The Reaper’s Dance: 1,000 Days of COVID

THE

REAPER’S DANCE

1000 DAYS OF COVID

Fourth Edition

Ravi R. Iyer, M.D.

Copyright © 2024 Ravi R. Iyer, M.D.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

Archway Publishing

1663 Liberty Drive

Bloomington, IN 47403

www.archwaypublishing.com

844-669-3957

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

ISBN: 978-1-6657-4472-0 (sc)

ISBN: 978-1-6657-4471-3 (hc)

ISBN: 978-1-6657-4473-7 (e)

Library of Congress Control Number: 2023909697

Archway Publishing rev. date: 4/17/2024

CONTENTS

Foreword

Introduction

Chapter 1 The Gathering Storm

Chapter 2 You Shall Not Pass!

Chapter 3 A Captainless Ship

Chapter 4 The Face of the Reaper

Chapter 5 Pandora’s Tears

Chapter 6 Gain of Function

Chapter 7 Kali’s Dance

Chapter 8 Man Who Would Be King

Chapter 9 The Hope of Heroes

Chapter 10 Vaccines and Violence

Chapter 11 Virulence and Variants

Chapter 12 Long COVID Zombies

Chapter 13 A New Normal

Epilogue

About the Author

The stories of individuals depicted in this book are thematically based on real stories during the pandemic. In every instance, these stories have been fictionalized to preserve privacy and mask the identities of real individuals. It is possible that some readers may recognize elements of their experience in these stories. The reader should not be under the impression that their life has been depicted but rather understand that their own life experience was synonymous with the experiences of thousands of individuals during the pandemic.

For my mother, who lit the lamp of self-expression in me,

For my father, who ignited the fire of resilience and drove me to find myself,

For my wife, my steadfast champion,

For my children, who give meaning to it all,

For my staff, who support me in my purpose,

And most of all,

For my patients, who believed I could keep them safe.

To the many physicians, scientists, and patients whose personal stories of courage, folly, suffering, and hope were the inspiration for this book and the story it tells, in the hope that we may never again return to the horror of those dark days—the world owes all of you an immense debt of gratitude.

FOREWORD

A crucial election loomed in the Indian state of West Bengal in April 2021. Living in Singapore, my brother and I watched TV news with foreboding as India’s Prime Minister Narendra Modi, ignoring the warnings of epidemiologists, addressed packed election rallies with tens of thousands of people in attendance, while the Delta variant ran amuck in a wave of disease and devastation. News and social media were awash with reports of hospitals turning patients away due to a lack of beds and of patients dying in hospitals that had run out of oxygen. Crematoria fires burned non-stop as the bodies piled up.

My parents lived in that state, and while they rarely ventured out, and always masked up when they did, I worried that the vector of the election rally-fueled infection would inevitably catch up with them.

A week later, despite receiving the 2nd dose of the Astra-Zeneca CoviShield vaccine both my parents were stricken with fever and the classic signs of the disease. Ironically they had caught the disease while waiting to be vaccinated in the overcrowded vaccination center!

I was in Singapore, behind closed borders and shutdown airlines. My parents were alone in Kolkata and the Reaper was standing by their bed! And so began my mother’s 2-week battle with the Delta variant while my Dad was more fortunate with a milder version of the illness. As I frantically worked the phones to get a hospital bed for mom, I was acutely aware of the good fortune that provided me access to a network of resources that few could enjoy. One element was my cousin, Dr. Ravi Iyer, who had been on the frontlines of Covid for a year, in Virginia USA.

Chapter 9 of The Reaper’s Dance speaks of the collaborative work of the GWAPI physicians as a consultative resource with Indian medical teams and my mother and I were direct recipients of this phenomenal network of courage and support that spanned the world. Together with other physicians, Dr. Iyer formed an informal medical advisory committee to support my family. When mum’s condition worsened, he was there to strategize with me as to what I should request of the Indian doctor while simultaneously checking in with my father who was isolated at home. Both my parents recovered and the Reaper was denied his quarry.

In this book, Dr. Iyer has distilled a lifetime of experience in medical practice and research, as a frontline medical worker in the war against the Covid pandemic. He expands on the lab leak theory as well as the hypothesis that the SARS-CoV2 virus jumped from animals to humans at the Wuhan wet market; he explains the mechanism by which the virus infects the human body, and how mutations occur; he shines a light on the policy and communication missteps of the Trump administration, and the fog of disinformation that frontline medical workers had to encounter.

And he shows a mirror to all of us. He compels us to examine our role in the global cycle of consumption, how we infuse our own biases with a sense of righteousness that reduces our ability to reach across the aisle in discourse and to lend a helping hand to others.

With continuing destruction of habitats bringing humans into close contact with wild animals, the probability of a new virus making a similar jump from animals to humans is a very real possibility. We must learn lessons from the Covid pandemic if we are to stand a better chance at saving lives and preventing mass economic distress to millions.

Informed and enlightened voters are the most powerful way to hold elected officials to account and make decisions that build our long-term capacity to tackle a health emergency. In an engaging narrative style, The Reaper’s Dance empowers us to understand the mechanisms that led to the spread of the Covid-19 pandemic. It makes an urgent case to address gaps in healthcare systems and infrastructure, and to respect the science.

The next time around, we can do better. We must do better.

Anusha Bhagat

INTRODUCTION

To say that the COVID-19 pandemic shook the world is like saying the eruption of Mt. Vesuvius of Pompei was a wakeup call. In every way the pandemic with its immediate threat to life and survival as well as the chaos of the response to it completely shattered the human psyche across the globe. The idea for this book evolved slowly over 2020 and 2021 out of my team’s experiences here at The Iyer Clinic on the frontlines of healthcare during the pandemic. The work we did at the clinic very quickly impressed on me the overpowering need to educate the public about serious issues facing them. I could see that my forty years as a physician was directly undermined by multiple forces that were destroying the fabric of human interconnectedness, and that leaders and public health authorities were doing an abysmal job in communicating the lessons that needed to be taught. The human experience is multifaceted and complex. It would be a grave injustice to cast everyone into a single dimensional story. There is no single hero or villain in this story and even the most egregious offender did do some things wonderfully well, while some of the greatest champions in the public health arena had their feet mired in some pretty dark dirt. When humans are brought face to face with their own fragile mortality and look into the abysmal blackness of the eye sockets of death, the veneer of pretentious morality is stripped bare, and the true substance of their character becomes revealed. The pandemic laid bare the human psyche at its most elemental level and for an intense 18-month period human society came to grips with existential questions of what it means to be human and have a relationship with us and our fellows. In this 2nd edition of The Reaper’s Dance, I take you, the reader, by hand through the days, weeks, and months of the journey we walked at the clinic and elsewhere while unraveling the story of the pandemic piece by piece for you to see, experience and absorb. Unlike other works the story of the Covid pandemic is still evolving and new information regarding its origins is emerging almost daily and lending urgency to the need for comprehensive reforms in the way we oversee and regulate all such research. Most of all this book is a plea and a pathway to understanding the essential interconnectedness that we have to each other and the health of even a blade of grass on every continent of this fragile planet.

CHAPTER 1

The Gathering Storm

At the end of time, when the many become one, the last storm shall gather its angry winds to destroy a land already dying. And at its center, the blind man shall stand upon his own grave. There he shall see again, and weep for what has been wrought.

—Robert Jordan, The Prophecies of the Dragon, the Essanik Cycle.

The Beginning

Thursday February 27, 2020

Mr. Hutchinson got out of his car at the Dulles Town Center mall. His faithful Labrador dog was turning eight years old that weekend. He was excited. He loved that dog. Eight years! he thought as he walked toward the pet superstore. It’s been quite a journey. A new kennel would make a perfect gift. He walked into the mall, crossing a line of window displays. He stopped and window-shopped a bit. A group of tourists bustled past him chattering excitedly as he strolled along gazing at the window displays. He walked into the pet store, stopping to pick up some treats for Oscar from a side aisle. The options were many, but he finally found a salesperson who was able to help, and he stood in line at the checkout counter with a kennel that was the perfect size for his dog.

Pushing his cart with the large kennel out of the store, Hutchinson felt a little shaky. He glanced at his watch. It was half past noon, and he hadn’t had any breakfast. Even though he had not taken his diabetic medications that morning, Hutchinson knew the telltale signs of low sugar. He had better eat. He rolled the cart toward the food court in the mall center, stopping at a Dunkin Donuts shop to pick up a frosted doughnut. He sat down at a table in the food court. The doughnut was a taste of sugar heaven. The crowd of shoppers passed his table, chattering excitedly as they stood in line at the Chinese food stall. Tourists, thought Hutchinson as he bit into his doughnut.

Behind him. a couple coughed loudly and then sneezed.

Hutchinson turned slightly.

Excuse me, the woman said, smiling apologetically.

Hutchinson smiled and nodded an acknowledgment. His doughnut was finished anyway, and he felt stronger. He got up to leave.

***

Saturday February 29, 2020

Hutchinson woke up feeling woozy. There was a dull headache, and his head felt heavy, like a hangover. He walked into the bathroom, reached into the cabinet, and popped a couple of pills of Tylenol. The party the previous day must have been too much, he thought, making a mental note to turn in early that night. He walked down to the kitchen to pop a Keurig coffee pod into the machine. The sound of coffee percolating into his cup filled the kitchen. But this time, the accompanying aroma was absent. He picked up the cup and sipped as he reached for his iPhone. Strange, he thought. The coffee tastes funny.

He turned toward the back door as a wave of dizziness washed over him. He staggered in midstride, and then,