Despite our daily briefing from mayor, governor, and president and the focus of our major media outlets notwithstanding, the most important questions in the world are not about the United States and SARS-CoV-2 but about India and the virus.
India has not tested very many people at this point—about 1% as many relative to its population as the United States which many people contend is too few. It has been claimed with some reason that were India to test 10 times as many people it would identify 10 times as many cases of COVID-19.
Neither South Korea nor Japan nor Germany nor the United States is the model for the many poor, populous countries in the world. India is. If India cannot control COVID-19, it will be a global disaster however the U. S. fares.
India has some handicaps. Not only is it poor, populous, and its cities densely populated it has terrible air quality and diabetes is believed to be quite common among its population. It has a fraction of the physicians, hospital beds, and ventilators relative to its population as the U. S. and the countries of Europe do. But it has advantages, too. Its health care system can be of higher quality than in many other poor, populous countries. It is the world’s largest producer of hydroxychloroquine. The entire country has been on lockdown for weeks. And it is hoped, at least, that India’s climate will stymie the virus, especially during the summer.
The history of SARS-CoV-2 will be written in India. If the worst case scenario is realized, millions will die there. And in Nigeria, Indonesia, Bangladesh, Malaysia, and other poor, populous countries.
The result will be driven by 2 forces pulling in opposite directions; a younger demographic vs far fewer resources for health care.
Let us hope younger demographic overwhelms fewer resources for health care. That would give hope to countries even poorer than India.
I think you are correct about the age thing, but in the really poor areas I would think of those young as being prematurely old due to malnutrition and frequent infections due to poor water quality. I wouldn’t make any predictions. What is social cohesion like there? Will they pay attention to social distancing and self quarantine rules?
” It is the world’s largest producer of hydroxychloroquine.”
I had my catch up meeting with some of my critical care people today. They are convinced enough about our success in keeping people off of ventilators and identifying the good interventions that they are changing our protocol. Everyone was receiving HCQ, AZ, Zinc, Steroids and sometimes Vit C. IL 6 inhibitor when appropriate (sicker pts) and lots of proning. Our new regimen eliminate AZ, HCQ will be optional, zinc optional. We will keep steroids and Fit C doesnt change. We pretty much cant find remdesivir now. We now do self proning up to 12 hours a day.
Steve
With this virus; it is more likely then not frequent infections is a good thing; as long as it is not due to immunosuppression like HIV.
There are papers showing recent exposure to other coronaviruses like the common cold conferred 30% immunity to SARS, so some cross-immunity is likely with SARS-NCOV2. The other part is the hygiene hypothesis and possible effects on the cytokine storm that seems to do a lot of damage in severe cases.
Steve: I’m glad you’re doing everything you can to keep people off ventilators. And from your description you’re being very nimble changing medications and procedures as needed/when proven effective. From what sounds like the size of your organization (multiple facilities) you seem incredibly on top of things and seem to have a staff who really gives a s**t which means so much in rough times.
India: I’m hopeful but not necessarily optimistic. The health care system for the rural populace varies from pathetic to non-existent, depending on the state and how bad local corruption is. There ain’t gonna be no social distancing. Self-quarantining? Not happening except maybe in the biggest cities among the wealthier people. Masks? Ditto. The relatively young demographic, the prevalence of HCQ and other anti-malarial drugs in common use, and and the hot climate may be the difference between total catastrophe and a relatively normal Indian medical crisis season.