Guest post by MAYA JOHN
[This is the first part of a two-part series on ‘society at the time of Covid-19’]
‘An elephant was attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff in panic and dies.’ – Anonymous
‘The idea of the self-sufficient character of science (“science for science’s sake”) is naive: it confuses the subjective passions of the professional scientist, working in a system of profound division of labour, in conditions of a disjointed society, in which individual social functions are crystallised in a diversity of types, psychologies, passions …. The fetishising of science, as of other phenomena of social life, and the deification of the corresponding categories is a perverted ideological reflex of a society in which the division of labour has destroyed the visible connection between social function, separating them out in the consciousness of their agents as absolute and sovereign values.’ – Nikolai Bukharin, 1931
The specter of Covid-19 is haunting India and many other countries in the world. As the fear of the novel Coronavirus (SARS-CoV-2) grips India, and draconian state measures unleash havoc on the poor, it is imperative to trace back the clock so as to fully comprehend the underlying thrust of the current paranoia. Who have been carriers of the disease into India and what was done to identify and contain them? Whose paranoia is determining state policy? And are we possibly witnessing an ‘over-reaction’ shaped by the anxiety of upper classes? These questions imply the need, in class terms, for a closer scrutiny of the reasons behind the declaration of the pandemic.
The trajectory of recent events in India does hint at the possibility that the paranoia gripping the country is far from devoid of a class bias. For a country like India with entrenched inequalities and rampant poverty, is Covid-19 the enemy? Aren’t the poor succumbing more rapidly to many other unidentified and undifferentiated communicable diseases? When and why do alarm bells ring for a country? At what conjuncture are medical emergencies recognized and used to propel a complete lock-down of an economy already in shambles?
From a lax, negligent response to pressing the panic button
Tracing back the actions of the Indian government, it is clear that the initial response was an under-reaction. By end January 2020 the World Health Organization (WHO) had declared the outbreak of Covid-19 as a Public Health Emergency of International Concern as cases began to be reported outside China, i.e. in neighbouring countries like the Republic of Korea, Japan, Thailand and Singapore. A Covid-19 pandemic was announced on March 11, 2020 after the number of reported cases surged in the US and Europe. In its spread westwards (into Europe and the US), and into India, it was evident from the start that globe-trotting elites have been the carriers of the disease. Thus, the virus’ entry was not unforeseeable. Indian authorities knew exactly where to start and enforce precautions.
However, overlooking the need for stringent targeted testing at airports and strict quarantining/isolation of foreign-returned travellers, the lax approach of Indian authorities facilitated the slipping through of many such persons at mismanaged screening check points before the final closure of all airports. We’ve seen London-returned, party-hopping singer, Kanika Kapoor overriding the recommendation for quarantine; top level bureaucrats who’ve ensured their children bypass screening protocols at Indian airports and then subsequently failed to quarantine their spoilt brats; as well as worried foreign-returned Indian students entering India’s airports after popping Paracetamol pills to clear thermal testing.
The fact of the matter is that the government’s policy has been driven by a sharp class bias. On the one hand, we have seen the criminal negligence with which many individual travellers were allowed to pass through lax screening processes at airports, and on the other hand, a lock-down has been imposed with no concrete plans for sustaining the basic needs of millions of labouring poor. There were planes to bring back well-to-do Indians from the hotbeds of the pandemic but no concrete plans for the poor. I shall save the discussion on the inadequacies of the 1.7 lakh crore relief package of the Central government for a subsequent piece.
The Indian government’s evacuation plans for well-to-do Indians show that the ruling elite were far from oblivious of the growing paranoia building up worldwide. Daily reports of many public figures coming down with the infection or having a close shave were continuously creating ripples amongst global elites. Noted celebrities like actor Tom Hanks and singer CY Tucker of the Beatles fame, as well as other public figures like the princess of Spain, Maria Teresa; next-in-line for the British throne, Prince Charles; the Prime Minister of Britain, Boris Johnson; wife of the Canadian Prime Minister, Sophie Trudeau; personal doctor of German Chancellor Angela Merkel; Cristiano Ronaldo’s teammate, Daniele Rugani; and many more have either gone down with Covid-19 or succumbed to it. Needless to say, India’s alarmed corporate elite began booking private chartered planes to bring back their kith and kin from abroad. It is being said that probably these private jets also carried close relatives of top politicians.
However, aware of the unfolding frenzy worldwide and informed of the WHO’s official declaration of a pandemic, India’s ruling elite were not inclined to press the panic button. This was evident from the 13 March press conference of the Health and Family Welfare Ministry, Government of India. Here it was stated clearly that the country was not in the midst of a national health emergency due to Covid-19. The press briefing in fact mocked Opposition party leader, Rahul Gandhi, for his claims of an unfolding crisis and need for enhanced precaution.
Although the ruling elite began introducing measures of social distancing, work-from-home orders for employees of non-essential sectors, and began discussing plans of quarantining of key cities, the corridors of power were relatively unshaken by the impending threat of the disease’s possible transmission to the community. It was business as usual with BharatiyaJanta Party (BJP) functionaries participating in the toppling of the State government in Madhya Pradesh (MP). Nevertheless, amidst the unfolding drama of the MP government’s collapse and unfolding experiments of short-duration curfews (like the Janta Curfew on 22March), the Kanika Kapoor episode began making headlines.
London-returned pop star, Kanika Kapoor, breezed through the security check at the Mumbai airport on March 9, 2020, and landed in Lucknow a few days later. She was supposedly advised to self-quarantine herself given her travel history, which she of course ignored as she attended four different parties, checked into a five-star hotel in Lucknow and visited various establishments like salons before testing positive for Covid-19 on 20 March. According to numerous sources, Ms. Kapoorattended several parties, including a function on 15 March in Lucknow, which was attended by many of the ‘who’s who’ of Indian politics. The Uttar Pradesh Minister of Medical Health & Family Welfare, Jai PratapSingh; former Union minister, JitinPrasada; former chief minister of Rajasthan and senior legislator of the BharatiyaJanta Party (BJP), Vasundhara Raje; Raje’s son, Dushyant Singh, who is a Minister in the Government of India; and many other political bigwigs were in the said social gathering.
As the pop-star tested positive for Covid-19 shortly after the party, Vasundhara Raje, Dushyant Singh, and other ministers quarantined themselves as a precautionary measure. The news expectedly sent shockwaves across the political top brass and bureaucracy since Dushyant Singh had been in attendance in Parliament and had participated in at least two official meetings shortly after the Lucknow gathering. Given that Dushyant Singh had attended a breakfast meeting hosted by the President of India, Shri Ram Nath Kovind, on 18 March, the Rashtrapati Bhawan went into a tizzy, cancelling all engagements of the President as a precautionary measure. In a blink of an eye, Covid-19 seemed too close for comfort! High functionaries of various political parties, top-level bureaucrats, well-known socialites and the President of the country himself…no one seems to have been spared the threat of transmission of the contagious novel Coronavirus. Kanika Kapoor tested positive a second time on 23 March. On 24 March, in a televised address, the Prime Minister called for a lock-down of 21 days. Can this be a mere coincidence? Did intense precaution become the buzzword, and did it manifest itself in an ill-managed lock-down precisely when the ruling elite pressed the panic button?
A Covid-19 ‘overreaction’: ways of knowing and ordering diseases
In India even if we leave aside lethal non-communicable diseases and starvation/under-nutrition-related deaths, there are several communicable diseases like TB, diarrheal infections, etc., which have continued to wreak havoc across predominantly poorer sections of society. Let us not forget that what still appears to be a cluster level infection of the novel Coronavirus has fuelled extraordinary harsh state measures. All this, when the country’s ruling elite have remained unfazed by widespread transmission of TB and the growth of other diseases among scores of poorer citizens.
Class, region and other social dimensions are important to explain the prevalence of different diseases. These dimensions are also important in the identification of the disease itself, and the order of priority given to it. This brings us to the crucial point that many of the illnesses prevailing among poor people and backward regions have not been identified with a definitive aetiology, leading to non-identification of many diseases. For the detection of a new disease that has symptoms which are similar to other known diseases, but has different aetiology, it is a clinical case or series of clinical cases that trigger the process of its categorization. In other words, an accumulation of anomalies, i.e. in terms of contradictions between the medical evidence and the categories/classifications being utilized, can prompt some scientists to pick up on different aetiology of a disease which otherwise shows familiar symptoms.
This entire process of smooth and neutral discovery of a disease is not what unfolds in the real world. For one, a significant number of infected poor and marginalized people do not necessarily report their condition to certified doctors, and they instead fall prey to quacks to whom they often have easier access. Second, even when infected persons report to doctors/hospitals, their clinical case does not always culminate in required testing (blood/serum, throat swab, sputum, stool, urine, etc.). Third, even when clinical cases lead to microbiological or cytological investigations, the tendency for pathology laboratories to resort to categorization of diseases on the basis of pre-given classification/pre-existing knowledge/parameters is so predominant that differentiating and separating pathogens on the basis of variations in groups, subgroups, strains, etc. is minimal. This way many pathogens are wrongly categorized into existing classificatory schemes.
There is pervasive non-identification of definitive aetiology of many diseases. Not surprisingly, many ailments are consequently clubbed together and referred to by generic names like ‘Respiratory Tract Infection’ (RTI), ‘Urinary Tract Infection’, ‘Acute Undifferentiated Fever’ (AUF), ‘Acute Febrile Illness’ (AFI), ‘Fever of Unknown Origin’ (FUO), etc. Ironically, many of these undifferentiated fevers and respiratory infections are not mild diseases. They tend totake a huge toll on human life, and some like AFI are noticeably on the rise. Let us look at some figures. Acute Respiratory Disease and Severe Acute Respiratory Disease claim approximately 40 lakh lives and lead to lakhs of hospitalizations in developing countries per year. Acute Lower Respiratory Disease (ALRTI), affecting mostly children below the age of 5, infects approximately 3.40 crore every year worldwide, and results in roughly66000 to 199000 deaths. A whopping 99 percent of these deaths are reported from developing countries, and India has a larger share in it. Indeed, the persistent use of generic names actively conceals the need for discovery of the diseases in question. Perhaps next time if you hear a doctor in a crowded public hospital loosely refer to “age-related complications” or “infection” or “lung failure” as a cause of death then you will consider the politics that goes into such generic terminology.
Similarly, in general parlance, a number of medical conditions and deaths are associated with malnutrition and starvation. The connection that is made appears indirect and even casual than what actually exists on the ground. The problem of malnutrition triggers an immuno-compromised condition, which dangerously enhances the propensity for contracting infections. Expectedly, it is the labouring poor who are predominantly the victims of malnutrition and the resulting low immunity and contraction of disease. The numerous diseases they contract remain under-analyzed for most of the time despite high fatality. The prevailing political economy of virology and vector biology thus leads us to half-truths, dangerously leaving behind a trace of undifferentiated diseases. It does not matter if these undifferentiated diseases, or more importantly, undeclared silent epidemicsof these diseases cause enormous deaths and suffering every year.
Even once a disease is discovered with a definitive aetiology, for its serialized occurrence among people of a particular region to be ascertained, a robust disease surveillance system is crucial. In India, theMinistry of Health and Family Welfare is coordinating disease surveillance through its Integrated Disease Surveillance Program (IDSP), which focuses on tracking epidemic-prone diseases. The program works on the basis of coordination with research institutes and health departments of State governments, but surveillance remains very weak, to say the least. Nonetheless, if an active disease surveillance system discovers a disease – such as in the case of Covid-19 in China –there remain other concerns. If there is a locality-wide occurrence, does it always lead to declaration of an epidemic? Similarly, if the newly discovered disease is contagious with an R0 value higher than one and is in circulation over a very wide region like across continents, does it automatically culminate in the declaration of a pandemic?
Again, for the declaration of epidemics/pandemics, external impetus is hard to deny. Here again class, region and other dimensions play their definite role in shaping the level of priority that a discovered disease is given. Presuming that a disease with serialized occurrences is recognized, the next step of disease control is naturally one that demands a greater amount of research. For this, the disease in its serialized occurrences within a locality/region needs to have a certain signaling effect for the scientific community. In majority of instances, it is only when there is a threat of transmission to the well-to-do sections of society or wealthier regions that the disease actually has such a signaling effect.
In the real world, some regions are less important for the consistent focus of medical science. Similarly, some diseases which affect a certain class of people are less important and easily fall of the radar of existing surveillance systems. Skewed funding for scientific research is one such manifestation of this bias. Thus, to a large extent it is diseases that are of current priority for WHO which are well funded and consistently researched.Private pharmaceutical companies are quick to catch on such trends and perpetuate them in a manner that supports their own profit generation. Medical research in this way comes to be closely dictated by the funding priorities and profit calculation of the private pharmaceutical industry. As a result, even at some point if the definitive aetiology of a disease is separated out and differentiated from the category of undifferentiated diseases,it does not necessarily gain undivided attention of scientific research. As the disease evolves but ‘interest’ in it remains fleeting, the differences developing in the sub-groups, strains in genotype,etc. of the concerned pathogen fail to be consistently tracked. Knowledge of the pathogen, and consequently the required disease control soon lag behind.
Let us take the case of diseases whose definitive aetiology is being tracked and for which disease control measures are well-known. Here too the impact of prevailing inequalities is undeniable.Hence, for those who still believe that we cannot ‘possibly’ know all that’s out there, the current mismanagement of long-standing diseases like TB can further elucidate the biases of disease surveillance and disease control.
TB is a bacterial infection that usually affects the lungs, and is highly contagious in its active form. It typically spreads through aerosolized droplets emitted by an infected person and has been spreading at the rate of one person every ten seconds! According to the Ministry of Health & Family Welfare of India, the country had 21.5 lakh new tuberculosis patients in 2018. In this India TB report, the figure of 21.5 lakh new cases notified was out of an estimated 27 lakh cases; meaning that some five lakh infected people were left out of the ambit of registration and treatment under the Government DOTS Program. Of course, the figures from India can still be much higher than these. Inits Global Tuberculosis Report 2018 WHO has criticized the Indian government for under-reporting and under-diagnosis of TB cases.
For an individual country, India is throwing up disproportionately high figures every single year. The disease is clearly pervasive in India and is definitely a community level infection. In its 2019 Global Report on TB, WHO further corroborated this worrying reality by highlighting that eight countries accounted for two thirds of the global total of TB cases. India topped this list at 27%, followed by China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%) and South Africa (3%). According to public health experts, TB kills up to 1400 people in India every day and overall four to five lakh people in a year. There is no saying if we will ever win the battle against the infection, given the crumbling public health care system of the country and the dangerous inadequacy of research in the field.
If we look more closely at the issue of inadequate public health care services for TB, it is the tragic truth that due to the lack of TB wards and quarantine centers, many infected people die at home. And so, the figures of TB deaths per year are in all probability higher than reported. Furthermore, we should also factor in the questionable categorization of deaths that occur in TB and respiratory wards of large hospitals. Indeed, the stigma or pressure that accompanies high mortality of TB has meant that TB-related deaths are categorized as deaths caused by heart failure, lung collapse, pneumonia, etc. If this practice is avoided then we are sure to have a much higher figure for TB mortality.
TB is essentially a poor man’s disease. Although the bacterium Mycobacterium tuberculosis is said to have infected a quarter of the world’s population, it transitions from a latent to an active form – essentially becoming a disease – in conditions of compromised immunity, i.e. in people living with HIV, malnutrition or diabetes, or people who use tobacco. Expectedly then it is heavily concentrated within the labouring poor, who are victims of malnutrition, overwork, unhygienic and cramped living, as well as polluted workplaces.
Being a poor man’s disease, TB has elicited fleeting interest of private pharmaceutical companies, which control the bulk of production of necessary antibiotics. An acute shortage of crucial TB drugs is thus rampant in India. It is nothing short of a crisis, given that treatment of the disease requires the use of multiple antibiotics over a long period of time and is thus a costly affair. The most advanced and recently manufactured TB-drugs like Bedaquiline and Delamanid are limited in supply and thus not easily available outside designated public sector hospitals. Many are therefore denied requisite treatment, and some give up substitute medication due to overwhelming side effects.
Overall, the current scenario in India testifies to inadequate and overburdened testing facilities in public hospitals, overpriced testing in private hospitals, and numerous instances of ad-hoc treatment. The inaccessibility of treatment and half-baked experimentation/trials with more easily available TB-drugs are contributing to the worrying growth of drug resistance in many TB patients. Not surprisingly, India has topped the list of countries with the largest share of the global burden of multi drug resistant TB (MDR-TB). Importantly, the cure for even drug-resistant TB exists, but it simply remains out of reach for the majority. Untreated and rising figures of drug resistant TB are also a red flag, given that such persons remain contagious beyond the usual 2-week cycle of contagiousness attributed to a normal TB patient. Essentially then, a country with lakhs of people affected by TB should certainly have alarm bells ringing. This has, of course, not been the case. Prime Minister Modi addressed the country on 24 March, calling for a complete lock-down in the wake of the Covid-19 pandemic. Ironically, 24 March was also World TB Day.
Given the pervasiveness of TB and other debilitating diseases, can we blinker out the challenges brought on by Covid-19? Let us be clear on certain counts: we have reason to fear the novel Coronavirus – for which we have no established cure – but we have even more reason to fear a combination of Covid-19 with existing medical complications like TB.
Many studies have observed that in countries reporting a Covid-19 outbreak, the fatalities have been concentrated among those with preexisting medical conditions. Covid-19 has proved lethal for the elderly whose age-related medical complications and diseases have made it difficult for their bodies to combat the novel Coronavirus. Meanwhile, healthier persons to have contracted Covid-19 have recovered during their quarantine or isolation. Current reports therefore show that the deterioration of health and possible death cannot be attributed solely to Covid-19 but to host of factors. In technical medical terms, this is a situation of comorbidity; compelling us to ponder whether a line can be drawn between dying of Covid-19 and dying with Covid-19.
Clearly, the enemy is not just the novel Coronavirus but the numerous, downplayed communicable diseases and medical complications plaguing the average working-class (wo)man, which the novel Coronavirus shall join forces with to unleash unthinkable levels destruction.
Having said this, there remains the scope of actually questioning the danger and ‘high’ death toll attributed to the novel Coronavirus. For all the current panic surrounding Covid-19, the most reliable estimates place the transmission capacity or infectious nature of the disease to an R0 (basic reproduction number) in the range of 1.4 to 2.5. The R0 value indicates the expected number of cases directly generated by one case in a population where all are taken as susceptible to infection. The R0 values so far prescribed to Covid-19 mean that an individual with the disease can transmit it to approximately 1.4, or 2.0, or 2.2 or 2.5 more persons. In contrast to this, certain studies argue that we have the transmission capacity or R0 value of 10 for untreated TB!
Several reports, including the observations of WHO, have also pointed to the fact that testing for Covid-19 remains limited across most countries. Importantly, limited or selective testing in certain countries has meant that their recorded fatality rate is bound to be high. Since everyone with Covid-19 symptoms are not being tested, the denominator is limited to the number of people who are admitted to hospitals on the severe deterioration of their health or just happened to be tested before their self-isolation and recovery. Against a limited denominator, the number of infected succumbing to the disease shall appear much higher than it actually is. In reverse, countries with expansive testing have reported lower fatality rates for Covid-19 as their denominator has been larger.
This apart, in countries reportedly reeling under the Covid-19 pandemic due to its community transmission, many critical studies reveal that the deaths attributed to the disease are much lower than those caused by similar respiratory diseases prevalent in the general population.
We have case studies from Italy as well as the US which highlight that the Covid-19 deaths reported were predominantly confined to the same age group of (elderly) persons who usually succumb to influenza (flu), pneumonia and other similar diseases. In other words, victims of the Covid-19 are a category of persons who would have unfortunately died anyways of a respiratory complication related to age-defined lower immunity. The flu, an infectious disease caused by commonly known viruses of the Orthomyxoviridae family, has taken 68000 lives in Italy for example during epidemics recorded between 2013/14 and 2016/17. Per year, that would be more than 22000 deaths in Italy – a figure way higher than what has been attributed to the Covid-19 outbreak in the country.
US flu related deaths indicate the same high figures, with the Centre of Disease Control (CDC) reporting 12000 to sometimes even 80000 flu deaths in recent years. The disease is spread across a wide social/class profile but has obviously been life-threatening to those with fewer resources and access to health care. It appears that for a typical flu season, Covid-19 caught attention of governments in the West because the target population turned out to be well-to-do travellers. If this had not been the case then Covid-19 would have in all probability gone unnoticed as a spike in flu deaths and the reverse transcription polymerase chain reaction (rRT-PCR)test would never have been used to isolate the novel Coronavirus the way it has in countries outside China. Renowned Nobel laureate scientist, Michael Levitt, has opined that the novel Coronavirus, SARS-CoV-2, is best characterized as “flu with good public relations”. Having said this, he fails to identify that imperialism, euro-centrism, and class bias shape the ways of knowing and ordering diseases in our real world.
In lieu of a conclusion
As critics worldwide hint at a Covid-19 overreaction, we have much to introspect about in India. We know that the Covid-19 outbreak in the US and European countries has coincided with the usual flu season but also with the typical travel season of Europeans and Americans. For a vast population that throws up comparatively fewer international travellers than the West, it was highly unlikely for India to come in contact with the dreaded novel Coronavirus. The virus was, however, let into country by lax ruling elites, who have now utilized the world frenzy and their own close shave with the virus to resort to increasingly authoritarian rule. Indeed, the pandemic has created an uncanny opportunity for many authoritarian dispensations to try to grab more power and silence brewing discontent.
The ugliest face of this manufactured crisis is the current situation of distress that the working class has been thrown into. Scores of hapless workers and landless labourers are desperately trying to survive the ill-prepared lock-down. Many are running out of money, rations and essential commodities in the wake of unemployment and the soaring prices induced by the lock-down. Large numbers have been trying to flee the hostile metropolises so as to reach their villages. They are, in the process, exposing themselves to fatigue, weakness, hunger and various infections as they crowd into buses and temporary shelters. Many who are sick with various diseases have little access now to major public hospitals in the wake of the lock-down and corresponding reduction of OPD services. Huge public hospitals like All India Institute for Medical Sciences (AIIMS), Ram ManoharLohia (RML), Safdarjung, etc. have postponed surgeries. Patients’ consultation is being pushed back by months as they are ‘advised’ (read forced) to return later. Such an exercise can trigger an aggravation in existing diseases plaguing large populations of people who are dependent on public health care services. Who will answer to a spike in the mortality rate of other diseases? Our Prime Minister who chose to address us about Covid-19 on World TB Day and bypassed addressing the problem of TB altogether? The study of the comparative fatality rates of numerous diseases in the time of the Covid-19 awaits future endeavors.
What all we can actually glean from the panic, paranoia and extreme measures of the Indian government post 24 March is kept for a later discussion. For now I leave you to ponder on the following. As of today, “Corona” has become the most occurred word in human history, perhaps after the word “hello”. Paradoxically, a majority of our country’s poor have been bombarded by the perceived and/or real threat of Covid-19, and are now more aware and fearful of the disease than those like TB which already plague them or have much greater propensity to reach them. These peculiar circumstances demand that we lay bare the skewed relationship between social epistemology (ways of knowing) and epidemiology (study of incidence, distribution, and control of diseases) in order to lay the ground for people to havea different cognitive (re)mapping.
Aetiology refers to the cause, set of causes, or manner of causation of a disease or condition.
 A pathogen is a bacterium, virus, or other microorganism that can cause disease.
For a useful elucidation, seeTN Susilawati andWJ McBride (2014),“Acute undifferentiated fever in Asia: A review of the literature”, Southeast Asian Journal of Tropical Medicine and Public Health, Vol. 45, pp. 719-26.
BLRao (2003),“Epidemiology and control of influenza”, National Medical Journal of India, Vol. 16, pp.143-9.
H. Nair et al (2010), “Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: A systematic review and meta-analysis”, Lancet, Vol. 375, pp. 1545-55.
WHO, World Research and Development Blueprint(2018), Annual review of diseases prioritized under the Research and Development Blueprint: Informal Consultation. Available from: http://www.who.int/emergencies/diseases/2018prioritization-report.pdf?ua=1
Down To Earth Bureau (2019), “India still has the biggest TB burden”, Down to Earth, 17 October.https://www.downtoearth.org.in/news/health/india-still-has-the-biggest-tb-burden-67307
As per a personal communication with a nursing staff who works in the Respiratory Ward, Super Specialty Block, Safdarjung Hospital, New Delhi, and prefers to stay anonymous.
Medical scientists have known about the family of Coronaviruses since the 1960s. This family of viruses has been known to be the cause for approximately 25 percent common-cold and cough related illness. For a recent assessment of research on Coronaviruses, see Volker Thiel (ed.) (2007), Coronaviruses: Molecular and Cellular Biology, Caister Academic Press, Norfolk, UK. Especially see “Chapter 13: Grand challenges in human coronavirus vaccine development” and “Chapter 16: Current status of antiviral severe acute respiratory syndrome: coronavirus research”.
There are several viruses and viral diseases that exist in the Indian population. For a detailed assessment of trends in Indian virology, see Devendra T.Mourya et al (2019), “Emerging/remerging viral diseases and new viruses on the Indianhorizon”, Indian Journal of Medical Research, Vol. 149 (April), pp. 447-467.
 An R0 value less than 1.0 indicates a low extension capacity of an infectious disease, while R0 values greater than 1.0 indicate the need to use control measures to limit its extension.
Megan Coffee, MD (2019), “R0 for Determining the spread of Disease”, 21 November. Available at https://www.verywellhealth.com/some-diseases-spread-some-dont-how-to-know-which-will-1958758
DipuRai (2020), “How deadly is Covid-19? Things you should know about coronavirus risks”, India Today, 27 March.https://www.indiatoday.in/diu/story/deadly-covid19-coronavirus-risks-data-testing-sars-mers-1660165-2020-03-27
 John P.A. Ioannidis (2020), “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data”, Statnews, 17 March. Available at https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/.According to Ioannidis’ bio-note, he is a professor of medicine, epidemiology and population health, as well as professor by courtesy of biomedical data science at Stanford University School of Medicine, professor by courtesy of statistics at Stanford University School of Humanities and Sciences, and co-director of the Meta-Research Innovation Center at Stanford (METRICS) at Stanford University.
See Aldo Rosano et al (2019), “Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14–2016/17 seasons)”, International Journal of Infectious Diseases, Vol. 88, pp.127-34. DOI: https://doi.org/10.1016/j.ijid.2019.08.003
Mike Stobbe (2018), “CDC: 80,000 people died of flu last winter in U.S., highest death toll in 40 years”, Associated Press, 27 September. https://apnews.com/818b5360eb7d472480ebde13da5c72b5
See his statement in Haaretz, 19 March 2020. https://www.haaretz.com/israel-news/.premium-the-expert-who-says-israel-is-overreacting-to-coronavirus-1.8689010
 Shaun Walker (2020), “Authoritarian leaders may use Covid-19 crisis to tighten their grip”, The Guardian, 31 March.https://www.theguardian.com/world/2020/mar/31/coronavirus-is-a-chance-for-authoritarian-leaders-to-tighten-their-grip
The author teaches in University of Delhi, and is an activist with a union of domestic workers called Gharelu Kamgar Union (GKU). She can be contacted on firstname.lastname@example.org