Somehow, 88 fills me with dread. It’s the figure I remember the most from the first wave of the pandemic. Patients would be wheeled in with their clip-on pulse oxymeters blinking in the red. 90, 89, 88…. The oxygen mask would be strapped on, and life would flow through plastic, but I have vivid memories of patients talking calmly on their mobile phones, their sense of comfortable breathing undisturbed. They talked their way to ICU—the low oxygen imperceptible even as their organs were being starved of it. Things would be seemingly stable, and then suddenly the ground would give way, spiralling all the way to lung failure…. Numbers play tricks on perception. An oxygen reading of 89 was reassuringly close to 90, but 88 was far too close to 87, and my stomach would tighten at what it foretold.
When my mother’s oxygen dipped to 88 the other day, I was paralysed with dread. They had been very careful, my parents. In their 80s, they isolated and masked and socially distanced with diligence. This was Chennai, and down south, the second wave was not as bad as in the rest of India. When she first developed fever, we swabbed, expecting normal results. She was swab positive. Six weeks after the first vaccine dose, we reckoned that she should have some protection and the infection should be mild. Plus, the vaccine would render her less infectious to others in the family bubble.
Then the cough started, and oxygen fell. I was the doctor daughter. We discussed the option of steroids at home, tele-consultations, hospital. She wanted none of it. “Corona had better pay its time share if it wants to hang on in my body” was her attitude, and she ploughed on with her breathing exercises. She dismissed the idea of home oxygen outright: “Do you even know the realities here?” She cited Mr Bean’s method of administering oxygen by waving the air at a man who had collapsed in front of him. That day, as I spoke to her via Whatsapp, I found myself taking many photos of moments. In a surreal turn, for some reason, I found myself using sign language with her the way I had done with my ICU patients when we were separated by layers of masks that annulled sound. As though the distance that separated us had annulled sound but not sight. That night, sitting miles away, my thoughts went back to my patients in Spring 2020 who moved from conversation to ICU to fatality in a span of 48 hours.
The annals of Covid will have as many chapters of disgrace and greed on the part of nations and corporations as those of suffering and courage of ordinary people. Three things stand out for me.
First off, vaccine. A single dose of vaccine has the capacity to take the edge off respiratory failure, even in the elderly. Relief beyond words. Vaccine hesitancy was prominent early in 2021. Now, to be sure, hesitancy is a function of individual psychology and attitude: much has been written on it, and huge progress has been made by targeted drives to reassure people with basic science and the alluring idea of the world returning to normalcy. Consequently, vaccine uptake is higher now, globally. Centres in India are overwhelmed, and maybe even vaccine hoarders are discussing the practicalities of whether and how to display humaneness.
Some blemishes linger on that map, though. The UK prime minister said recently that greed and capitalism helped Britain’s vaccine success. At what point should corporate and national greed be satisfied and vaccine formulae revealed? I have been looking for references but have not found any. Vaccine nationalism must have intangible criteria, grown-up discussions behind closed doors, in contrast to vaccination targets where victories are announced like a triumphant school-child….
The second is caution—or to be more precise, the way caution was wilfully abandoned. The precautionary principle is simple in definition, complicated in use. It was first enunciated thus in relation to environmental waste: one cannot use lack of knowledge to justify environmental crime. In other words, you cannot dump waste in the ocean just because there aren’t conclusive studies on how this might cause harm. Potential harm must beget utmost caution, even if cause-and-effect relationships aren’t fully clear. The Wingspread definition embedded it in public health. And with this pandemic, even cause and effect are crystal-clear.
In the premature lifting of lockdowns and in the utter unpreparedness for crisis; in the flamboyant display of public gatherings, we witness a collective disregard for caution. We have repeatedly let our guard down. Fuelled by hope and faith, but not informed by reason and caution. Despite having a lot of evidence and experience to know this virus’s patterns of behaviour, that it feeds on crowds. Entire nations are at fault for abandoning caution. Sweden and the US are examples of this fallacy in thinking. But to throw caution to the winds in the face of ongoing danger—to not stanch a bleeding wound in front of you—is an entirely different level of carelessness. It is criminally negligent. When every country was experiencing a second wave, everything cried out for you to err abundantly on the side of caution.
Those two segue into the third: leadership in abdication. The most arrant display of these collective failures is now in India. It is also a stark reminder that our leaders have let us down time and again, that common sense lies buried—left to fossilise as rapidly as the glaciers melt. Instead, we have a risk/benefit-based approach (risk to whom? risk of what? benefit to whom?). Or worse, political ambition and corporate greed dictating national responses.
But what about societal responses? As leaders are accused of posturing, denial and misinformation, what about the question of striving for a more humane new normal? Are we too numbed? Have we buried the question we asked ourselves at the beginning of the pandemic? Possibly we have. Covid’s assault has been vicious and very, very tiring. But that is not an excuse to regress. We should demand at least that much from ourselves and our leaders. To vaccinate everyone must be on everyone’s priority list. Governments everywhere should commit to this and societies everywhere should push for this. And until then, we must remain cautious.
Her cough worsened. Oxygen still hovered at 88, 89, 87…. She looks better, and, inexplicably for me, will not brook steroids. But she’s on edge about the others in the bubble. She wants everything she declined to now be done for my father. For my father was now infected, more unwell than she, his oxygen dipping more rapidly. He had been on tenterhooks about her and was relieved at her stability. When she strode to the kitchen, flouting rules, he was reassured. The next day, he started coughing and he knew. They had worried about this ‘who goes first’ question in its myriad forms for some time and the year’s isolation had sharpened their views. I hoped he would settle—one vaccine dose, steroids, home oxygen—but as I write this he is waiting for an ambulance and I am numb. The dreaded 88 barrier has crashed. If things go right, soon he will speak in sign language.