Intimations of mortality

Until yesterday I had not realized that I was beginning to slip into depression. I’d neglected work. The news was horrible: people begging for hospital beds for family members, others dying outside overfilled hospitals, doctors filmed crying, other doctors begging the government to divert industrial oxygen to medical use, black marketeers making money on drugs with limited efficacy for COVID-19. Locked down at home, I vacillated between consuming this horror show and mindless rom-coms. In February I’d posted a photograph showing how complacent people had become about the falling numbers of infections. That was reinforced by the trips I took in March and April. Courts have begun to question the administration’s contention that only common people are to blame for this disaster.

There was a time when meadow, grove, and stream,
       The earth, and every common sight,
                          To me did seem
                      Apparelled in celestial light,
            The glory and the freshness of a dream.
It is not now as it hath been of yore;—

William Wordsworth, Intimations of Immortality

My nieces do not have this freedom. One, a counselor, realized she was in depression caused by listening to her clients trying to cope with the world that I just described. Her own therapist is counseling her from hospital while being treated for COVID-19. Another niece is in the vanguard of today’s lost generation. She finished her architecture degree from home during last year’s lockdown, and was lucky enough to get a job. So she is in a town completely new to her, setting up her home and commuting to work. She is fairly confident of her work environment; every one is masked all the time, she says. But she finds commuting scary, since in her town many people do not realize masks help protect you. Other nieces are a little further back in the same cohort. One is doing her final year’s internship from home. Another is beginning her second year of college from home. And yet another has just had her school leaving exam cancelled.

I realized that I had been depressed only when I came out of it yesterday. The trigger was that The Family and I got our second shot of vaccine. I had been depressed by thoughts of my own mortality, then. Unlike the two of us, my nieces spend time on social media, which is choked with an outpouring of grief and helplessness from individuals. They are still not eligible for vaccines, and next month, when they are, the vaccine shortage will really begin to hit. Their generation will be changed; I don’t know how.

There are just three simple things to remember about COVID-19: mask up, keep your distance when possible, and do not gather with many others.

Food by Naini’s Tal

The lake district is easily the most popular part of Kumaon for tourists. Within easy reach of Delhi if you want a long weekend’s vacation, Naini Tal fills with crowds which are, if not madding, at least maddening enough for me to avoid. I prefer to stay near one of the fuddy-duddy Tals, any lakeside whose peace is not broken by unending crowds and late-night Bhangra discos. But in this second COVID-19 year, as our holiday drew to a close, and cases exploded in Delhi, tourists were staying away in droves. We had lunch on the terrace of a completely empty cafe overlooking the lake (featured photo). We could stand the music because we were outdoors, we weren’t trying to sleep, and the selection was largely from the 70s (with surprise appearances by Buddy Holly and Elvis Presley).

Tal is the local word for lake. After lunch we took a short walk by the tal. At the street food vendors’ end I noticed that the most popular food seems to be chai with bread, or with some combination of eggs and bread. Naini Tal is part of the hills, so a bowl of Maggi is also common. The number of vendors selling corn on the cob was much smaller, and there was no chanawala in sight. The man selling sweet pastries out of a tin box was a whiff of the times when Buddy Holly was all the rage. In these times you might expect that street food vendors would be distanced and masked. Not so in Naini Tal. Masks, if they are seen at all, are used as chin guards. The stiff breeze from the lake is perhaps the only thing that has kept this place safe until now. I saw four other people whose masks covered both their mouth and nose. Of them, the cotton candy man is the only one who seemed to have discovered what I find in the hills: that a properly worn multi-layer mask is a wonderful face warmer.

There are just three simple things to remember about COVID-19: mask up, keep your distance when possible, and do not gather with many others.

Vaccine after-effects

About 50 million Indians, 3.5% of the population, had taken the first shot of their COVID-19 vaccine before I joined the queue on Monday after lunch. It went very fast. I had the jab less than an hour after I joined the queue. A half hour under observation at the hospital after that, and I was out. During the wait I downloaded my certificate of vaccination. Pretty smooth systems, I thought. The Family had got her first shot the previous week. We’d decided not to take the shots together because both of us might have had to deal with the usual after-effects of a vaccination. She hadn’t had any effects, not even a soreness at the site of the injection.

Sometimes I wonder whether all this happened because I didn’t forward that WhatsApp message to ten people. – forwarded on WhatsApp

Four hours later I noticed the first twinges from my immune system. I developed a slightly runny nose. This was a probably my non-specific immune system responding. Four hours later, my internal defense system realized that there was a persistent invader which needed more drastic measures. I developed a very high fever, bad enough to set my teeth chattering. A fever is one of the defense mechanisms that the body has against invading pathogens. Raising the body temperature stresses cells. An out of control fever can be killing, but it is a scorched-earth measure that an immune system adopts to slow an invader before new forces are brought into action.

By end of March the fraction vaccinated had risen to about 3.5 in every 100 people.

I was fairly certain that the fever would recede fast. I had a restless night, but by morning the fever was gone. I had the usual post-fever distress, a mild headache, a touch of nausea for the rest of the day. A mild fever recurred in the afternoon. I dealt with it as I have done whenever I had a bad infection: sleep. This time round I knew that the symptoms would be gone in a day as the adaptive immune system comes into play. This prediction was right. I woke in the morning at my usual time, still with sniffles, but otherwise fresh. There was a mild soreness at the spot of the injection, but I expect it to fade.

Sputnik V emergency use | India to discuss approval of Russian vaccine – MoneyControl news Report

My reaction to the vaccine were pretty much average. About six of the ten males in my age group I talked to had similar after-effects to the Astra-Zeneca vaccine, fading about a day and a half after the shot. One, an older and somewhat immuno-compromised person, had fever and body ache that lasted longer. Three had no after effects. The Family had talked a more eclectic set of women, and it turned out that among women of all ages about half suffered the same reactions as me. If you have this kind of a reaction you can be pretty certain that your immune system is reacting as it is expected to.

At most, perhaps 5% of people have been infected (with SARS-CoV-2)….If all that pain, suffering and economic destruction got us to 5%, what will it take to get us to 60%? That’s a sobering thought. All of that suffering and death is just getting started.” Michael Oseterholm in The Guardian, Jun 10, 2020

We will go on another small trip at the end of next week. Unfortunately, the second wave is still raging across the country, so we will have to remain masked and vigilant during the trip. After all this first shot has only primed the immune system, and the second shot is yet to come. The usual precautions are still needed.

There are just three simple things to remember about COVID-19: mask up, keep your distance when possible, and do not gather with many others.

Second wave

Bad news came in over the weekend. Cases are up in Mumbai, and in several smaller towns. Kerala, which had beaten back the pandemic in its early days, has been going through enormous pains in recent weeks. This week, overall, cases are up in India by about a third. We seem to be at the beginning of a second wave. Friends around Mumbai have been discussing the inevitability of such a thing ever since the local trains were opened to the general public. I have been playing the devil’s advocate (what an appropriate phrase at this time) with the argument that if livelihoods are to be safeguarded, we have no choice but to let people move around. An increase of cases today inevitably leads to the conclusion that the policy changes made two or three weeks ago are at the root of the problem. Governments agree, and sometimes have gone the whole hog again, imposing full lockdowns in some towns.

My early training predisposes me to seek answers in an engineering discipline that is called Systems Design and Control Theory. One of the things that we learnt was that you could try to control a system by using its output to influence its input. This is called feedback. There is a theorem which says that feedback with delays leads to oscillations. Every teenager who has tried to form a rock band knows about the screech of feedback which badly placed mics and speakers can lead to. Others can more easily relate to the frustrating experience of making sure that the water in the shower is a comfortable temperature as an experience of oscillations due to delayed feedback.

Why should this lead to second and third waves of epidemics? The argument goes something like this. When it becomes clear that there is an epidemic, governments put various restrictions in place. But these are temporary, and when the number of cases decreases they are removed. Clearly there is a feedback. The delay comes from two sources: it takes time to realize that there is a consistent rise (or fall) in the number of cases, and it takes time for committees to make decisions.

Fortunately, the theorem assures us that we are not doomed to be tossed about forever by waves of the pandemic. If there is friction in the system then that damps out the successive waves. Where does this friction come from? One is the brutal calculus that the most susceptible are the earliest victims of the epidemic, so successive waves of disease, eventually, find better prepared immune systems. The second source is our personal learning and initiative. When we realize that there is danger, we personally take precautions. And we learn what are the most important, and best, measures. The third is the most enlightened reason of all: medical practice evolves, so that treatments and vaccines become available.

Human behaviour is unpredictable. There are no theorems which guarantee how I will act. Still, when studying a large enough body of people, there are general principles which seem to govern how such collections will respond to circumstances. There are limits to such predictions. Different countries, even different cities, have had a their second and third waves of COVID-19 at different times.

There are just three simple things to remember about COVID-19: mask up, keep your distance when possible, and do not gather with many others.

Don’t get fooled again

The eye is so easy to fool! I’d posted the featured photo in colour before. Just for fun I decided to convert it to black and white. I was surprised that it works. Perhaps because the yellow of the tiny flowers is so luminous that although the whole plant is in shadow there is enough contrast there. That got me thinking about decomposing it by colour. I dialled down the saturation of everything except yellow, and the eye still saw it as not very different from before. You really have to put the two next to each other to remind yourself what the difference is. And even then you may not notice that in one photo the leaves are not green.

Are we thinking right in our response to the pandemic? The world locked down again and again to flatten the curve, to prevent hospitals from being overrun. Wuhan was absolutely locked down at the beginning, and that stamped out the disease in that city completely. In other cities we thought it wouldn’t hurt to go for a walk, and perhaps talk to the people we see. Surely meeting one acquaintance in a couple of weeks would not change things, we reasoned. Was that right?

June Almeida was the first scientist to image a human coronavirus (for bio, click on pic)

If the disease spreads evenly, that is every infected person has the same chance of passing on an infection, then even very mildly leaky lockdowns do not prevent a single death! When you study the total number of deaths, it seems to make no difference whether the lockdown was leaky, or whether there was no lockdown. The only difference is the availability of health care, and whatever that implies. Strange!

So lockdowns were thought of as a tool to “flatten the curve”, not as a long-term solution. But that step involved an assumption. It turns out that if you have epidemics (like the flu or COVID-19) which depend on super-spreading events, then the situation could change. The simple expedient of closing every place in which, say, more than 20 people can gather, can cut the transmission of the disease by a large factor. This saves many lives. Strange!

John Snow is widely regarded as the founder of the field of Epidemiology (for bio, click on pic)

It seems that the maths works out. Not quite as transparent as 2+2=4, but apparently quite as definite. But I am always left a little doubtful by mathematical arguments in which every assumption cannot be tested in real life. Maths is a bit like that photo in yellow; an approximation of the real world. Some scenes can be captured in yellow, others not. Believing blindly in mathematical models of the world led people to theories of the aether once. It leads others to believe in market economics today. Both could have been right, but without extensive testing we would not have known better. You don’t want to make the same missteps again with epidemics. The world is stress-testing epidemiology now. I wonder how the subject will change in a couple of years.

Learning to live with danger

How easy is it to catch a disease again? Chicken pox, never. A cold, perhaps even twice or thrice a season. For a new disease like COVID-19 this may be hard to figure out, but with tens of millions of people infected around the world, one can get rough answers surprisingly fast. Of course, the question needs to be qualified. Is there a version of “long COVID-19” which has periods of dormancy, so that a resurgence of the same infection may look like reinfection? If so, should we count this? Should we count infection by a new strain of virus to be a reinfection? Reasonable answers seem to be “Perhaps”, “No” and “Yes” respectively. With this in mind, it seems possible today that the chance of reinfection, while small, could be higher than that of death. All these estimates are provisional, of course. Partly because doctors around the world are learning to manage the infection and reduce the rates of death. Partly because the chances of new strains of virus to emerge depend on the number of people infected, and this number is still increasing.

Now that we know that recovering from a COVID-19 infection is not always the same as becoming our old healthy self, the statement that death is less likely than reinfection does not seem to be as much of a relief as it would have been nine months ago. Instead it raises new concerns. Would the effects of vaccines wear off? Will reinfections cause a mild disease or a worse one? There are, as yet, strong opinions but no definite answers to these questions. But the questions force us to re-examine the lives of our grandparents. They lived in a world of communicable diseases. Human life expectancy was lower, because you could die of such a disease before your heart started to act up. How did they live?

For some months we hid ourselves away from the world, regarded everything that had to be brought home with suspicion. Then we learnt to distinguish between levels of danger. Once we figured that we had been infected, we let our guard down for a while. Again, after realizing that we may not be safe for ever, we are back to masking and distancing. Life is not on hold any longer: regular work has resumed, dentists need to be visited, other medical check ups have to be done, some socialization is needed, holidays are necessary. The way we do things has changed, but life has resumed. I suppose all of us will have to find how to resume life. Even in medieval, demon-haunted times, people lived and worked. We know better, we will live safer; this I am certain of. No other disease has been studied by such a variety of scientists: I have read research reports on COVID-19 by doctors, data scientists, physicists, biologists, economists, and even engineers. We will learn from each other the safe ways to navigate the world.

Our journey so far

On December 31, 2019, WHO declared that an emerging new disease had been reported by China. The Family and I were on a trip, and like most others across the world, did not pay much attention to this news. Within a few days, the news from China began to take up more of the news cycle. The disease acquired the name COVID-19, and the virus that caused it was gene sequenced in China, found to be new, and dubbed SARS-CoV-2. I had a full year of business trips and vacations planned, and knew that I had to keep an eye on this. (New words: COVID-19, SARS-CoV-2)

It was hard to see the big picture in early 2020

On 30 January, 2020, WHO declared that the disease was a pandemic. On the same day, a traveler returning to India was found to have the new disease. This was the first reported case of the disease in India. Wuhan and its surroundings had been locked down for days. I’d already talked to my colleagues in Wuhan, and they told me of their tedium. It was hard to imagine spending weeks inside the four walls of a flat, energetic children cooped up in the same space, looking out at deserted streets. Little did we know that the world was to follow suit. (New word: pandemic)

The world was beginning to close in

In February we made a small trip to see the winter’s birds (the featured photo of the black-shouldered kite, Elanus caeruleus, comes from that trip). The news was beginning to get dire. Countries were locking down flights. Italy was badly affected; on a call with her sister in Milan, The Family heard sirens from racing ambulances in the background. I was on conference calls with colleagues across the world trying to decide whether to move schedules for meetings. A divide was perceptible: people from Europe, the USA, and Australia were sure that this would pass in a couple of weeks, and no long term measures were necessary. People from East Asia were convinced that it would take longer to normalize. Indians and South Africans on these calls were not sure, but tended to be cautious. (New phrase: contact tracing)

Everyone was captive in their own houses

When the first large cluster of infections was detected in Punjab, it had been brought in by a traveler returning from Europe. Soon a clutch of cases brought by tourists began to spread in Rajasthan. The Family and I shared a laugh with our extended families about the passing phase of reverse racism on the streets: any white tourist was given a wide berth, and there were mutterings about why they should stay home for now. I began to teach myself epidemiology just in time to understand the advise that was soon being offered on safety. But then, the government of India decided to shut everything down very suddenly. (New word: lockdown)

Wild oscillations between euphoria at remaining healthy and tedium at being locked down

The resulting human tragedy of unemployment and displacement was enormous. For a while we, like the rest of the middle class, remained hopeful, because the skies cleared up due to the lack of new pollution. Then the monsoon storms reminded us that planet was still warming from older pollution. And the new obsession with cleaning meant that more plastic and detergents were being pumped into the earth. In the beginning we cleaned obsessively. The Family brought her professional expertise to the matter and found safe ways to disinfect food: soak fresh food in brine for half an hour. Sealed packages could be dunked in soap water and then washed. Brine and soap water could be reused, since they do not allow the growth of bacteria and viruses, so buckets full of them could be reused, saving on water usage. (New word: social distancing)

A grey and colorless world

Locked down at home, we realized how important our internet connectivity was. New services for video conferencing were quickly adopted. Our meetings went online, and suddenly that part of our work had been revolutionized. We forced the pace of moving work on-line. The Family and I decided early on that we had to fight back at the black depression that threatened us. We decided to keep a strict routine, and eat only healthy food. We shared household chores, and cooking, learnt new time-saving techniques, and set aside time for watching movies and TV, and meeting friends and family through video conferencing. (New word: Zoom)

It is hard to see the big picture even now

Now, one year on, Mumbai is opening up. Today, on 1 February, 2021, the local trains are starting up again. What did we learn? What did we change? First, that when you are afraid of a respiratory disease, mask yourself. This would be enough to slow down the disease. Quick deaths, although in the millions now, turned out to be not the most likely bad outcome of the infection. People have reported recurring breathing difficulties, heart disease, extreme fatigue. These symptoms pass in a few weeks, or months, for most people, but others have continuing problems: the COVID long-haulers. With all this knowledge, the second lesson is internal, one that most people I speak to seem to have learnt. It comes out in little ways: your life is important, its quality is important, family and health are important, socializing is important, being chained to a machine is secondary. We do not yet know how things will evolve. Vaccines are available, but it will be a decade before most people get it. In the meanwhile new variants of the virus are appearing, cases of reinfection are being discovered. Perhaps the disease will be a thing of the past in another three to five years. Or perhaps we will learn to live with a deadly disease, as earlier generations had learnt to live with small pox. New ways of working, new politics, new power groups have already begun to emerge, and they will be part of the new normal. (New phrase: new normal)

For all of us this has been a journey into ourselves, finding what we are capable of, learning new skills. Like most people, we spent more time cooking than before. I tried to learn how to identify the birds around me by their calls. I kept a record of the days through my photos (the ones above are my photographic journey through the year) and through occasional blog posts.

Flying in the pandemic

We heard a lot of different things about flying since May 25, when airports reopened across the country. The early flights were crowded and had unreliable schedules. It was not yet clear how safe airports and aircrafts would be. There was a lot of drama about cleaning surfaces, but not enough was being written about cleaning the air. By October the outlines of the problem and its solution were clear enough that there were media stories about it. The two points about safety I got were this. First, planes usually have very good airflow and filtration systems, and the air is scrubbed clean much faster than in the building where I work. As a result, the main risk is from people around you transmitting viruses in the usual way: breathing, talking, and coughing. The second point is that we already know how to deal with this: masks and shield, and distancing, when possible. I realized that I had lost my fear of flying in the time of the pandemic.

This tree near the check-in counters makes the empty airport look welcoming

We put this to practice a couple of weeks back, when I realized that The Family and I have never had a holiday in Kolkata. There would be no year better than 2020 to see Christmas lights in this city, since most people are still avoiding going out. We knew that we are taking risks, and it would be safer to stay home, as others are doing. But perhaps with good masks, worn as well and as safely as we know how to, and other safetly precautions, we can still travel now and then. As it turned out, Mumbai airport (photos here) was not crowded. It was possible to deposit baggage, check in, pass through security, and wait in the passenger areas while maintaining distance most of the time. The aircrafts we traveled by were far from full. The airlines are not taking care to maintain distance between occupied seats, but when the load is so little, it is possible to move to seats as far from others as you can. Airlines hand out mask, shield, and sanitizer when you board, and we used them all. Arrivals is a little more chaotic, with knots of people around baggage collection areas, and the exits. Nevertheless, we felt very safe because all the passengers behaved sensibly; the pandemic has encouraged civility. I am happy we tried this out, I think flying is a risk we may be able to take now and then as we wait for a vaccine.

Al fresco

I wonder where the phrase dining al fresco comes from. But that is what we did on our little workation. The first time was a shock. The Family ordered up chai with pakoras, and we sat out in the little garden waiting for it. When a man walked up to us with a full tray, I had a moment of confusion. Both of us were without our masks with a stranger near us. This had not happened in more than nine months. I curbed my instinct to dash in to get my mask. We were outdoor, with a nice breeze coming down from the hills behind us, and the server was wearing a mask and a shield. It was reasonably safe. A little chit chat as he set up the table stabilized my heart, and I was able to concentrate on the food. The perfect sweet and milky chai and a plate of hot pakodas with a spicy hot coriander and mint chutney, things we haven’t had for months! Time to take a photo of a world renormalizing, and dig in.

We were even more adventurous for dinner. The Family said we should go down to the restaurant. I’m still unsure about meeting more than two strangers at a time; when I go in to work I don’t take a lift if it has more than two people in it. I was a little reluctant. Our compromise was that we would sit outdoor. We need not have worried, the resort had set up its dining entirely in a garden, with tables distinctly more than two meters from each other. In the lovely glow of stars overhead, trees lit up, we relaxed into a mood where we could begin to come to terms with a changed world.

In the light of the little oil lamp on our table I began to put into practice the intellectual understanding that I had reached earlier, as we planned how to reopen during the pandemic. Similar thought had gone into the adaptation of this space. Guests, like us, were isolated islands in a large open space with a nice breeze coming through it. The weather was colder than I’m used to Mumbai, but everyone was prepared for it. People were put into tables according to the size of their bubbles; we were escorted to a two person table, larger family groups had tables of up to eight people. The service personnel wore masks and shields; they were more at risk than us, since they were forced to meet strangers. There was a singer on a little podium placed away on one side, about four meters from the nearest table. There was only a low bush between her and the edge of the cliff, so there was always a breeze around her. It was all very well thought out, and I could dismiss my concerns once I’d looked around and taken it all in. The rest of our time there was very relaxed. As we walked back to our cottage I looked up at the clear sky. We were not yet passing through the Geminid meteor shower. Perhaps next week, I remarked to The Family.

WFH can be WFA

No one cares whether you wear slippers or shoes when you work from home. That was part of our 2020 vision. Slowly we are all learning that no one cares whether you work from home, or work from anywhere, as long as your work gets done. I decided to check out the possibilities last week. After eight months confined to our home, The Family and I decided on a few days away. My criterion was good wifi and open spaces; she wanted lovely views and good service. We found a place which satisfied us both, and spent three days away from home. The highway towards Nashik is little used now, and I could finish a meeting on the road. We drove off the highway at Igatpuri, and stopped by the lake behind Bhavali Dam (featured image). I lost connectivity there, but my meeting was over. If we travel while working we’ll have to have maps of mobile coverage (Google, I need this layer on your maps, if you are listening).

Getting away, working in a resort outside towns, was a pleasure. The sight of a red veined darter (Sympetrum fonscolombii) sitting on the car antenna in the morning, relaxed me as I eased into work. The pandemic is not over, but hotels and resorts are adapting to changed circumstances. Open air dining, in-room dining, good wifi, isolation, many places are able to turn these pre-existing facilities to their advantage. Several districts and towns, especially those which have avoided the pandemic, restrict visitors quite strongly. Bhandardara town, our home for the work week, was of this kind, but we were happy to stay in our private cottage high above town and meet only the staff at the resort. Many other people had reasoned like us. The place was full, even though it was the middle of the week. We could wave a distant hello to people in nearby cottages while we sat in the small garden and worked.

Is this part of the future of work? It has been a long time coming, but I believe that this new category of a break, WFA (work from away) is finally here to stay. What else can you call it? Awaycation? Workation?