Waiting for vaccinations in Kodai, this May (Photo credit - Azad Reese)
Waiting for vaccinations in Kodai, this May (Photo: Azad Reese)

Overview: Kodai in the Time of Covid

Most of us are sick of (even if we haven’t been sick with) the SARS CoV2 virus and the illness it causes, Covid-19. News of personal adversity and loss, national catastrophe, and personal or group heroism fill our ears, minds, and hearts, but what do we really know about this illness that has brought the world to its knees?

Let me start with the basics: SARS CoV2 is a respiratory virus which is a new human infection crossed over from infected bats in Wuhan, China, although there is a school of thought propounding a theory of a lab engineered bat virus which may have infected lab workers first. Once infected, there is a potential (in a small percentage of those infected) for lung damage and possible damage to multiple organs, causing death.

On to some simple math. India is currently in the grip of the single most overwhelming Covid outbreak in the world, in terms of human cost. The economic cost will be counted later. Where does the math come in? The news is filled with chilling statistics, but interpreting these correctly helps to keep things in perspective.

Firstly, 80-85 percent of people who contract Covid have few or mild symptoms. These include fever, headache, body pain, sore throat, fatigue, runny nose, cough, mild shortness of breath, diarrhoea, maybe loss of smell and taste. This percentage of mild (rather than severe) cases could be slightly higher, since testing has not been done for hundred percent of the population; this further underscores that, by and large, the vast majority of people that contract the virus have recovered from the experience.

Those with mild symptoms, particularly if their oxygen saturation is 92 percent or above on the plains, or 90 percent or above at an elevation like Kodai, needn’t be hospitalized. Breathing exercises, steam inhalations (keep a two-foot distance from the steam pot and use a steam tent), vitamins with zinc, and plenty of rest should suffice. A pulse oximeter is an excellent tool to have at home.

About 13-15 percent may be more affected (O2 saturation of less than 90 percent in Kodai) and will need closer monitoring, such as a CT scan of the lungs and regular check in with a healthcare professional. A subset of these―maybe six to eight percent of those with Covid―could require admission to a hospital and nasal O2 if the saturation shows a downward trend, based on their healthcare provider’s judgement. (*Note: it is possible that calculations in hindsight may show a higher percentage in this subset with the second wave from the Delta variant which was first observed in India, given the intensity of its impact as of now.)

Only two to three percent of people who contract Covid will fall very ill, requiring ICU or high dependency care. But in a country of 1.395 billion, two to three percent represents between 28 million to nearly 42 million people (in the eventuality that we all get Covid)―a veritable crisis. Let this sink in.

Why am I bringing up math here? Because when we hear extreme stories related to the illness or vaccine, or when we are personally affected by loss, we tend to forget the math and focus on the events. There is no doubt that we have a humanitarian crisis on our hands, but it is also useful to remember that over 80 percent of us (that’s millions and millions of people) have survived Covid with mild symptoms, and many haven’t contracted the virus at all.

At this point it may be worth comparing Covid deaths with those of other common causes of death in India:

Waiting it out: Covid-19 in India (Photo courtesy Pixabay)
Waiting it out: Covid-19 in India

How Are We Affected in Kodaikanal?

Now let’s zero in on Kodai. The following information is based on conversations with the Block Medical Officer, Dr M Aravindh Krishnan, and others from the capable government medical response team and other front-line workers.

As of 5th June, Kodaikanal has had a total of 916 cases of Covid since the beginning of the pandemic last March and 414 since March this year (official figures as of 5th June). There have been 22 deaths in total, seven of them counted since this March. Currently, there are 53 active cases. This May has witnessed the highest caseload since the start of the pandemic. The government medical machinery has been carrying out random testing in various rural and urban pockets across the country as well; the asymptomatic positives from this random testing may not be included in this count of active cases. Around 41,050 swabs have been taken since last March; 12,411 of them since this March.

One of the reasons for relatively low numbers is the system of contact tracing, quarantining, and random-testing. Unfortunately, in the case of these spot tests, a Covid-positive group might wander around Kodai for a while before they are rounded up by beleaguered officials once their results are known. The lockdown has been instrumental in curtailing this.

Medical Facilities and Preparedness in Kodaikanal

There are two places in Kodaikanal to get RT-PCR swab tests, which must be done before 1 pm because the samples need to be sent to laboratories on the plains. At the Government Urban Primary Health Centre (Ph: 04542 243253), Anandagiri 4th Street, swab tests are free of cost and usually take between 24 and 48 hours to be reported, occasionally longer based on the number of tests being processed at the government laboratory in Dindigul. Van Allen Hospital (Ph: 04542 241273/ 241254), located near the entrance to and overlooking Coaker’s Walk, on St Mary’s Road, charges Rs 2,500 for each test, which is sent to a private lab in Coimbatore and reported in 24 hours.

Kodaikanal has had two dedicated Covid wards since the start of the pandemic. Additionally, the TN Government Order of May 13th has designated all hospitals as potential Covid primary care centres. The Covid ward at the Government Hospital on PT Road (Ph: 04542 241292) has 34 beds with oxygen and four with ventilators. Van Allen Hospital has two Covid wards (eight general beds and seven private beds) with piped oxygen, a high flow nasal oxygen device, and an oxygen generator. Out of the 48 sanctioned beds, 36 are available as of 5th June.

The town has two quarantine centres. The government Covid care quarantine centre, with 60 beds, is located at the Mother Teresa Women’s University hostels in Attuvampati, Kodaikanal. Closer to the GH, the Municipality Guesthouse on PT Road, with 17 rooms, has been converted into a centre for level 2 patients who will need monitoring by healthcare personnel but do not require oxygen. Mild and asymptomatic Covid patients can also go to BC Hostel in Attuvampatti (25 beds) and CS International Hotel in Naidupuram. This makes for a total of more than 100 beds, of which 91 were available as of 5th June.

There is also a private quarantine centre at the Swedish House, Swedish Compound, Upper Lake Road, on account of a partnership between Van Allen Hospital and Kodaikanal International School. Van Allen is the admitting authority.

The Kodaikanal Health and Medical Services (KHMS) Hospital (Ph: 04542 241379), located on Sivanadi Road and run by the Devadoss Hospital in Madurai, is in the process of opening a Covid facility.

Why Do We Have a Second Wave?

A major contributing factor to a second or third wave, world wide, is the spontaneous mutations that SARS CoV2 (and many respiratory viruses) undergo to increase human infectivity and efficiency of propagation.
The current wave of infection is the result of events from six to eight weeks ago. To understand this, it is important to understand the concept of ‘doubling rate’, which refers to the time taken to double the current numbers affected by Covid, or the number of days since the total cases load was half the current total number. Each place will have a particular doubling rate, unique to their situation.

Kodai’s doubling rate will be longer than that of Delhi or Chennai, indicating a slower spread, but will vary according to external factors. With measures such as distancing, containment of hotspots, and lockdowns in effect, the doubling time increases, but in the absence of these measures, the infection grows exponentially.

Exponential growth means that numbers will jump by a particular factor; for example, if the factor is two, the increase will be from one to two to four to 16 to 256 to 65,526 to 4,294,967,296 and so on. Notice how exponential growth initially seems very slow and under control for the first five to six degrees of growth or spread. After that it suddenly spirals out of control and everyone is left gasping.

Cases have mushroomed through May. Mitigating measures, such as lockdowns, will help to plateau this sooner.

Kodai residents were given access to vaccinations via multiple camps and sources through April and May (Photo credit - Azad Reese)
Kodai residents were given access to vaccinations via multiple camps and sources through April and May (Photo: Azad Reese)

Why We Need to Vaccinate

The novel coronavirus (SARS CoV2), being previously unknown in humans, has not made any immunological imprint on our immune system. This is the reason for the severity of illness and the speed of spread―the fact that we have no specific immunity. The SARS CoV2 vaccine provides the body’s immune system with the raw material (viral particle) to stimulate the immune system to recognise this new virus and develop specific immune cells against it. The only other way to develop immunity specific to SARS CoV2 is to take your chances with the illness.

Diseases like tetanus, polio, diphtheria, and rabies are killer diseases, but have become quite rare thanks to vaccines. Smallpox was completely eradicated, again because of vaccines, and polio is on the brink of eradication.

The SARS CoV2 vaccine uses techniques and ingredients similar to more established vaccines. Thanks to this existing research and knowledge base, coupled with modern technology and manufacturing capabilities, the virus has been isolated and vaccines produced at unprecedented speed and with unparalleled efficiency.

What is missing is the study of long-term effects, which takes years. The WHO and other regulatory bodies, such as the Indian Council for Medical Research (ICMR) and Center for Disease Control (CDC) of the USA, nevertheless allowed emergency approval of several SARS CoV2 vaccines, as they considered the (potential) adverse effects of the vaccine to be lower than adverse effects of Covid.

For example, the risk of blood clots with the AstraZeneca vaccine is 4 in 1,000,000 (0.0004 percent), whereas the risk of blood clots with Covid is 110,000 in 1,000,000 (11 percent), based on studies from Europe. More on this here.

Now you may ask: “But how does this compare with the total population of India? When only 2 percent of the population are falling seriously ill, am I better off risking serious illness, or should I risk adverse vaccine events?”

To answer this we turn to math again, because it helps to bring figures into perspective.

So: 11 percent of two percent of the total population. Consider that two percent of 1.395 billion is 27.9 million who have a chance of Covid-related serious illness; 11 percent of this two percent is a total number of 3.069 million who may get blood clots from Covid.

Compare 3.069 million who may get blood clots from Covid with 0.0004 percent of 3.95 billion (population of India) who may potentially get vaccinated, which is 15,800 who may get clots from the vaccine. In other words, adverse events from the vaccine are negligible compared to those from the illness.

As yet unknown are the long-term effects of the vaccines; but then, neither are all the long-term effects of serious Covid-19 known. There are other illnesses that cause the kind of organ and structural damage that serious Covid has exhibited, which does give the medical fraternity and sorority some inkling of what long-term damage would look like; but not all after-effects are evident as yet. This is a continually evolving illness, both in terms of fresh mutations, as well as newly recognized effects.

For more information on vaccines read these (and other) links, chosen for their clarity of explanation:

India currently has Covishield (AstraZeneca) and Covaxin (Bharat Biotech). The Russian Sputnik V, produced in India by Dr Reddy’s Laboratories, was launched for the Indian consumer through Apollo Hospitals from 18th May, 2021, at a cost of Rs 1,250 (currently only available in Hyderabad and Visakhapatnam, but soon to be extended to all metro cities).

Covishield and Covaxin vaccines have been available (except during times of shortage) at the Kodaikanal GH, the Urban PHC, Van Allen and KHMS. The Rotary Club of Kodaikanal has also been conducting weekly vaccination camps at the Rotary Office, near the GH on PT Road.

In Kodai, alone together (Photo credit: Azad Reese)
In Kodai, alone together (Photo: Azad Reese)

Perspective: How Do We Carry On?

The hidden impact of Covid-19 is the emotional cost―across all age groups, economic groups, and professional groups. Everyone has their unique experience of adversity, whether loss of education, livelihood, future, or life. Let’s be kind and gentle with one another, including with those who have different understandings, attitudes, and approaches.

So what can I leave you with? Mask up (however uncomfortable or frustrating it feels). Do not touch your face and mask with unsanitized hands. Wash your hands frequently (always a good idea anyway). Keep meetings to outdoor locations. Stop smoking. Get vaccinated. Avoid panicking for yourself and others. Trust the scientists ahead of the mythologists. And, most of all, keep your humanity intact―your compassion for those who have suffered through the loss of a loved one, through being isolated because of the illness, through economic loss and hardship, loss of home and livelihood. Above all, remember that in Kodai we have the miracle of space, to live as normal a life as is possible, in these strange times. Stay safe, stay strong, stay loving.

Note: ‘COVID-19’ is standard usage as per the World Health Organization, but we are adhering to our in-house style guide by using ‘Covid-19’.

Dr. Malini Devanandan

Dr Malini Devanandan completed her undergraduate training at CMC, Vellore, and her post-graduate training in family medicine at the Christian Fellowship Hospital, Oddanchatram. She currently works at Kodaikanal International School.

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