The CoViD-19 virus is presently the queen on the chess board. But, in chess, the focus should be on all the other pieces too. Western countries, the whites in the game, despite their good hygiene, and low population, majorly due to high old age and obesity, have been the worst affected than most of the Asian and African nations, the blacks on the board. While things are different on the white and black side of the chess board and the black is likely to win the CoViD-19 endgame, it will lose the tournament as lockdown will only lead to loss of livelihood and many lives which could, otherwise, have been saved had black not opted for the drastic measures imitating from the white side of the chess board, writes epidemiologist AMITAV BANERJEE
One of my favourite methods of teaching epidemiology and public health is to compare this fascinating field with the game of chess. While a clinician treating individual patients sees a disease problem in piecemeal, a public health epidemiologist has to see the larger picture.
In chess, the beginner gets fascinated with the power of individual chess pieces, the favourite of most being the queen. A seasoned player on the other hand, not only sees all the chess pieces but also the combinations of these pieces with each other. A novice player who focuses only on one piece at a time loses easily to an experienced player. In chess seeing one’s own pieces as well as the opponent’s pieces and their relationships to each other is important to win.
The CoViD-19 virus is presently the queen on the chess board. Most novice players and self styled experts have their vision firmly focused on it oblivious to the other pieces and their combinations on the chess board on which the CoViD-19 chess game is unfolding. Presently it is in the middle-game phase, ideal time for seeing the other pieces and analyzing their combinations on the chessboard.
Black is winning. A rapid look at data (as on 17 May, 2020) from a sample of Western, South Asian and African countries will make this apparent [Tables 1 – 3]
Western countries have better hygiene and sanitation with much lower population density than most Asian and African Countries, still they are the worst affected not even the royalty being spared. Most African and South Asian countries have very high population densities with a large part of their population staying in slums where “physical distancing” and “hand washing” the measures promoted to control spread of CoViD-19 is just not feasible. For e.g. the total slum population of India is over 6.5 crores, the size of most European countries. For more than a month this large slum population is confined indoors due to lockdown, in fact achieving the opposite of physical distancing and hand washing. Anyone who has visited a slum will see the crowded living conditions (5-10 persons in a room), the scarcity of water and common toilets.
Why the sky has not fallen on this population of 6.5 crores? Spain, Italy, UK and France with population equal to or less than 6 crores are having almost 30,000 fatalities from CoViD-19? India with a population of 130 crores, has below three thousand deaths so far. Lockdown cannot be the reason as explained because of the proportion of slum population size which is equal to most European countries.
The same pattern can be observed in almost all the countries in Africa and South Asia shown in Tables. Western countries which can indulge in the privilege of social distancing and frequent hand washing are having 200 to 500 times more fatalities from CoViD-19 than the crowded and unhygienic populations of South Asian and African countries.
What are we missing? Why are we insisting on one size fits all? Obviously something is very different on the white and black side of the chess board. Let us look at the other pieces on the board. As will seem striking from the Tables the Western countries have much higher median age and much higher levels of obesity compared to the Asian and African countries. Older age is associated with higher fatality from CoViD-19. So is obesity, it compromises lung function and also is a surrogate marker for other co-morbidities such as hypertension and diabetes, conditions increasing bad outcome from CoViD-19 infection. It seems that even a little higher prevalence of obesity increases mortality from CoViD-19. Among African countries Egypt and South Africa are having higher obesity rates and also higher mortality in Africa from CoViD-19 albeit far lower than the Western countries.
Some have also suggested that past infections with other corona viruses, likely in overcrowded living conditions may offer cross immunity against CoViD-19 – this has to be confirmed by proper studies.
It is possible that factors like lower age of population, lower prevalence of overweight and past infections with other corona viruses may be acting in combination (like weaker chess pieces) to trap the CoViD-19 queen on the black side of the chess board.
This is the middle game analysis… with the massive advantage so far… black is likely to win the CoViD-19 endgame. The serious concern is that it may have won the game but will lose the tournament. Due to lockdown there will be loss of livelihoods and many lives which could have been saved had black not opted for the drastic measures imitating from the white side of the chess board.
The take home message both in chess and public health is that we should see all the pieces and their combinations on the board to win and avoid the present zugswang state.
AMITAV BANERJEE is Professor at Dr DY Patil Medical College, Pune. An epidemiologist, formerly with the Mobile Epidemiological team of the Armed Forces Central Epidemiological Surveillance Centre at AFMC, Pune, he has experience of control of epidemics at different locations of the country such as outbreaks of pneumonia, hepatitis, typhoid, German measles, food poisoning and tribal malaria. https://www.youtube.com/watch?v=bZOWByfbYNY . He can be reached at email@example.com
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