Friday, July 1st, 2022 19:12:21

Covid death. Cry me a River!

By Sarat C. Das
Updated: February 13, 2022 8:00 pm

There is something more dreadful than death. It is the apathy towards death. In the first wave of the Covid-19 we were dealing with the unknown, the deaths seemed to be warranted as we were knowing this beast. We mourned the deceased and buried them reverently. Then the second wave swamped us. The deaths seemed to be bigger on the count than our human emotion could measure up, thus incapacitated us. Paralysed with emotion and grief, we were truly shell-shocked. The hospital and sanitation workers helplessly piled the bodies high and torched them. The families and relatives kept off the mass funerals. The cling film plastic wrapped bodies were putatively transmitting virus more effectively than unmasked super spreaders! We were not outraged by this preposterous health advisory.

The non-descript villages on the banks of Ganges could not lay the bodies on pyre. The bodies were eased into the muddy river expecting them to be drowned and settled in the bottom, but the swollen cadavers surfaced.

The third wave of pandemic had left many of us Covid fatigued. We sleepwalked into death, with a dreamy languor; our response to death was like a hibernating animal could experience death if such an eventuality came upon this creature. The BBC noted that survivors of twentieth-century flu pandemics experienced a kind of lingering depression that left them “in a state of suspended animation”; Oliver Sacks described these sad patients as “insubstantial as ghosts, and as passive as zombies.” The worst is still awaited. The third wave would change us more than we had ever imagined.

Max Healthcare reported that 60 per cent of the patients who died during the current wave of COVID-19 pandemic were either partially or fully unvaccinated. Deaths were largely among those old adults over 70 and those suffering from multiple comorbidities such as heart diseases and diabetes.

In the middle of the third wave, as this story is going into print, India reports 678 deaths, much less than the second wave. People who died due to ‘’Long Covid’’ may not be counted, such as the demise of India’s most beloved singer Lata Mangeskar, known as the “Nightingale of India ”.  The epidemiologists and mathematical modelers do not see the third wave deaths are on steep gradient.  During this ongoing wave, India officially announced reaching half a million Covid-19 deaths. The grim milestone not only hinted at under-reporting of death but as much as our lack of curiosity and determination to know the actual deaths on the ground.

The US-based Center for Global Development (CGD) study estimates that between 3 million and 4.7 million more people died during the second wave, the Grim Reaper’s period between January 2020 and June 2021.

“The reality is, of course, catastrophically worse … What is tragically clear is that too many people, in the millions rather than hundreds of thousands, may have died.” The report acknowledges that establishing an accurate Covid-19 death toll may “prove elusive” but that such a toll “is likely to be an order of magnitude greater than the official count”. The CGD researchers estimated that the first wave “was also more lethal than is widely believed” and that about 2 million people may have died in the first wave alone.

“Most studies put excess deaths during the pandemic at between 3 and 5 million – around seven to eleven times official Covid deaths,” according to Dr Murad Banaji, a mathematician from Middlesex University in the UK, who has been closely mapping India’s COVID-19 data since beginning of the pandemic.

Sharing his opinion with the Quint, Prof K Srinath Reddy, chairperson, Public Health Foundation of India, said, “You may misclassify the deaths, you may not ascertain the cause of deaths, but the fact of death is generally difficult to miss.”

The total number of fatalities caused by the pandemic may be even higher, for several reasons, as the Economist reveals. First, the official statistics in many countries exclude victims who did not test positive for coronavirus before dying—which can be a substantial majority in places with little capacity for testing. Second, hospitals and civil registries may not process death certificates for several days, or even weeks, which creates lags in the data. And third, the pandemic has made it harder for doctors to treat other conditions and discouraged people from going to hospital, which may have indirectly caused an increase in fatalities from diseases other than covid-19.

One way to account for these methodological problems is to use a simpler measure, known as “excess deaths”: take the number of people who die from any cause in a given region and period, and then compare it with a historical baseline from recent years. The new metric known as excess deaths— the number of deaths over what was expected based on historical averages — is turning all the official death statistics on their heads. The Economist used statistical models to create our baselines, by predicting the number of deaths each region would normally have recorded in 2020 and 2021. And the gaps between official recorded deaths and real deaths is staggeringly high.

A score of countries such as Bulgaria, Serbia, Russia, Lithuania, Peru, Bosnia, Romania and Mexico still need to account for these excess deaths alongside India. Understating the caseload and death toll has real consequences for how a country responds. Governments could fail to direct funding and other resources to an area in need if the virus appears to be a relatively low threat there. Under-reporting deaths also may show collective apathy towards death, co-opted by governments and public institutions. Such an apathy is more infectious than the virus itself, undeniably the art of this underreporting comes with its insouciance.

Apathy towards others, the indifference to death in its worst form, can exhibit insensibility or sluggishness.  In psychology, we have identified this behavior as learned helplessness, an exhibited behavior after the person endures repeated aversive stimuli beyond his or her control. It is caused by the person’s acceptance of their powerlessness: discontinuing attempts to escape or avoid the aversive stimulus, even when such alternatives are unambiguously presented. It undermines the person’s self-efficacy and the innate ability to achieve goals. The learned helplessness is a key factor in depression that is caused by inescapable prejudice, known as “deprejudice”. Thus, the helplessness born in the face of inescapable prejudice matches the helplessness born in the face of inescapable shocks.

There is a medical condition, which “describes people who respond to traumatic stress by developing extreme apathy, give up hope, relinquish the will to live and die, despite no obvious organic cause.” Dr. John Leach of University of Portsmouth identifies this as ”pshychogenic death”, which he terms as ”real”. According to Leach’s research, the condition has five stages: First is social withdrawal. Following a trauma, people may become self-absorbed and indifferent and show a lack of emotion. The second is apathy – an emotional or symbolic “death,” researchers say. Apathy is “a demoralizing melancholy different to anger, sadness or frustration.” The third stage is an extreme lack of motivation paired with a weakened emotional response, known as aboulia. The fourth stage is psychic akinesia. Although this person is conscious, they are in a state of extreme apathy and do not react to extreme pain. The final stage is psychogenic death. Leach states this is the “disintegration of a person.” He said “nothing … can make them want to live.”

While most of us will see a single death as a tragedy, we can struggle to have the same response to large-scale loss of life. Too often, the deaths of many simply become a statistic. I run a Covid Foundation known as ”Fight Corona” with multiple online groups. In recent months, a few dropped out of our whatsapp groups stating they were suffering from coronavirus news fatigue, hence, choosing to read less about the pandemic. Is it conforming to the psychological phenomenon that “the more people die, the less we care”?

“The fast, intuitive gut feeling is miraculous in many ways, but it has some flaws,” says Paul Slovic, a psychologist at the University of Oregon who has been studying psychic numbing for decades. “One is that it doesn’t deal with numbers in magnitude very well. If we’re talking about lives, one life is tremendously important and valuable and we’ll do anything to protect that life, save that life, rescue that person. But as the numbers increase, our feelings don’t commensurately increase as well.”

In a series of studies in Sweden in 2014, Slovic and his colleagues demonstrated that we not only become numb to the significance of increasing numbers, but our compassion can actually fade or collapse overall as numbers increase.

There may be a relatively simple explanation for this complacency: the pandemic has disproportionately affected populations, hence, all of us have varied experience of witnessing these deaths, and accordingly our responses are shaped.

In the US, the superannuated died in care homes, minorities in their ghettos, the farm and wood workers perished in the hinterlands, jail inmates died in overcrowded prisons, and refugees in immigration detention centers. In India, people died in slums and faraway villages, ill-equipped and understaffed hospitals, and then the unreturned pilgrims from Kumbh Mela, considered as the “world’s largest congregation of religious pilgrims”. The authorities’ response to this human crisis is more or less similar, bafflingly pernicious, managing the death numbers.

Today, governments across geographies have decided to unlock their cities and invite more people to cross boundaries to keep the tourism curve inclined. The countries are organizing festivals as big as the US’ Thanksgiving, holding elections such as India’s upcoming mega election of its most populous state Uttar Pradesh, and sporting events such as the Winter Olympics of China.

Result: More deaths seem to be inevitable.

The apathy towards Covid deaths has been unable to engage us with the public health resources, the more equitable allocation can change the fate of our societies. We must need to shake ourselves off this torpor, the mental sloth, which is more fatal than the virus.

 


By Sarat C. Das

 

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