How to lock out the virus without a lockdown.
BENGALURU: Between the extremes of a prolonged total lockdown and inaction awaiting herd immunity, how can we protect ourselves from any new or mutant pathogen is the trillion dollar question worldwide. For the first time in human history, we have had a flurry of new coronaviruses. While the rest of the world is fighting vaccine trade wars, vaccine hesitancy and anti-lockdown civil wars, the vaccination priorities of the Chinese government are radically different. The unique vaccine program with Chinese characteristics prioritises armed forces and economics over health workers and leaves out those above 59 years of age. To the GDP and global domination obsessed rulers of this aging population, the aged and vulnerable seem a liability.
* Preventing and reducing virus transmission without a lockdown: Strategic stocks of protective equipment will enable rapid, early, free distribution to an entire community affected. All kinds of crowding, especially indoors should be proscribed. Signal data of mobile phones can identify crowding in real time. Movement of people should be reduced by remote working and home delivery of essentials. Effective contact tracing, testing and isolation and appropriate public behaviour are essential to avoid a lockdown. Once a vaccine is available, a vaccine certificate should be essential for moving out of one’s home with a mask.
* The Edinburgh alternative to lockdown: The University of Edinburgh’s stratify and shield plan involves protecting the elderly and high-risk individuals from infection, while allowing exposure and immunity to grow among low-risk individuals until most of the population is protected by herd immunity. They believe it will end an epidemic in months, while restoring economic activity, avoiding overload of critical care services, and limiting mortality. The key uncertainties are the extent to which infection confers immunity, the prevalence of immunity and the infection fatality ratio. However, Professor Blakely of Melbourne University said, “This black-and-white concept of magic herd immunity, I suspect we’ll never achieve it because variants will keep coming up and popping up.”
* The Bengaluru alternative to lockdown: Researchers from Indian Institute of Science Bengaluru have suggested a multi-lattice small world (MLSW) network for cities. Through simulation studies they found that restricting lockdowns to infected wards (Ward Seal and Open WSO strategy) identified by a hotspot surveillance strategy can indeed out-perform global lockdowns in both reducing the attack rate and also shortening the duration of the epidemic. This policy only constrains the residents inside the ward and the remaining populace go about their business. WSO strategy crucially depends on the ability to test all residents in the hotspots. Contact tracing within the ward definitely helps in improving the WSO policy outcomes, though it is not necessary. Shortage of testing kits makes WSO unviable. Instead a partial opening of the economy, such as a Two-Day Work Week, can be effective if augmented with extensive contact tracing.
* Preparing the public for a pandemic or bio war: Routine frequent training and education between epidemics is required to ensure appropriate behaviour during any epidemic or bio war. Even in normal times people should be encouraged to use masks routinely to protect against air pollution, allergens, common cold etc., so that they get used to the use of a mask. Everyone’s immunity can be improved by encouraging a healthy lifestyle and nutritious eating habits from a young age. All that is injurious to health like pollution, junk foods, tobacco and alcohol should be discouraged and all misleading advertisements banned.
Pandemic or bio war management policy and infrastructure: Adequate high quality anonymous data, better analysis, stakeholders’ feedback and social sciences research are essential for better data and testing driven policy. A simple common protocol with a decentralised management allowing enough leeway to empowered local bodies is required. One size fits all policy is not practical in a large nation like ours due to differences in geography, population density, urbanisation etc. To ensure efficient deployment and use of scarce resources, health apps with an efficient nationwide communication and logistics network is needed. All necessary emergency facilities like oxygen supply and ICU facilities should be planned such that they can be rapidly scaled up and shifted to wherever they are needed and deployed by the natural disaster response force (NDRF). An effective, extensive healthcare system with infrastructure and staff, covering the poor and all remote populations is needed. Industries, essential services, training institutions, etc., should plan in advance to provide residential facilities in-house during an emergency. Broad spectrum antivirals and anti-infective agents, polyvalent vaccines and essential drugs should be developed and stocked. Production facilities should be rapidly scalable to global capacity. The Epidemic Diseases Act should be updated to cover exigencies arising out of bio warfare.
Vaccines, the ultimate weapon: Each new virus necessitates rapid development and deployment of a new vaccine. This needs adequate public funding of research, testing and production facilities. A strategy to quickly develop, test, give regulatory clearance and deploy, is essential. Vaccination should be free for the poor and carried to the doorstep where needed. Transparency, mass education campaigns and celebrity endorsement are essential to prevent disinformation campaigns and vaccine hesitancy. Vaccination certificates should be made essential for moving out during an epidemic.
The vaccine conundrum: There is no place for politics, hoarding and patent denial in a pandemic. This pandemic has exposed the international differences in vaccine program priorities. Some nations have prioritised their armed forces. China has left out those above 59 years of age (see the image of their website). Health workers are fourth on their civilian list of essential workers. Their autocratic regime is more concerned about the economy and the youth as they are worried about large scale protests if the youth and economy are affected. The aged and vulnerable are not a priority for them in an already aging population. This would be morally reprehensible and politically suicidal in any free nation.
Containing rogue nations: Rogue nations and entities will not allow WHO to function and will sabotage it from inside. An international agreement on standard operating procedure for pandemic and bio warfare management is essential to put up a united fight for humanity. The agreement should include a strategy to declare the entire rogue nation as a containment zone and block all trade and travel to that area to prevent further bio weapon attacks. Our bio-policies have to evolve with the evolving geo-politics.
Dr P.S .Venkatesh Rao is Consultant Endocrine, Breast & Laparoscopic Surgeon; National Delegate (India) to International Society of Surgery; President 2014-15, Indian Association of Endocrine Surgeons; former Professor of Endocrine Surgery; former Faculty CMC (Vellore), AIIMS (New Delhi), UCMS (Delhi), MSRMC (Bengaluru).