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.

I need your help

On Saturday the streets of downtown Mumbai were deserted. With the number of cases rising again, people were safeguarding themselves. Optional travel was clearly down, and most people were more safely masked than before. It was an even Saturday, so few businesses were open. The first wave was a learning experience for everyone. Now we know that measured and graded response is better than a long shutdown. I finished my work and then tried to take photos of the food carts. The mid-day sun is harsh. Sometimes I persist even with this awful lighting because of the human stories I see. Today, the lack of crowds killed interest as effectively as the harsh light.

The featured photo has a story. A pregnant woman tries to sell a good-luck charm (the string of chilis and a lime) to the food vendor, as she turns to look at her two young children at their “home” on the pavement. I wish I had looked more carefully first, and positioned myself to get the whole story in one shot: the cart, the woman, her children at “home”. Street photography involves more than just the camera. The lockdown across the world has been harsher on the poor. Pavement dwellers have no masks. I would like to help buy some. If you know of organizations or citizens’ initiatives which are distributing masks to homeless people, or otherwise trying to help them against COVID-19, could you please let me know in the comments?

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.

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.