In Focus

COVID-19: Some Lessons other than Medics

Being a pilot by profession I couldn’t restrict the flow of my thoughts leading to various scenarios where movement through air comes under focus while facing the pandemic of COVID-19. On the one hand, we find the global air travel coming to a virtual halt; an unthinkable scenario, plunging such a big industry to ground level. And on the other hand, we also find critical role of air mobility once it came to tackling the crisis in Wuhan.  In February 2020 PLA used six Y-20s, three Il-76s and two Y-9s transport aircraft to carry 1,400 medics as well as medical supplies from seven cities across the nation including Urumqi, Shenyang and Chengdu. This military style concentration of medical resources played a vital role in containing the spread of COVID-19. In Italy and France especially equipped helicopters are flying day in and day out, transferring patients from the over-stretched facilities to other facilities. And as I write this article, there are over 20 flights by China alone to various countries supplying the critically needed medical supplies, besides an airlift of a team of Cuban doctors to the current epicenter of this calamity, Italy. If the Bubonic Plague took more than 5 years to spread from Mongolia to London in 1330’s it has hardly been less than 90 days that COVID-19 is entrenched in New York and California in the U.S. Is this fastest means of transport responsible for the rapid spread of disease or is it going to be a critical tool in the hands of humanity to overcome this pandemic? Triggered by the thoughts primarily focused on the role of aviation within the perspective of global calamity, I was driven by the intense pressure of emerging social scenarios as portrayed by media and the flood of information leading nowhere but towards the layers of anxiety. Therefore, you will find a collection of thoughts, information and analysis as gathered from various means pitched with the background knowledge built overtime through reading etc.



One can’t help but find the thoughts drifting to various parts of history and imagine certain similarities, both in explanation and dealing with it, once it comes to the means of transportation. It was in the year 1346 when Bubonic Plague is recorded to have spread through trading ships, originating from a Genoese port of Caffa along the coast of Black Sea. The disease entered Europe though Italy, port of Messina, and later moved up north and by 1347 it had claimed lives of millions. Back then, other than religion, there was no explanation of such a calamity which displayed no distinction between poor and rich, pious and immoral and, above all, it had no mercy for clergymen. Most believed it to be a punishment from God for their sins. Passivity and fatalism became the standard response. Religious foundations were shaken and severed, leading to the emergence of protestant reformation in the later years. Nevertheless, taking its natural course the disease died away; speeding up in spring and summer and slowing down in winters, obliterating more than 50% of the population in five years. There wasn’t simply a solution to it other than the discovery that it had a direct relationship with black rodents and the merchant ships/shipping routes which transported them. Later it was also added that in this early phase of modernisation, Europe was also on the way to ‘the golden age of bacteria’, when there was a great increase in epidemic diseases caused by the increase in population density, and in trade and transport. Cholera being the most lethal in unhygienic cities, not to mention the sporadic spread of smallpox and many other.  


Combination of state policy, responsible behavior of media centers and general level of awareness of the people can make a huge difference in own favour. As I write these lines there is a news on television that WHO has launched a mobile application which would keep people aware of the latest on COVID-19 along with the list of precautions – a real-time example.      


In 1918 there was no air traffic yet a deadly flu became the pandemic spreading from U.S. to Europe and India claiming more lives than the WW-I. In India alone it claimed 3.5 million lives. Yes, its spread was slow in comparison but it gave no time whatsoever to state machineries, and in the span of three years claimed the lives of young men and women in millions. Nevertheless, it was also before the advent of antibiotics which were first made commercially available in the 1930s and information sharing was made difficult due to WW-I. The combined effect was that in U.S. alone 675,000 lives were lost, mostly roboust young ones as it attacked the younger population. 
Now coming back to an era which saw the introduction of aircraft and air travel. Citing the example from own area, it became common practice, starting from early 1930’s, that a fighter aircraft sortie would fly from Risalpur to Gilgit and Darosh in Chitral for the delivery of vaccine for the Bubonic Plague. Gilgit and Chitral being the most northerly points of British India were the confluence of various caravan routes which originated from Chinese Turkestan by numerous passes and defiles. From here, caravans took months to reach Indian cities to sell their merchandise (the Silk Road). It was thought that the best way to stop the spread of plague in India was to have all the caravans vaccinated before they began their journey south. British resident agents were responsible to receive and later ensure the administration of the vaccine. Such was the seriousness in according priority and administrative strength of the British Government in India. Nevertheless, by then humans knew the scientific explanation of the epidemics and they had the tools and awareness to tackle it with speed and focus. The clear objective was to contain an epidemic and prevent it from turning into a pandemic. One can only imagine the courage of pilots and the authorities in undertaking such missions in piston engine aircraft which had no onboard wireless communication, no oxygen and no means of finding the latest weather conditions, regardless of the fact that navigation in valleys is the easiest part. One such mission is amply described in the book Never Stop the Engine When it’s Hot written by Air Chief Marshal Sir David Lee covering his time as a young RAF officer. 


On the one hand, militaries are being assigned to ensure the state declared lockdowns and curfews and on the other hand military hardware is being reassigned to establish field hospitals and transport the critically required medical supplies. In Pakistan, Pakistan Army is at the forefront, aiding the civil administration. 


In 2020 the most plausible model predicting the pace and direction of the COVID-19 is through the density of flight operations originating from Wuhan, China. Before its magnitude and lethality was realized through air traffic it had spread to various parts of the world and soon countries like Italy, Iran and Spain were found overwhelmed by the scourge. Now, governments have not only shut down all means of transport but have also imposed restrictions on movements at the very individual level. Such are the challenges of today’s world and the decision makers. Nevertheless, human capacity to fast tackle epidemics and pandemics is exponentially enlarged as compared to mere 50 years ago and 100 years ago, i.e., during the Spanish Flu pandemic. Steadily but surely human prowess has been successful in tackling many middle age scourges like leprosy, smallpox, cholera, measles and polio. It wasn’t a small feat in 1980 when humanity was officially declared free of smallpox. People of my generation have vivid memories of getting anti-smallpox shots in schools under the global schemes. However, post smallpox world, less few parts of Africa, takes contagious diseases as something of the past and kind of a temporary issue which has its readymade solution. Advancements in medical sciences coupled with globally constituted and adequately resourced organizations have literally turned the world to such a safe haven that for our generation the very word pandemic is hard to understand upfront. No wonder, the whole world is in shock in assimilating the helplessness of human race once confronted with COVID-19.  
Pandemic in the Age of Digital Revolution
The world is under the cusp of benefiting from digital revolution. Advancements and easy availability of super computers in conjunction with Artificial Intelligence advancements have turned the word “data” into gold dust. To our advantage, we are facing this pandemic in the beginning of the latest industrial revolution. It has been approximately 17 years since the discovery of this virus when it first broke out under the name of SARS. In 2003 there were no super computers available in the medical laboratories along with the absence of accumulation of data in digital formats. This time, even before the breakout of COVID-19, it had been mapped at gene level and with the help of super computers various models of tackling the virus are being tested and analyzed. Under such technically advanced environment the medical circles in the world are quite optimistic to achieve a solution for this pandemic. As of now there are over 19 advance level facilities working day in and day out to find a sustainable solution for COVID-19, albeit, shaking the developed countries to the basic question of not according resource priority to research institutes. If a vaccine is made available within a years’ time it will be a feat un-thinkable even 5-10 years earlier.    


There is also a need to enhance the faith in modern sciences and the value of research in societies like ours. Our younger generation needs to be fully aware that the world before the advent of antibiotics was not a safe place at individual and community levels. The niceties of the modern world which we take for granted are recent in reality. It was in 1980 that the world finally declared itself free of smallpox. 


Age of Information Technology
Another thing which has profoundly changed is that in 1935 other than the British resident in Gilgit, Mr. Clarke, no one in the entire area would have known why those air machines landed at a place which was only frequented with double humped camels and hordes of merchants and guards. However, in 2020 the people in Gilgit are aware of the magnitude of the loss of human lives i.e., that more than 10,000 people have died by the end of March in Italy and what is the global total of the affected and deceased etc. This is the single most serious challenge for most of the societies and cultures have been facing difficulty in being able to find ways to tackle and avoid social discomfort or panic.  Paradoxically, given the magnitude of populations in metropolitan cities and overall in the world, for any state it would have been next to impossible to spread the instructions and precautions or even lockdown etc., without the ability of an individual to have an access to real-time information.  On the one hand if the information highway is fast spreading the latest news, at the same time it’s a great tool in the hands of the governments to reach out at the individual level for the dissemination of centrally conceived instructions. In 1919 radio and the newspaper were the only means to spread a national message through the population, an ability only limited to well-off people of the developed countries of the time. Imagine how difficult it would have been to make a large number of people aware of the dangers of an act as simple as sneezing or coughing. Combination of state policy, responsible behavior of media centers and general level of awareness of the people can make a huge difference in own favour. As I write these lines there is a news on television that WHO has launched a mobile application which would keep people aware of the latest on COVID-19 along with the list of precautions – a real-time example.      
The Paradox of Border Closing vs. Concept of Borderless Help
Growing trade and tariff wars are seriously challenging the recent but promising concept of globalization. Three months ago it seemed that ‘global village’ concept was not standing upto the realistic demands once it comes to economics at the very country level and etc. There was an air of disintegration of regional economic pacts and alliances like the European Union, breakaway of Scotland from England, Catalonia from Spain and uneasiness of Greece in the European Union were the dominant trends. Defined geographical borders symbolizing nation statehood have literally been sealed. But the speed and scope of the mere spread of the COVID-19 has proved that today’s world has in fact been reduced to a mere borderless village. Geographical distances and physical borders have proved to be meaningless vs. COVID-19 in a matter of two-and-half months. Paradoxically, the only thing which clearly had a speed advantage over the disease was the speed of information. The very first appearance of COVID-19 in humans was reported immediately by the Chinese doctors in the last week of December 2019. From the very beginning Chinese doctors have dealt all the patients as per the dictates of digital data collection. This very data is now available to all the modern facilities in the world and all the countries of the world which are devising various models of strategies to confront COVID-19. Holding back of critical information, especially new findings, is not going to be of any economic use in real terms. Current TV programs are urging greater coordination among the countries, joining up of resources and knowledge should the humanity desire to survive such pandemics. One wonders about the selection of its name by a world famous NGO that goes by the name of Doctors Without Borders/Médecins Sans Frontières (MSF). Very few of us know that MSF sent  3.5 metric tons of medical protective equipment from its supply center in Brussels, through the Hubei Charity Federation, to Wuhan Jinyintan hospital – one of the hospitals on the forefront of treating patients with COVID-19 in the midst of crisis. In fact, the whole world stands to learn from their experiences in dealing with epidemics, especially through the involvement of communities. “Community engagement is a crucial component of any outbreak response” is the most important message by them. 


In mere three months it has proved that the pandemic is as bad and as horrendous as a nuclear war can be. All the modern states may now need to reconfigure the security paradigm inclusive of pandemic threat and response. 


Social Distancing and Responsible Behaviour
Most of the known challenges encountered by the human civilization have been pinning hopes through social integration, removing social distances and joining hands to fight a common enemy/calamity. Modern awareness of epidemics is a rather strange kind of battle which needs individuals to keep distance from each other. This measure is more challenging in societies like ours which draws primary source of strength from religious traditions and instructions. Prayers and funerals are under unprecedented pressure to alter as per the threat, leaving very little choice. Again thanks to modern means of communication and household civic/kitchen facilities that despite individually being under lockdown we are connected and aware of each other’s wellbeing beyond international borders. Indoor toilets, piped water, cooking stoves and refrigerators allow us to survive healthily for weeks despite being locked up in houses. Nevertheless, 25% of our population may not have such facilities but their presence and their addressable needs largely depend upon the modern means of communication. The degree of abiding by preventative measures may vary from country to country and culture to culture. Even by the end of March the trends are showing differences. Disciplined people like in China and Germany stand to help their respective governments in tackling the challenge by simply following the instructions of social distancing in comparison to populations of third world countries where states would be bearing the additional costs of enforcing laws physically. Having touched the larger perspective, the whole crisis handling still boils down to an individual and community behavior. Just to cite an example, a street cleaner in Hong Kong attended an MSF health promotion session on COVID-19. “It is the first time to learn that if I cough without a tissue, I should cough into my elbow but not my hands. This helps keep my hands clean, and I think it is important for a cleaner to know that,” she said. In 1918 the posters warned “Spitting Spreads Death”, in 2020 posters are advising “Wash Hands Frequently”, an advice directed at the very personal level. The bottom line is that the centre of gravity in any outbreak lies in community awareness and behaviour.
Misinformation and Disinformation
This being the first pandemic in the era of social media, the impact of large quantity of information has been phenomenal. People have shown their inability to discern misinformation from disinformation. Perceptions like the virus is unable to spread under hot climatic conditions, boost of immune system creates the first wall of defense, inhaling of hot air and drinking hot water makes a lot of difference etc., all have now been catogorised as misinformation. Meanwhile, narratives like intentional spread of virus as a biological weapon first by East and then by the West have all been dumped as disinformation. Western propagated narratives that China underplayed the epidemic and kept vital information away from the world hence leaving little early warning for the rest of the world has also been found as disinformation. Nevertheless, this uncontrolled massive amount of information does create frustration and anxiety at the societal level. In the larger perspective, in the backdrop of history we must at least consciously attempt to avoid falling prey to conspiracy theories and doomsday scenarios. We are not living in mid-14th century when the priests even fixed the date of end of the world – Peter Frankopan in his book  amply elaborates the extent of orthodox social thinking leading to despair and submitting to fatalistic thinking. Sadly, it lead to senseless persecution of Jews in Europe. Example of 1918 Spanish Flu stands tall. Owing to the fact that most of the developed countries were in a state of war, true information was held back as a sign of exploitable weakness. Spain being a neutral country was the only one openly sharing the extent of damage which went as high as 300,000 deaths. The result was that flu epidemic was named as the Spanish Flu despite being the fact it originated in U.S. and claimed more lives in U.S. than Spain. Regretfully, it also led to the persecution of Jews in Russia resulting in mass exodus of Jews to U.S. “Fear can often spread faster than a virus, so helping people manage their stress and anxiety is a key focus for us,” said Karin Huster, who oversees MSF’s project in Hong Kong. The primary conclusion is that today the state needs to share up-to-date, evidence-based medical information and even more crucially, listen to and answer the many questions that this new disease has generated. Only then can a highly informed and inquisitive population be kept calm and confident about the future – not succumbing to fatalist thoughts and narratives.   
Militaries vs. Pandemics
The role of militaries in the times of crises other than war has been profound throughout modern history, especially after the industrial revolution when states could afford large standing armies. Earthquakes, floods and epidemics all have benefited from the resources otherwise dedicated for the enemy only. With the exception of the Spanish Flu, as it was mainly originated and spread through the military camps and movements across the world, militaries have not in fact faced a pandemic after 1918.  As of now militaries all around the globe are at the forefront to assist the state machineries in best handling the crisis. On the one hand, militaries are being assigned to ensure the state declared lockdowns and curfews and on the other hand military hardware is being reassigned to establish field hospitals and transport the critically required medical supplies. In Pakistan, Pakistan Army is at the forefront, aiding the civil administration. Given the motivation level of our troops and the public’s respect for them, the overall security situation in the country remains good. It is through this that our government can focus its attention and resources to medical facilities rather than the upkeep of general law and order, besides the fact that all military medical facilities have been made part of the national effort. As I write these lines, our helicopters are busy in anti-locust operations in Balochistan and our cargo helicopters are transporting medical supplies to various parts of the country.      
Conclusion
The first quarter of 21st century is going to have a lasting impact on the way societies interact with each other and the way states accord priorities to their security paradigms. There is also a need to enhance the faith in modern sciences and the value of research in societies like ours. Our younger generation needs to be fully aware that the world before the advent of antibiotics was not a safe place at individual and community levels. The niceties of the modern world which we take for granted are recent in reality. It was in 1980 that the world finally declared itself free of smallpox. Shouldn’t our children know how difficult it was for Edward Jenner in 1796 to prove that a vaccine of smallpox was worth trying? To prove upon, he had to administer the vaccine on his son which nearly amounted to sacrificing his son but he had faith in science. This is the kind of faith in science we need to inculcate in our society only then we can have better understanding critically required both in preparations and response strategies. Only then can we optimize the advantageous usage of modern tools and methods not only to confront calamities like COVID-19 but to enhance our national response to modern day challenges.  This is what was predicted so aptly by Bill Gates five years ago and by many unknown scientists who predicted it so well. The spread and speed coupled with the total inability to stop its spread and the way states accord ones borders have also exposed the very futility of any possible/potential usage of biological weapons in the modern world. In mere three months it has proved that the pandemic is as bad and as horrendous as a nuclear war can be. All the modern states may now need to reconfigure the security paradigm inclusive of pandemic threat and response. 
In the end, I would highlight that one of our MI-17 helicopters is standing by to fly to Gilgit following the same route as was flown by then Squadron Leader David Lee in 1935 to deliver the vaccines but this time it is in reverse order. Our helicopter is bringing much needed medical supplies sent across the old caravan route of Khunjerab Pass by our Chinese brothers. I dedicate this article to Dr. Usama Riaz who sacrificed his life while dealing with COVID-19 patients in Gilgit.


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