As this essay is being penned, I have just completed two weeks of home isolation with this latest lockdown and am waiting to hear if it will be extended or relaxed for the coming week. Having endured four months of it earlier, and now full two weeks without stepping outside my house – and exhibiting no Covid symptoms – I can say I am Covid-free and so will anyone be who will come into close contact with me. Today. But am I or they completely safe?
This is where Covid science as currently practiced completely fails me and all who may come into contact with me. First, lockdown, i.e. converting my home into a hospital ICU and me and family members as its patients work only for the upper and upper-middle class and only for the isolation period, which itself is difficult to maintain. It is impossible for those who have to work for a living and impractical even for those who may not have to work as long as their savings last, but do need to go out to get daily necessities like milk. Once my home lockdown ends, I could inhale the virus just by going out to buy vegetables.
Second, testing does not help either, even when discounting their unaffordability to most Nepalis. Rapid Diagnostic Tests (RDTs) which try to detect the virus protein have high unreliability and are not recommended by WHO for clinical diagnostics but may only be used for research. The more reliable Polymerise Chain Reaction (PCR) tests which detect relevant antibody in the blood are "very labour intensive with several stages prone to errors between sampling and analysis with false negatives as high as 30%". Other more reliable serological tests are even more difficult to conduct within Nepal's health system and too expensive for most. Most important, given that in Nepal results of tests rarely come before a week or more, my sample given today might come back negative a week hence. But me sitting on my balcony tomorrow watching people in the street could be blessed with an updraft of breeze carrying droplets with Covid from someone infected who just sneezed two floors below me. How many testings can one do? Under Loktantra, multiple and free testings are only available (and at home) for Our Dear Leaders!
Covid lockdown and isolation have completely unraveled the mass movement-dependent global economy; but as a solution to the health crisis, they do not seem to have much success to show. New cases are rising in Nepal and India, and even in places like Vietnam that had completely contained it. Of those infected, the death rate is only 1.76% for India, 3% for the US, 0.6% for Nepal, and 6.88% for Sweden that imposed no lockdown whatsoever. When analyzed per million population, the US (554) and Sweden (575) are high while India (47), Nepal (8) and China (3) are very low. More interestingly, in the US as per the Center for Disease Control, of the total deaths from Covid, only 6% were from Covid itself while 94% were from other underlying conditions (hypertensive diseases, dementia, cardiac weaknesses and renal failures etc.) compounded by Covid. In the UK, a quarter of the Covid deaths were in people with diabetes; and in Sweden, it is mostly old people who died.
Even in Nepal, most of the Covid deaths had other serious causes, and the social consequence of Covid lockdown has resulted in unnecessary deaths of other patients who could not get timely health care such as those related to childbirth, cancer and kidney treatments, etc. The conclusion seems inevitable: in the industrialized West, high death rates are due to the older-aged population with pre-existing conditions, diseases from prosperity-induced obesity, and privatized health system making affordable health inaccessible to the majority. In contrast, India and Nepal have more resilient younger populations and China has a highly socialized public health system. Ours (and India's) fails on the social front.
In a world in panic and going mad, what exactly are the facts about Covid that one can have confidence in and what are populism-driven fads masquerading as science? As the West now adopts untouchability with a vengeance that would shame even the most orthodox Brahmins of yore (e.g. social distancing, no handshakes, burka-like masks in public) questions have been asked about their efficacy. UK's deputy chief medical officer has questioned the efficacy of masks, saying that there is no strong evidence in either direction (e.g. masks protecting the wearer or those the wearer comes in contact with). Said by anyone else, they would risk being labeled Trump-supporting barbarians and deplorables! And while vaccines have proven their worth for cases like smallpox and polio, it is not clear for Covid, as an when they become available, if they are good for a lifetime, for two years or just a few months. Ultimately, it is said, it is going to be herd immunity with or without vaccines, masks or social distancing. That is how Sweden has flattened the infection curve despite a relatively high mortality rate (primarily among its senior citizens).
Herd immunity is when 70 to 90% of the population has been exposed to the virus and survived, thus reducing its transmission and infection-spreading capacity. It is inevitably going to be the evolutionary, survival-of-the-fittest solution; but the only concern public health folks seem to have with it is the overwhelming of hospitals and health facilities before herd immunity is achieved. Underlying this ambivalence is the serious problem Western medical science has with the very idea of immunity: it has reductionist cases and chemicals to deal with them aplenty; but it is unable to explain what exactly it is and why it is strong in some individuals but badly depleted in others.
There are basically three types of immunities: innate that evolution has built into us; adaptive that our individual bodies learn along the way countering infections our innate systems cannot deal with, and building specific antibodies and lymphocytes along the way; and passive that we acquire socially from mother's milk in babies who import a mother's immunity, or from plasma therapy. The latter is fluids from adaptively immune people transfused into sick ones which, while somewhat effective, smacks of modern cannibalism for the comfort of many.
The failure to understand immunity lies in the nature of modern Western science (including medicine) and its basis in reductionism that eschews holism and a systemic approach. Philosopher Julian Baggini, in a recent book on comparative philosophies titled How the World Thinks, describes reductionism as "the idea that the best way to understand anything is to break it down into its constituent parts, emphasizing these over wholes". One thus learns more and more about less and less, missing the forest for the trees. While reductionist methods have resulted in remarkable successes in technology, their application in the social and policy sciences has resulted in the disastrous individualism (and ignoring social goods for narrow private benefits) of today's global capitalism.
Even in the sciences, reductionism has led to the narrow rationality of methodological individualism that another philosopher of science Paul Feyerabend (famous for his book Against Method) fulminates against in his last book The Tyranny of Science as leading to a kind of authoritarianism that in the end is bad science. In line with the tradition of methodological pluralism championed by Feyerabend, Foucault and others, the Italian philosopher Giorgio Agamben decries the "techno-medical despotism" of Covid lockdowns. He argues that political power has been disguised as expertise and used as a pretext for withdrawing the rights and privacy of citizens, it being nothing more than the discredited narrative of "national security experts". Given their failure in controlling Covid, one can hardly dismiss his charges.
How should we in Nepal begin to re-think Covid and our individual as well as collective responses to it? Modern medicine and technology do have reductionist benefits in extreme cases but fail at the larger social level as well as individual well-being. It may be time to include Complementary Alternative Medicine (CAM) in our portfolio of community wellness. (The US Congress in 1998 did establish the National Center for Complementary and Alternative Medicine at Bethesda's National Institutes of Health!) CAMs science is not reductionist individualism but methodological systemic wholeness. There are five major traditions within and near us that we should give more thought to Chinese (Kampo, acupuncture); Tibetan (Sowa Rigpa that is pre-Buddhist); South Asian Ayurveda (which is holistic and uses plant products, diet, and lifestyle changes with exercise); homeopathic (based on Eastern ideas of the body curing itself but founded in Germany in the 1700s); and Unani (from ancient Greece but now practiced in India via Persian-Arabic traditions to minimize chances of disease). No one lives forever, but one can live relatively healthy if one sees one's body and the society it is within as one composite that needs to be addressed, not in parts but as a whole.
(Gyawali's previous Covid related pieces are: