“Fear is the lengthened shadow of ignorance”

- Arnold Glasow

Understanding the Pandemic

COVID-19

Dr. G. Thangavel
Assistant Professor -Epidemiology, Department of Environmental Health Engineering,
Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research
(Deemed University), Porur, Chennai

Dr. Jayaprakash Muliyil

Former Professor –Epidemiology, Department of Community Health,
Principal Retd., Christian Medical College, Vellore.

Anoop Jaiswal
Secretary, Theosophy Science Centre, Theosophical Society, Adyar, Chennai
2
Contents
What is a corona-virus? .................................................................... 5
What is COVID-19? ........................................................................... 5
How do people get COVID-19? ......................................................... 6
Can a person catch COVID-19 from non-respiratory body fluids of
an infected person? ......................................................................... 7
What are the symptoms of COVID-19? ............................................ 7
Do we have treatment for COVID-19? .............................................. 7
Why should we be concerned about contracting COVID-19?........... 8
How can we avoid getting affected by COVID-19? ......................... 10
What is called breaking the chain and flattening the curve?.......... 11
What is herd immunity? ................................................................. 13
How can we use herd immunity to our advantage? ....................... 14
Other frequently asked questions .................................................. 15
1. What are the advantages and disadvantages of the lockdown? 15
2. We don’t have that much space and how can we keep safe
physical distancing from our elderly parents from catching the
virus? .............................................................................................. 16
3. Why in India we don’t have that many deaths as compared to
many developed countries? ........................................................... 16
4. Can a person cured of COVID-19 get re-infected? ...................... 17
5. Can a person cured of COVID-19 continue transmitting the virus?
....................................................................................................... 17
6. Yesterday, when I was buying vegetables in the nearby shop
someone unknowingly came very close to me. Should I worry? .... 18

3
7. Should vegetables and milk-packets be washed with soap before
using it? .......................................................................................... 18
8. Can COVID-19 spread from newspapers, coins, bank notes, or
ATM cards? .................................................................................... 19
9. Does BCG vaccination protect against COVID-19? ...................... 19
10. Indians have a lot of innate immunity. Will it protect us from
COVID-19? ...................................................................................... 19
11. Is the virulence factor of the virus low in India and hence, we
don’t see many deaths in India? .................................................... 20
12. Will the summer heat protect us from COVID-19? ................... 20
13. Can I take Siddha/Ayurveda/Homeopathy medicine or hydroxyl-
chloroquine, to prevent or get cured from COVID-19? .................. 21
14. What is the risk of getting COVID-19 from packages delivered
through the postal system? ............................................................ 21
15. Can air conditioning spread the corona virus? ......................... 22
16. How to handle the dead body of a person who died of COVID-
19? ................................................................................................. 23

4
What are viruses?
Viruses are an enigma. They are less than a living
organism but more than an inert collection of organic
molecules. A virus has only one function similar to a
living organism i.e. to replicate and multiply itself by
invading a living cell whether animal or plant. Viruses
are parasites, which need a living host to reproduce and
survive and cannot survive outside for a long time. They
are much smaller (1/10,000 of an mm) than bacteria and
can only be seen by electron microscopes.
What is a corona-virus?
Corona-virus is a family of viruses made up of a
single strand of RNA. They have fatty envelops with
several protein spikes, which gives an appearance of
radiating Sun (Corona in Latin). There are seven different
types of corona-viruses that affect humans. Notable ones
are SARS-CoV, which caused an outbreak called severe
acute respiratory syndrome or SARS in 2003 and MERS-
CoV which caused Middle East respiratory syndrome or
MERS in 2012. The common cold is also caused by some
types of corona-viruses.
What is COVID-19?
COVID-19 is a respiratory disease caused by a novel
(new) corona-virus named as SARS-CoV-2 that is
genetically related to the previous generation of corona-

5
virus which caused the SARS epidemic in 2003. It has
evolved naturally, and being new no one has specific
immunity against it. Therefore, it is wreaking havoc
across the globe.
How do people get COVID-19?
People can get COVID-19 from others who have the
virus. The disease can spread from person to person
through small droplets from the nose or mouth when a
person with COVID-19 coughs, sneezes or speaks.
People can catch COVID-19 if they breathe in these
droplets from a person infected with the virus. These
droplets can land on objects and surfaces around the
person such as tables, doorknobs and handrails. People
can become infected by touching these objects or
surfaces, then touching their eyes, nose or mouth. There
is a theoretical possibility of the virus getting transmitted
airborne beyond 6 feet, but it is highly improbable to
happen in real world settings.
An infected person can shed the virus between 2 to
14 days. Even asymptomatic people (people who are
infected, but don’t show any symptoms) do infect others.
Hence, a non-infectious person may get infected if he/she
gets in close contact with the infected person during the
viral shedding period. The chance of getting infected
increases with the duration and closeness of contact with
the infected person.
6
Can a person catch COVID-19 from non-
respiratory body fluids of an infected person?
Although virus particles has been detected in blood,
stool and semen of infected persons, it is not yet known
whether non-respiratory body fluids from an infected
person including vomit, urine, breast milk, or semen can
contain viable, infectious SARS-CoV-2.
What are the symptoms of COVID-19?
The most common symptoms of COVID-19 are
fever, tiredness, and dry cough. Some patients may have
aches and pains, nasal congestion, runny nose, sore
throat, or diarrhoea. These symptoms are usually mild
and begin gradually. Some people become infected but
don’t develop any symptoms (asymptomatic) or they
merely feel unwell. Most people (about 80%) recover
from the disease without needing special treatment. Older
people, and those with underlying medical problems like
high blood pressure, heart problems, or uncontrolled
diabetes etc., are more likely to develop serious illness.
People with fever, cough, and difficulty in breathing
should seek medical attention.
Do we have treatment for COVID-19?
At present, there is no specific treatment for
COVID-19 either in modern medicine or in the
complementary and alternative system of medicines such

7
as Siddha, Ayurveda, and Homeopathy. In fact, for many
viral infections (e.g. Dengue), there are no specific
treatments. Most people will get only mild symptoms and
spontaneously recover from COVID-19 because of the
action of their immune system. However, elderly people
aged above 65 and with some underlying disease
conditions, might get serious complications which
require hospitalisation for management. Studies on
COVID-19 across the world have shown that the
majority (60 to 80%) of people who got infected were
asymptomatic. Only a small proportion, about 5%, of the
population who were exposed to the virus got a severe
disease, which required hospitalisation and critical care
and for some fraction among them it proved fatal. In
other words, the virus is not that virulent. Each country
defines/reports COVID-19 cases differently, hence,
globally a lot of variability is observed in COVID-19
death percentages. As of now, the death rate is estimated
to be less than 1% among the infected if one considers a
large fraction of the untested and asymptomatic
population. Children do get infected, but almost all of
them get a mild form of the disease.
Why should we be concerned about contracting
COVID-19?
The virus SARS-CoV-2 which causes COVID-19 is
a brand new virus and hence, none of us have a specific

8
immunity against this virus. If a new virus is introduced
into a community, there would be a large number of
patients in a short time as everyone has the same chance
of getting infected when there are no control measures in
place. Initially, the number of infected will start
increasing gradually and at one stage the number will
increase exponentially and at that stage, many people will
die as the hospitals cannot handle the increased number
of patients with serious illness. We have seen this
happening in Wuhan (China), Lombardy (Italy), and
Indore (Madhya Pradesh, India). What initially happened
in all these places was that many patients thronged the
hospitals in a very short period and the hospitals were not
equipped well with sufficient number of beds, ventilators,
and treating doctors. Hence, many lives that could have
been saved were unfortunately lost. Thus, if the speed at
which the virus spreads is not controlled, it can wreak
havoc, even if the virus is not very virulent.
Epidemiologists have determined that the speed at
which the virus spreads can be measured by a parameter
called basic reproduction number, denoted as R0
(pronounced as R naught). There are three factors that
determine the value of R0: a) infectivity of the virus, b)
the duration of infectivity of the virus, and c) the number
of uninfected people who are in contact with the virus at
a given time. The first two factors are virus dependent

9
and hence, non-modifiable. In other words, we don’t
have control over it until we find a medicine or vaccine
against it. But, the third factor is a human dependent
which can be controlled so that the number of susceptible
people who are in contact with an infected person can be
reduced at a given point in time to stop the virus
spreading at a breakneck speed. As far as the COVID-19
virus is concerned, it’s R0 has been estimated to be
around 2.5 to 3 when there are no control measures in
place, which means an infected person, on average,
would transmit the virus to about 3 persons in a
vulnerable community. Although this does not produce a
serious disease in the majority of the people, it is still a
highly contagious one. So when uncontrolled, it can
affect all of us and the vulnerable would succumb to the
disease.
How can we avoid getting affected by COVID-19?
Since the disease is mostly spread through droplet
infection, keeping a physical distance of more than 6 feet
away from an infected person is the first step in
preventing the spread of the virus. However, it may not
be always possible to identify an infected person as many
infected persons are asymptomatic. Therefore, it is
advisable to keep physical distance with everyone we
encounter in our day to day life. We can also catch the
virus through indirect contacts by handling objects

10
harbouring the virus. It is a human tendency to touch
objects and then unknowingly touch our faces with the
same hands. In a closed environment, especially where
already an infected person is there, the chance of
presence of the virus on the surface of any object would
be higher. Hence, it is advised to keep all surfaces clean
and disinfected as far as possible. We are also advised to
wash our hands as frequently as possible with soap or
alcohol based hand sanitizer. Since SARS-CoV-2 has an
outer layer made up of lipids, soap and alcohol can
destroy the lipid envelop making the virus inactive.
Finally, one can wear a facial mask to protect oneself
from contracting COVID-19. However, most masks can
only reduce the virus load. Thus, wearing a mask
combined with physical distancing and proper hand
washing would alone give better protection against
catching COVID-19. Also wearing a mask in public
places will reduce the chance of spreading COVID-19 to
others in case he/she is infected but do not have
symptoms.
What is called breaking the chain and flattening
the curve?
When uncontrolled, any viral infection would spread
exponentially as no one in the community is immune to
the virus. However, after a few months, the number of
new infections will come down with the same speed with

11
which it had started after infecting a substantial
proportion of the population. This happens without any
intervention such as medication or vaccination because
the virus does not have enough unimmunised people to
catch (exhaustion of susceptible persons). The substantial
proportion varies with each viral infection. For example,
the H1N1 (Swine flu) in 2009 had infected 40% of the
people before it subsided in the first wave. Diseases like
measles would infect a greater proportion of people, over
80% before it dies down. Similarly, it is estimated that
the current COVID-19 epidemic would infect about 40-
60% of people before it stops. However, if unchecked,
during the transmission phase it would kill thousands of
people, as noticed in China and Italy. Therefore, we must
try to flatten the curve by reducing the speed of the
transmission. This is achieved by not allowing people to
get closer to each other, by keeping a safe distance, so the
chances of the virus to spread from one person to another
is decreased (See Figure 1 below) thereby effectively
reducing the speed of transmission (denoted as Rt). This
is called breaking the chain. Remember, this process does
not allow the virus to go extinct. The virus will still be
there spreading slowly in the community. However, as
the speed of the transmission is greatly reduced, the virus
will take many more months to affect the required
number of people before it spontaneously stops and thus
flattening the curve. This process reduces the number of
12
people infected at any given point in time thereby
decreasing the load on hospitals during the time the
infection is spreading in the given community (See
Figure 1 below).

Figure 1: Flattening the curve

What is herd immunity?
As discussed, all the infectious disease epidemics
spontaneously stop after the pathogen has affected a
substantial proportion of the population. Once a
particular community attains this threshold stage then it
is called that community acquired herd immunity. In
other words the community as a group has got the
resistance to the epidemic spread of that infectious
disease. People who got the infection in this process,
including the asymptomatic ones, will be immune to the
pathogen, meaning they will not be affected by the same
pathogen again, lifelong or for a long period. Immunity
to a particular pathogen can also be attained by

13
vaccination. During vaccination either a live attenuated
or killed pathogen is injected into a person’s body. Since
the pathogen is deactivated, it cannot produce the
disease. Yet, it can induce our bodies to produce
antibodies against it. The presence of antibodies against a
particular pathogen means that the person has attained
immunity. Generally, for viral infections, the acquired
immunity through natural infection is stronger than
vaccine-induced immunity and it may even be life-long.
How can we use herd immunity to our advantage?
Herd immunity is the natural/induced process and
the epidemic spontaneously stops once this stage has
arrived. For COVID-19, since there is no vaccination
available, eventually about 40-60% of the population
(depending on the population density of the area) has to
get infected naturally to acquire the herd immunity for
the epidemic to die down in the first wave. Even with
proper physical distancing in place, this will have to
eventually happen, albeit slowly. Therefore, herd
immunity is a natural process and it is not a strategy to
overcome epidemics. However, we can make use of this
natural process to our advantage. The strategy is to keep
our elderly and other vulnerable people away from
catching the virus and the rest of the population can
resume work, of course, with proper physical distancing
in office and home spaces. Here, we should consider that

14
about 85% of the people in India are below the age of 60
years. By this strategy, the young and the healthy
individuals will gradually get the infection and over a
course of time, they will exclusively contribute to
building the herd immunity while the vulnerable are
protected. Remember, the chance of getting a severe
disease increases with age and most of the young persons
below the age of 60 years will be asymptomatic or get a
mild disease. Even if few of the young fall sick with a
severe disease they can be saved by proper medical
attention. It will become only unmanageable when
everybody, both young and old, gets exposed to the virus
in a shorter period. If we follow this strategy, we will
have less number of deaths and yet we will overcome the
epidemic. Obviously, this is a long process, but this is the
only best way forward in the absence of a vaccine or
medicine for a foreseeable future and we cannot keep the
country under indefinite lockdown.
Other frequently asked questions
1. What are the advantages and disadvantages of
the lockdown?
Lockdown slows down the speed of the disease
transmission in the country so that we can better equip
ourselves to face the epidemic. It buys time from the
disease but it does not eradicate the disease. Countries
like India cannot remain under lockdown for an extended
15
period of time as the damage that it will cause would
have a more severe impact on our people’s health as well
as on our economy.
2. We don’t have that much space and how can we
keep safe physical distancing from our elderly
parents from catching the virus?
This has to be worked out at each family level. The
more distance that young people maintain with the
elderly, lesser the chance for them to contract the virus.
For example, allocate a chair exclusively for the elderly
father/grandparent and request no one in the family to use
that; during summer one can sleep outside of the home,
etc.
3. Why in India we don’t have that many deaths as
compared to many developed countries?
This disease produces serious problems and death
among the elderly and that too with co-morbid
conditions. India is a very young country. More than 50%
(70 crores) of our population is below the age of 30 years
and only about 8% (10 crores) is above the age of 65
years. In developed countries about 20% of people are
above the age of 65. So obviously they have more deaths
compared to us. Moreover, in many European countries
and in America, the epidemic spread very fast due to
increased air travel within and between the countries,
whereas in India, the air traffic is relatively low. Also, we
16
announced the lockdown early as compared to many
developed countries. In India, the many under-developed
districts have not yet got the epidemic; mostly the large
cities which have contributed to the disease burden.
However, there are few states where the overall mortality
is already above 5% (Gujarat, Madhya Pradesh and West
Bengal) among the tested population, as on the middle of
May, which is at par with the developed country
statistics. Research has shown that the death rate among
the elderly can be as high as 3.28% (Verity et al., The
Lancet), which if extrapolated to our population of
elderly, will have more deaths, if they are not protected.
Therefore, we cannot be complacent.
4. Can a person cured of COVID-19 get re-infected?
As of now there is no evidence that the cured person
will get re-infected from the same virus. There were
initial reports from South Korea that some of the persons
who were believed to be cured from the disease got re-
infected. But, later it was clarified that either the previous
test was false negative or the second test picked up the
dead viral particles present in the sample of the cured
person’s body as positives.
5. Can a person cured of COVID-19 continue
transmitting the virus?
No. Once the person is completely cured of the disease
he/she will not have an active viral load in his/her body.
17
However, a person has to be tested twice and both the
tests should be negative for the person to be labelled as
cured.
6. Yesterday, when I was buying vegetables in the
nearby shop someone unknowingly came very
close to me. Should I worry?
No. Although people catch the virus from their
contacts, causal contacts like this will not spread the
disease. Epidemiological researches showed that disease
transmission occurs in people who have reported
sustained close contact for a longer period of time in
closed or crowded places. In fact, in United Kingdom, a
study has found that casual talking in an open or semi-
open space did not lead to disease transmission.
7. Should vegetables and milk-packets be washed
with soap before using it?
It is always advisable to wash vegetables in running
water. But, washing them in soap water is not advisable
as this may produce other unwanted side effects. In
Chennai, Koyambedu a largest whole sale market for
vegetables, fruits, and flower, recently became a hot spot
for COVID-19 spread. Thousands of persons from
faraway places (few even from Kerala) who are
associated with the market such as vendors and load men
got infected, but the contact tracing did not produce a
single case that was spread through the vegetables sold in
18
the market. So, there is a theoretical possibility of the
virus spreading through vegetables, but there is no
epidemiological evidence for it.
8. Can COVID-19 spread from newspapers, coins,
bank notes, or ATM cards?
So far there is no such epidemiological evidence.
Therefore, one need not be too alarmed. However, it is
always sensible to take precautions like washing hands
with soap as frequently as possible.
9. Does BCG vaccination protect against COVID-
19?
There is no clear evidence that BCG will protect us
from COVID-19. The non-peer reviewed study which
proposed this hypothesis had several scientific
weaknesses. However, a recent study, with better
methodology, found that the risk of contracting the
disease among both BCG vaccinated and unvaccinated
group remain the same. Therefore, one need not give
much importance to this proposition.
10. Indians have a lot of innate immunity. Will it
protect us from COVID-19?
Initially, there were a number of claims, which after
observing low number of cases in India said that Indians
have innate immunity against COVID-19. They called it
as Indian paradox: since we are special, COVID-19 will

19
not affect us. The reason they believed so was that
Indians are already afflicted with lots of infectious
diseases and hence, we must have developed some
immunity against COVID-19. But, now they are proven
wrong that we are not special and in this regard we are
like other people in the world. On the contrary, the fact
that India has so many infectious diseases reflects India’s
poor state of public health!
11. Is the virulence factor of the virus low in India
and hence, we don’t see many deaths in India?
Although viral mutations do happen in the middle of
the pandemic, they are not that strong enough to produce
a different result in the virulence or infectiveness of the
virus. Also one cannot (and should not) blindly compare
cases and deaths in different countries in the middle of
the pandemic, because there are several factors which
determine them, such as different phases of the epidemic
in different countries, difference in demography, local
environment and people’s behaviour in each country,
how governments implement control and mitigation
strategies and most importantly how each country defines
and counts cases and deaths.
12. Will the summer heat protect us from COVID-
19?
Although temperature and humidity affect the
transmission of the virus to some extent, it is not the
20
primary factor that determines the spread of the disease
in a given community. It is how people behave during
cold and hot months, which primarily determines the
spread. During winter months, people prefer to stay
indoors which favours the disease spread. However,
during hot summer days, majority of Indians, especially
men, tend to sleep outside in an open or semi-open
environment which negatively affects the disease
transmission.
13. Can I take Siddha/Ayurveda/Homeopathy
medicine or hydroxyl-chloroquine, to prevent or
get cured from COVID-19?
Nothing is wrong in taking these medicines under the
supervision of a qualified doctor. But there is no proven
medicine either to prevent or cure COVID-19. Moreover,
majority of the infected persons will spontaneously
recover, irrespective of whether they take any medication
or not.
14. What is the risk of getting COVID-19 from
packages delivered through the postal system?
The presence of virus on cardboards for 24 hours has
been established in experimental setting under controlled
environments. In practice, however, there is no evidence
of the infection ever being transmitted through
contaminated packages that are exposed to different
environmental conditions and temperatures.
21
15. Can air conditioning spread the corona virus?
Respiratory infections can be transmitted through
droplets of different sizes: when the droplet particles are
> 5-10 μm in diameter they are referred to as respiratory
droplets, and when they are < 5μm in diameter, they are
referred to as droplet nuclei. Droplets, due to their
heaviness, quickly settle down, but droplet nuclei can
remain in the air for long periods of time and prone for
airborne transmission over distances greater than 1
m. According to current evidence, SARS-CoV-2 virus is
primarily transmitted between people through respiratory
droplets and direct contact. However, a possibility for
airborne transmission exists in clinical care settings when
procedures or support treatments that generate aerosols
are performed. In non-clinical settings, the possibility of
such aerosol generation generally does not exist, and
hence airborne transmission is unlikely.

Sensing the plausibility of air borne transmission,

various Heating Ventilation and Air Conditioning
(HVAC) federations/societies of different countries,
including India, have come up with guidelines on HVAC
operations during the COVID-19 pandemic. For
residential air conditioners recirculation of cool air must
be accompanied by outdoor air intake through slightly
opened windows. This guideline is applicable if someone
in the home is infected and she/he is in an isolation room
22
fitted with an A/c. For public spaces with centralised air-
conditioning, if the A/c is fitted with the provision of
fresh air intake, it should be operated. If fresh air intake
provision is not inbuilt in the centralised air conditioning
system, it is recommended to actively open operable
windows.

However, these operational guidelines of HVAC

will be effective when it is combined with the more
reliable prevention measures such as physical distancing,
frequent hand washing, mask wearing at personal level,
and sanitization of the flooring in office and public
places.
16. How to handle the dead body of a person who
died of COVID-19?
As the dead body does not have any physiological
function, such as coughing and sneezing, the chance of
getting infected from droplets is absent. Only the lungs of
dead COVID patients, if handled during an autopsy, can
be infectious. Moreover, the clothes of the dead body
might harbour the virus. In this regard, refer to ministry
of HFW guidelines.

23
Useful resources
1. World Health Organisation, Geneva:
https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/question-and-answers-hub
2. World Health Organisation, Geneva: Myth busters:
https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/advice-for-public/myth-busters.
3. Ministry of health and family welfare, GoI:
https://www.mohfw.gov.in/pdf/FAQ.pdf
4. Centre for Disease Control & prevention, CDC, Atlanta,
Georgia, USA: https://www.cdc.gov/coronavirus/2019-
ncov/index.html
5. European Centre for Disease Prevention and Control:
https://www.ecdc.europa.eu/en/COVID-19/questions-answers
6. Verity et al. Estimates of the severity of coronavirus disease
2019: a model-based analysis. The Lancet March 2020;
https://doi.org/10.1016/ S1473-3099(20)30257-7.
7. Indian Society of Heating, Refrigerating and Air Conditioning
Engineers (ISHRAE) -
https://ishrae.in/mailer/ISHRAE_COVID-19_Guidelines.pdf
8. MoHFW – COVID-19 guidelines on dead body management -
https://www.mohfw.gov.in/pdf/1584423700568_COVID19Guid
elinesonDeadbodymanagement.pdf

24