Covid in Quarantine? Malaria in Mumbai!

"suddenly everyone is rushing for the oxygen"

It’s the 5th of March 2020 and Rajesh is heading back to work in West Africa after enjoying a few weeks at home with his family in Mumbai. Coronavirus cases are on the rise throughout China and Europe, and as Rajesh transits through Frankfurt airport he soon notices that people are already wearing masks. He is reminded of the Ebola outbreak which happened only a few years ago, causing his company to start providing masks and hand sanitizer for its employees when they needed to travel. Per the protocol he has packed a mask with him and adjusts it over his nose and mouth as he makes his way through the busy airport.

He is only back at work for a week when the storm which has been brewing steadily, finally erupts across the world. Flights are cancelled and airports close, including the one that he needs to fly in and out of for work. Initially, Rajesh is not too concerned - he is scheduled to be at work for another few months still so he figures everything will be over by the time he is due to go home. As the weeks pass, however, positive cases back home in Mumbai quickly rise due to the density of its population and Rajesh becomes increasingly worried about his family. The seriousness of the virus hits hard when a young West African colleague becomes infected and actually dies. Rajesh later hears of another colleague back in Mumbai who has also died after being placed in isolation in the COVID centre. It shakes everyone up, fuelling the underlying fear amongst the staff, and Rajesh starts to wonder about going home.

The airports are still closed to commercial flights, but on 25th June, a repatriation flight is finally arranged for the Indian community living and working in the region. At first, Rajesh is the only Indian not booked on that flight – he is needed for an important work project that is just entering a critical phase. At the same time, no one knows when international flights will start again, so if something happens at home, it will be virtually impossible for Rajesh to leave. In the end, he obtains authorization to work from his home in Mumbai and is able to join the flight. The group of about 10 passengers are taken to the local airport, but after they are stamped through immigration, they receive the news that there is a technical problem with the plane. They have no choice but to wait for ten hours in the derelict airport while COVID circulates in the humid air, their faces damp behind masks as they try not to touch anything.

They are still waiting in the airport that afternoon when Rajesh begins feeling unwell. His temperature is high and his body shivers involuntarily. Rajesh says nothing, everybody knows now that fever is a symptom of COVID and he doesn’t want to cause a panic – particularly in the airport where the local officials may direct him to some hotel, or even the local hospital with questionable sanitization standards. Despite the sinister symptoms, Rajesh is sure that he does not have COVID; the potential for exposure is low. He has been working from home, hardly seeing anyone other than a game of pickle ball for a bit of exercise. In fact, it was during a game just the other evening that a mosquito bit him on the side of his head. Before COVID existed, a fever in West Africa generally pointed to one thing: Malaria. The tropical disease is prevalent in the region; so there’s every possibility that the pesky pickle ball-loving mosquito was carrying it. He takes some paracetamol to keep his temperature down and feels the sweat of the fever trickle beneath his shirt. The fever comes in waves, and Rajesh keeps quiet.

Their plane finally takes off, refuelling in Addis Ababa before landing in Mumbai. About 10 minutes before landing, Rajesh is hit by another wave of fever. A colleague finally notices him shivering and insists on checking his temperature which is undeniably high. His colleagues are scared, of course it must be COVID and since they all have been traveling together, they are all probably infected too. Rajesh takes some more paracetamol – if the Indian officials detect his high temperature they too will assume he has COVID and will haul him straight into the COVID isolation centre. If this happens, and he actually does have malaria as he suspects, the consequences could be fatal.

All international passengers arriving in India are required to enter hotel quarantine for 7 days. The next day, the fever cycle still rolling, Rajesh calls reception, explains his situation and asks that they send the doctor. Frustratingly, the Government doctor refuses to come until Rajesh is tested for COVID on day 5 per “standard protocol.” Rajesh, despairing, tells the doctor if he waits that long it will be too late – if left untreated, he could die in the hotel. He drinks more and more water, dosing himself with paracetamol, a bitter film coating his tongue. The doctor finally agrees to come after Rajesh calls in a favour with a childhood friend who works in the Ministry, but the medication he supplies is the kind used for local malaria rather than the deadly West African type. Rajesh sends a photo of the tablet to the clinic at his work in West Africa, who are experts in treating malaria, and asks them to verify whether he should take it. The answer is no. He has been given the wrong medication.

Desperate, Rajesh contacts his employer directly and a video appointment with a doctor from Delhi is finally arranged. It’s now been three days and the treatment window is shrinking fast. The doctor diagnoses him with malaria and to Rajesh’s utter relief prescribes him the correct treatment. He completes the 7 days quarantine and is cleared to return home, where although his symptoms have abated, his wife insists on taking him for a blood test. Malaria is confirmed.

Rajesh spends the next 3 months working from home. There is supposedly a lockdown in place but not everyone abides by the rules. People go to the vegetable stall, reaching across one another to get what they want, without worrying what they touch, without wearing masks. Police chase people in the street beating them with canes to try and force them to obey the rules.  Rajesh, an experienced engineer, determined to protect his family from contracting the virus, rigs up a bacteria-killing device using a cardboard box and aluminium foil rigged with ultra-violet light tubes. Every item his family brings in from outside the house goes into that box with the timer set for ten minutes - fruits and vegetables, but also cash, anything that might have been touched by multiple hands.

Rajesh returns to work in West Africa in September and is away from his family for 6 months until the critical project is finished. He talks with his wife every day and she describes how everything at home is open, people are going for picnics, the number of cases has gone down, people are starting to relax. Rajesh, ever-cautious, reminds her to stay alert, to keep taking precautions – continue using the UV light box and stay at home as much as possible.

Late February 2021 and Rajesh is looking forward to seeing his family. His wife has been complaining of body aches for three days – he urges her to get a COVID test but she refuses, she feels fine really, doesn’t have a temperature or any of the other usual COVID symptoms. They are only seeing 5-10 cases per day, no one is thinking about COVID much anymore, in fact the COVID centre is empty. It’s only a few days later, when her parents who are generally fit and healthy, and who practice yoga regularly, return home after their daily walk, struggling to catch their breath.

The next day her father has deteriorated - coughing slightly, he also has a temperature and is shivering, his chin vibrating as he talks. Both parents test positive for COVID and are admitted to the COVID centre. An MRI shows that 30-35% of the father’s lungs are already affected by the virus but the mother is barely symptomatic and is discharged after 3 days. The father is later taken for another MRI and the infection has spread - his lungs are now 40-45% affected, and if he doesn’t improve soon, it will affect his other organs. After 5 days they decide to move him to ICU in another hospital so he can receive a higher flow of oxygen. The only other option is a ventilator, but that may make it harder for him to recover. They move him to the hospital, increase the oxygen flow to 60 litres, and after another five days he thankfully recovers.

A second wave has clearly hit India and suddenly 1000 people are dying per day in Mumbai’s state of Maharashtra alone. There is another lockdown. Shop hours are reduced, but instead of limiting exposure, it has the opposite effect as crowds rush to the shops all at the same time. Some people ignore the rules because they have already had COVID and think they’re immune. The shrill wail of ambulance sirens fill the air continuously. Conversations amongst Rajesh’s family and friends regularly include remarks such as “he is sick because of COVID”, “he’s in hospital because of COVID,” “he died because of COVID.” The COVID centre which not so long ago was empty, is once again full. People queue outside and beg the staff to be admitted, to give them oxygen, even if there is no bed available, they will lie on the floor. But there is a shortage of oxygen as well as beds. The crematoriums too are full – when the mother of a family friend dies although not COVID related, the family is told that they cannot accept the body for another 8 hours. They don’t have the space.

Months later, there are still 40,000 cases per day throughout the country. India’s goal is to have 70% of their huge population vaccinated by the end of the year. Rajesh and his wife are vaccinated, but there is reluctance in certain villages, people are suspicious of the injection and misinformation is rife.

Even with sufficient supplies, vaccinating a population of 1.366 billion will take some time.