Coronavirus: Learn from Italy, save suburbs from commercial centres, elders from young ones

The origin, transmission and global outbreak of coronavirus has economic, ecologic and social roots. It has already shown its presence in more than 182 countries. Few countries have seen the worse form of the disease in the form of causalities whereas a few have accepted that the disease would affect 70 % of their population. The analysis of the origin, transmission and outbreak in China and Italy can provide a guiding light for the policymakers to make required interventions.

Ecological barriers demand respect

Every parasite needs a host. A virus is a parasite that revolves between the living and the non-living world. Every virus has a reservoir host species on which it is dependent for its survival. Till the numerical strength of its host remain stable the virus keeps feeding and multiplying inside that host. A barrier has to be maintained between two species to protect each other from their parasitic virus. 

When one species break the natural barrier and get too close to another species, the transmission of the virus happens. When human beings break such barriers as they did in the case of coronavirus, such transmission is termed as zoonotic. The mode of transmission of Zika, Nipah and Ebola virus was also zoonotic.

Initially, such transmission is not capable of sustained human-to-human transmission but upon repeated exposure to the animal reservoir, an outbreak of such infections may happen. The capability to sustain human to human transmission is acquired in 5 stages.

The five stages are as follows:-

The coronavirus is moving from stage III to stage IV. The original transmission from an animal reservoir to human beings is said to have taken place in Wuhan of China. The history and mode of such transmissions are depicted in the figure below.

The increased proximity to animals and changes in food habits have a direct contribution to the emergence of coronavirus-like disease. More such transmission can be expected in the days to come. Once the transmission begins, modern commerce is capable of spreading the disease independently to far-flung areas. (Source-Chapter 15 of Fenner and White’s Medical Virology)

Modern Economy, the new carrier

The modern economic theory is based upon the principle of generating a profit by producing cheap and selling dear. Colonialism forcefully opened the borders of nations and the ideology of globalization added value to open borders. Now the services, raw materials, parts and intermediate products transit through multiple borders before being incorporated into a final product of consumption. This translates into a supply chain. According to WTO products are no longer made in a country – they are now “Made in the World”. 

The international supply chain has the potential to transmit prosperity as well as misery through the transiting borders. This time it transmitted a virus. The COVID 19 infection went wherever the supply chain took it. 

Milan is the fashion capital of the world. It is located in the northern province of Lombardy in Italy. The fashion industry in Milan is dependent on cheap labour and material sourced from the city of Wuhan in the Hubei province of China.  3 million Chinese citizens are living in Milan. Most are employed as workers but many have also opened shops. Wuhan is connected to Milan through a directly connected flight. The virus transmitted to human beings in Wuhan after the natural barrier was violated by Homosapiens there.

It travelled from the urban commerce centre of Wuhan to the urban commerce centre of Milan. After settling down in Milan, the virus spread to other commercial centres in the adjoining provinces in Veneto and Emilia-Romagna begun. 

The young people working in the urban centres took the virus with them to suburbs where they live. The mode of travel of the virus was public transport. Finally, via suburbs the rural areas were engulfed. It is in rural areas that people started to die.

The above figure depicts the spread of Corona Virus in Italy (source- Italian Ministry of Health). The northern regions of the three provinces, Lombardy, Veneto and Emilia-Romagna, have been most affected by the outbreak. 85% of infected patients are in the region which is home to 92% of deaths so far.

Lombardy, the region most affected by the outbreak, accounts for one-fifth of Italy’s GDP. Had there been no supply chain connecting Milan with Wuhan, such carnage wouldn’t have taken place.

Deaths, Social cause

As I am writing this, the deaths in Italy have crossed the 4000 mark. 18 priests have also died. The average age of the people who have died is 81 years. The mean age of Italy is 47.3 years and it is expected to become 51 years by 2030. The life expectancy is 84 years. 35 % of the population is above 55 years and 23 % is above 65. The age pyramid of Italy is an inverted one. It is experiencing annual negative population growth. There is a high percentage of elders in the population of Italy.

The deaths underwent a jump in Italy when the virus spread to rural areas via the suburbs. The disease reached the grandparents through the young working in urban centres. In Italy, the institution of the joint family still survives. The young stay with their parents and grandparents and maintain a good bond. The young asymptomatic and those with mild symptoms brought the infection to their grandparents living in rural areas. 

The above age bracket/ Mortality rate graphs show high mortality in aged population inflicted with Covid 19 in Italy. (Source- Chinese Centre of Disease Control and Prevention)

The virus becomes highly deadly once it inflicts the age group above 60 years. The elders are at highest risk from the virus.

Lessons learnt and solutions

The similar system of the young workforce working in urban centres and living in suburbs exist in India. The young maintain close bonds with their grandparents. They either live with them or visit them frequently. 60% of the Indian population lives in rural areas. 11% of Indian are above 55 years and 5 % are above 65 years. The average age of Indians is 28 years. In absolute terms, India has around 151 million people living above 55 years. This is more than double of the total population of Italy. India also has the highest population of people living with cardiovascular disease and diabetes. Hence, the threat looms large on India.

The transmission has started in India but deaths are still less. The number of positive cases have crossed the 300 mark and 5 deaths have taken place.

According to the ICMR, the country’s top body for biomedical research, currently, the outbreak in India is in stage two, i e. local transmissions. There are yet no signs of community transmission, which is in stage three.

In Italy, more than 90% of the dead either had multiple underlying diseases or were above 60 years in age. Before the first case was reported on 20th Feb 2020 in Codogno, Lombardy, there was already an unusually high number of pneumonia cases recorded at a hospital in Codogno in this northern Italy city. This suggests that patients with Coronavirus were treated as if they had seasonal flu and health facilities hosting these patients could have become sites for infection, helping proliferate the spread of the virus. 

In India, all people landing from abroad are being screened and those who have a history of travel from outbreak centres are tested. People coming in contact with confirmed and suspected cases are also being tested. In total 14514 individuals have been tested which means one in 95000 people. Tests are being conducted by government laboratories. The private sector has been involved.

Every case of Pneumonia is still not tested. Public transport barring few restrictions is still running in business as usual mode. My good friend, an SDM in Delhi informed me of the patients who left the quarantine facility and were later diagnosed as positive. No economic relief has been proposed or announced. 

The key to controlling the outbreak can come from the experience of Italy. 

We have to protect our suburban areas from the commerce centres like Mumbai, Delhi, Chennai, Bengaluru etc.

Simultaneously the rural areas have to be protected from suburbs.

The elders have to be protected from young. 

Public transport should be grounded for 2 weeks. 

Till Gas station are open, people will move. If the movement of people has to be stopped the gas stations have to remain closed. This only can check the spread from suburbs to rural areas.

Every respiratory tract Infection case should be treated as a suspected coronavirus case.

Database should be maintained for Pneumonia patients after testing them for Corona Virus. They should be tracked and followed.

The testing should be made free. This will encourage people, especially the asymptomatic to go for testing.

Those in quarantine facilities may be allowed to leave only when the negative report comes.

The health facilities in rural areas to remain on alert. They are the weakest link in the fight with the virus and the virus will ultimately come for them.

The normal people learn from their mistakes but the wise learn from other’s mistakes.