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I'm From Kashmir And If I Can Stay Optimistic In This Time, So Can You: Trust Me

( words)
*For representational purpose only.

In a very short span of time, the world has become completely unmoored, panic-stricken and obsessed with fear. People across the globe check social media and news feeds that inundate and overwhelm us with information about COVID-19, which was declared a global pandemic by the World Health organisation. As the numbers in our part of the world are increasing day by day, over the past few weeks, the fear centres of our brain have been overdriven.

Let’s talk about death rates, while this is no apples-to-apples comparison. How we react to death is primal and when we hear about Coronavirus-induced deaths, we get on red alert. But allow me to contextualize the numbers for you about the other lethal diseases which undoubtedly aren’t much in our news feeds these days but have devastated and disrupted the mankind inhumanly as well. 

As the COVID-19 started spreading on one of the worst days for Coronavirus in China (February 10, 2020), 108 people died but on the same day as posted by Dr. Ramesh Byrapaneni on LinkedIn - there was more horrific news globally about the human loss due to many diseases like 26283 people died of cancer, 49041 people died of cardiovascular, 4383 people died of diabetes.

Meanwhile, suicide takes on average 2191 lives. Mosquitoes take the lives of over 2,740 people. And humans kill an average of 1,287 people every single day. Hence, this mammoth number is telling us how humans are getting perished due to many lethal diseases besides the new pandemic that brought the world to a standstill. A much needed standtill, I guess. 

We face a critical juncture from an emotional and behavioural perspective. We can pretend that things were once certain and controllable and try to cope with the immediate threat of COVID-19, or we can step back and recognize that certainty was nothing but an illusion all along. The reality is that we have been vulnerable to a viral outbreak for decades. In truth, it’s miraculous that such events don’t occur more frequently.

Ironically, once we accept the reality that our sense of certainty and control is an illusion — once we understand and appreciate our inherent sense of vulnerability — we emerge with the inner strength to face the crises with greater equanimity. Conversely, behaviours that give us a false sense of security not only exacerbate our anxiety but actually make the situation worse since they have negative consequences for our society as a whole.

For example, U.S. Surgeon General Jerome Adams warned that widespread use of face masks could actually increase the spread of the virus. More significantly, if market fears and downward trends continue, they could ultimately lead to national if not global recession, creating greater vulnerability to many of the catastrophic scenarios mentioned above. Along these lines, we must also consider that psychological concerns are the leading cause of disability overall, and the second leading cause of death for individuals aged 10–34.

There is no question in my mind that our emotional and behavioural responses presently are creating more damage than COVID-19 pandemic.

History is witness that during the 2017-2018 flu season the CDC figures put the U.S. influenza deaths stood at roughly 80,000. Meanwhile, global estimates indicated anywhere between 290,000-650,000 influenza-associated deaths from respiratory causes alone and in terms of deaths from influenza-induced lower respiratory tract infections, a 2019 study estimated 99,000-200,000 deaths for the 2017-2018 flu season. The following year, CDC figures estimated 35.5 million Americans fell ill with influenza, resulting in 490,600 hospitalizations and 34,200 deaths. Since, this past October, regular influenza has infected as many as 49 million and killed between 20,000 - 52,000 in the U.S. alone. While the fatality rate of Coronavirus now appears to be slightly higher than that of typical influenza (estimates range from 1.4% to the WHO’s 3.4%), the toll of the common flu is staggeringly higher than that of COVID-19.

According to the National Institute of Mental Health, nearly 20 per cent of adults have an anxiety disorder each year. But it is novel to realize how vulnerable we are to outright madness. Psychological science has identified a clear root to such extreme responses. We cannot tolerate situations that are uncontrollable and uncertain. Indeed, we cannot control nor predict what will happen next with COVID-19 pandemic.

In reality, self-quarantine and social distancing can play a significant role in its spreading but can not stop viral contagion. The only truly effective solution is that which Bill Gates outlined in late February in the New England Journal of Medicine: International system-wide changes to facilitate government and industry–partnered anti-pandemic efforts to efficiently develop and deliver billions of vaccine and antiviral doses within months of pathogen discovery. Let’s be realistic that COVID-19 and perhaps even the next pandemic will come and go long before such recommendations are likely to go into effect.

In our part of the world, the health care system does not have “surge” capacity rather is not capable to function in an emergency like situation. This is especially true during the flu season, when most hospitals run at nearly full capacity. Adding a high volume of patients with respiratory infections — all of whom would require private rooms — will severely strain most institutions. It will further block other important hospital activities, it already has, such as elective surgeries and transfers from other hospitals. This is already happening in most parts of the world and Italy tops the list.

Here in Jammu and Kashmir, testing for the new coronavirus is very limited due to a variety of reasons — not having the required equipments –PPE, Masks and other protective gear.

Less Manpower in top hospitals from GMC Jammu to GMC Srinagar, from SKIMS to other government hospitals, misguided policy, regulatory limitations and faulty tests — we only recently started broad testing for coronavirus among people with compatible symptoms or having any travel history outside the state or India. Even as the numbers are rising and doctors predict that by the end of April we may have thousands of positive cases, still only those who had travelled to regions with coronavirus outbreaks are eligible for testing. However, as per the government spokesman Mr. Rohit Kansal, “J&K was one of the first places in India to start testing locally.”

As of now, we have 4 testing labs in J&K. While the logjam on testing should end soon, it's probably too late to prevent extensive community transmission. As per a reliable source in the health department, “In case of any positive case in district Bandipora, we have to shift the patient to Srinagar as we don’t have any such facility in the Distt.” When asked about the total number of tests done for the population of 3 lakh 80 thousand people, the total number of tests done till 10th of April was less than 400, i.e equivalent to 1% of the total population of the said district. However, in District Shopian, such facilities are available in the district for positive cases as well, speaking to this reporter, Mr. Shahnawaz Shah – Nodule officer for COVID-19 had stated. 

The people at greatest risk for severe or fatal coronavirus illness are already the most vulnerable patients.

Like other viral respiratory tract infections — flu, respiratory syncytial virus, even rhinovirus (cause of the common cold) — older age and concurrent medical problems make coronavirus infection much more serious. Estimates from China suggest the mortality rate among those older than 80 is 15%. That's why the reported identification of cases in a Washington nursing home is particularly worrisome.

Hoarding of masks and other protective equipment could stress the supply chain, putting health care workers at risk. “All of us in health care accept that exposure to infection as part of our job.” Dr Rashid dealing with Covid-19 patients stated. “But to do so without the appropriate protective supplies cannot be permitted. It is critical that we have access to the specialized N95 masks and other gear, especially during procedures that increase the risk of exposure.” 

For other people apart from those working in the health sector “A: Only if you’re sick yourself, because the mask will protect others. Otherwise masks probably don’t do anything to protect you. Here is what you should do: Wash your hands!” Dr. Paul Sax, from Harvard Medical School, was quoted by a news agency who also is a specialist in infectious diseases like COVID-19.

But in times like these, here's why I'm turning towards optimism. 

We know the disease is mild in most people who get it. At least 80%, most likely more, won’t have an illness bad enough to warrant hospitalization. We’ll have a better idea once testing is more broadly applied, but it would not surprise me if the widely cited case fatality rate of 1-2% is eventually less than half that.

Children seem particularly protected from severe coronavirus disease. Many of the sniffles and colds kids experience are due to existing milder coronavirus strains, possibly giving them partial immunity to this more serious new threat.

There have been extraordinary global cooperation from doctors, scientists and public health officials. In most cases, this has included a remarkable sharing of clinical data and research. It is wonderful to see the medical community responding in such a unified voice, all of us trying to solve this new problem. Sadly, we're demotivating them to do their jobs with an open heart.

The COVID-19 Pandemic crisis is not a war but it is a ‘war-like’ situation in the sense that it requires the mobilisation and direction of resources at unprecedented levels.

Solidarity between countries and a readiness to make sacrifices for the common good are decisive. Without a grain of doubt, pulling together and cooperating across borders can be the best way to beat the virus and contain its consequences before they create more havoc and human fatalities. 

It is sometimes said that wars are won not by tactics or even strategy, but by logistics and communications. This seems true for COVID-19 as well, whoever is best at organising the response, quickly drawing on lessons learnt from around the world and communicating successfully towards citizens and the world at large, will come out strongest.

There is a global battle of narratives going on in which timing is a crucial factor. In January, the dominant framing was of this being a local crisis in Hubei province, aggravated by the cover-up of crucial information by the Chinese party officials. All countries of Asia were sending a lot of medical equipment to help the Chinese authorities that were overwhelmed at the time. Since then, China has brought down local new infections to single figures – and it is now sending equipment and doctors to other countries, as others do as well. China is aggressively pushing the message that, unlike the US to its neighbours, it is a responsible and reliable partner. 

The point for people of J&K is this that we can be sure that perceptions will change again as the outbreak and our response to it evolves. But we must be aware that there is a geopolitical component including a struggle for influence through spinning and the ‘politics of generosity' there is no way to defend them.

Let all view it as “Global Health Emergency” and not a platform to influence or to gain anything out of it. 

May Almighty Bless Us all. 

Stay safe, stay home. 

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