masked, the probability of you getting the infection is minuscule. The virus doesn’t fly out into your lungs.

6. Learn optimal mask hygiene. Consider the outer surface of your mask contaminated and carrying the virus if you’ve been in close proximity of other people. Do not touch the outer surface of the mask. Remove the mask by disengaging the earloops without touching the outer surface and discard it (if disposable) or wash it immediately on return.

7. Treat every individual you meet as an asymptomatic COVID carrier. Treat every surface you touch as potentially contaminated. That is the meaning of community transmission. Carry a sanitiser on your person. Frequently sanitise your hands after touching surfaces or objects. As we go about our lives, try your best not to get infected.

Remember, easing the lockdown doesn’t diminish the virulence or the transmissibility of the virus. On the contrary, it increases it. Your chance of getting infected today is 15 times more than what it was in the beginning of May. It will be a hundred times more by June-end.

Avoid stepping out, as much as possible, particularly for non-essential activities. Give Delhi’s healthcare apparatus a fighting chance. We all have to avoid falling sick at the same time. We’ll all be scampering for hospital beds at the same time. No one will get it.

“Living with the virus” is not the same thing as socialising in the middle of a pandemic. For all our sakes, behaviourally, assume that the lockdown persists unabated. Please do not be complacent.

This article first appeared in Dr Ambarish Satwik is a vascular and endovascular surgeon at Delhi’s Sir Ganga Ram Hospital. He is the author of the novel Perineum: Nether Parts of the Empire.


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