Covid-19 is a ‘lifestyle’ disease, where being wealthier is no longer a guarantee to being healthier – The Economic Times

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SynopsisThe last 12 months have changed a lot of our perceptions regarding life. The term ‘our’ here refers to the affluent and privileged classes — not local or national, but global.

The last 12 months have changed a lot of our perceptions regarding life. The term ‘our’ here refers to the affluent and privileged classes — not local or national, but global. A lot of things we took for granted no longer exist, most importantly, the ability to avail of the best possible healthcare, whether in India or abroad.

Infections such as malaria, tuberculosis, encephalitis, diarrhoea and dengue were — and still are — indicators of poor socioeconomic status. Hence, despite an annual toll of lakhs, these diseases never deserved dashboards or hogged headlines. A virus has changed all that.

Sars-CoV-2, the virus that causes Covid-19, especially attacks those affected with ‘lifestyle diseases’ — diabetes, hypertension, heart disease, obesity, etc. It seems to spare most urban slum-dwellers living in abysmal conditions, and for whom wearing masks, maintaining 6 ft distance and using sanitisers can be a cruel joke. While ‘we’ have kept ourselves locked in our houses and feasted on OTTs, these Indians lost, and continue to lose, their livelihoods.

They lost their lives too. However, not so much from Covid-19, but from starvation, exhaustion and illnesses brought on by things getting far worse economically. ‘We’ suddenly became aware of their existence, as the media flashed photos of families walking across the country from their workplaces to make their way ‘home’.

My apartment overlooks a large temporary settlement — mostly tin sheds with one common toilet for 100-odd people. These jhuggis are occupied by construction workers, whose wives and daughters work as domestic helps in the high-rises. I had asked one of them how they were coping through the pandemic. Did anyone die? Did they get vaccinated?

They are aware of something happening around them — they are getting their temperatures checked at building security posts, and are asked to cover their nose and mouth. If any resident of the apartment block gets infected, the domestic helps are asked to get tested and provide a negative report to re-enter the complex.

Where do they get tested? Do they get any counselling? As part of Covid protocol, they are supposed to be quarantined if found positive. Really? In 4×4 sheds, with a family of 5-10? But, then, who really cares, as long as ‘we’ are protected.

And, yet, we are not protected. We had largely ignored the virus, which has now mutated — ‘learnt’ to change its genetic make-up — to escape whatever little we did to fight it. Vaccines train the more sophisticated parts of our immune system, the T cells and the B cells that produce antibodies, to attack the virus at identified parts of its structure.

If the virus is ‘clever’ enough to change those genes that matter, then the vaccine may well need to be redesigned. That’s what we end up doing for influenza — change vaccines with new anticipated strains every year. And for those that mutate so rapidly, like HIV or hepatitis C virus, we are not clever enough to rid them with a vaccine. With or without intervention, if our first line of defence in the immune system — innate immunity — is strong enough, we may be able to thwart the Covid-19 virus from waging a serious attack and result in severe disease.

For those surviving through numerous life-threatening illnesses, innate immunity is bolstered for survival. The child on the street begging is more likely to be run over by a car than dying from Covid-19. This paradox of the ‘trained’ innate immunity partly explains why the ones living with diarrhoea, dengue, malaria and tuberculosis in their everyday lives may be less likely to die from Covid-19. This may also explain why African Americans have been dying disproportionately from Covid in the US, when compared to Blacks in mainland Africa who are far more familiar with numerous infections like Ebola and are, therefore, relatively protected.

Nigeria, Congo and Ghana have not fallen apart in the pandemic. Neither has Dharavi, or the tin-sheds in front of our high-rises. But I am not sure how long will they remain protected through the multiple waves of the Covid-19 virus — without jobs, food and the shelter of a lifestyle that has protected them so long.

It is time science, society and polity recognise this reverse disparity in the pattern of the infection and invest in a policy beyond lockdowns and slogans. Chasing away street-vendors is not going to end the pandemic. Covid-19 is a ‘lifestyle’ disease, where being wealthier is no longer a guarantee to being healthier.

The writer is head, department of blood and marrow transplantation and haematology, Dharamshila Narayana Superspeciality Hospital, Delhi

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