Effective masks, trustworthy, credible public policy and unity of purpose required.

Bengaluru: ADVISORIES, GUIDELINES, PROTOCOLS CAUSE CHAOS: “Dying from a policy is a manmade disaster”, says a Chinese message posted on Weibo. This pandemic, which Chinese authorities tried to pass off as a natural disaster initially, is now a policy disaster many times over. Over two years of this pandemic there has been a profusion of advisories, guidelines, protocols issued by WHO and various national governments and health agencies with frequent changes, U-turns, retractions, often contradicting each other. Blind obedience to WHO’s inconsistent guidelines and China influenced actions has demolished the world economy and WHO’s reputation. Inability to pinpoint what led to this pandemic and lack of imposition of consequences on those responsible have further eroded the credibility and authority of international bodies and leaders. Hitherto globally trusted health agencies and regulators have got into multiple controversies about their pronouncements on infectivity, risks, restrictions, precautions and treatment, and for biased recommendations about vaccines and drugs. Profiteering by pharmaceutical and health related companies and their acolytes has led to a huge trust deficit. All this has led to chaos and confusion, with widespread protests against testing, vaccine mandates, green pass, travel restrictions, quarantine, lockdowns and even masking. The virus keeps mutating and spreading thanks to the absence of Covid appropriate behaviour and inadequate vaccination, while humanity suffers the multiple-whammy of unemployment, economic and financial losses, social and family disruption, mental issues, ill health and death.

TRUSTWORTHY CREDIBLE PUBLIC POLICY REQUIRED: To restore confidence, trust and credibility in the authorities and agencies managing this pandemic, common sense and clear-cut policy is needed based on scientific facts and data in a transparent way by credible unbiased experts. The names and antecedents of the members of the decision-making regulatory commissions should be made public; they should meet frequently—virtually or personally. The minutes of the meetings and the references to studies and data on which decisions are proposed, should also be put in the public domain for quick comments like any preprint scientific article before deciding the protocol or guidelines. Separate guidelines are required for treating doctors, supporting health workers and the affected public. Good communication skills and ability to win the trust and cooperation of health workers and the public at large is essential for the success of any public health policy. Unity of purpose between governing and opposition leaders and between nations against an enemy of the entire humanity is the only way to end the pandemic and recover from it.
GOOD POLICY IS DRIVEN BY ACTIONABLE, RELIABLE DATA: CoWIN app has enabled an efficient rollout of nearly 1.6 billion vaccinations in India. The national figures, guidelines and policies are available on the website: www.mygov.in/covid-19/. The enormous data we have in India about the virus incubation period, transmissibility, genome sequencing, quarantine period, Covid infection symptoms, complications, factors related to mortality, comparative data on masks, safety and efficacy of vaccines, treatment and vaccine protocols, and mix and match of vaccines, can make a huge national and global impact only if properly collected, analysed, disaggregated and published as reliable, actionable data with linkages across databases.
LEADERS, CELEBRETIES INSPIRE REBELS: Many world leaders refused to act, calling the deadly virus only a mild flu. Many celebrities like sports and film stars, social media influencers encouraged vaccine resistance. Political and religious leaders held large rallies and gatherings in total disregard of masks and social distancing. Partying and holidaying by the rich and influential even during the lockdown set a bad example. These bad trendsetters led to avoidable public disillusion and rebellion, to the benefit of the virus. They should have instead led the charge against the virus.
NATIONALISM AND POLITICS: Governments influenced by commercial and national considerations recognised only their own vaccines and certification like the Chinese government insisting on Chinese vaccines for those wanting to visit China. US, Europe and UK promoted their own vaccines, while finding fault with each other’s vaccines leading to vaccine resistance. Politics affected testing protocols, quarantine rules and travel restrictions to the dismay and misery of the infected, the contacts and those on the move. There should be universal consensus on managing pandemics and other global problems like climate change. Global resilient supply chains and disaster management facilities are necessary.
ZERO COVID TO HERD IMMUNITY POLICY: Some US states offered cash as incentive to get vaccinated, while Greece is fining those above 60 years of age who do not get vaccinated. Zero Covid target of China has caused untold misery—from compulsory testing of entire population of cities for even two to three cases, leading to massive queues and crowding, to contacts being forcibly dragged to container like quarantine facilities and locking down of whole cities and regions, leading to untold hardship and disruption of local supplies of essentials and international supply chains. Island nations like Taiwan, Australia and New Zealand shut all borders and tried to set up a fortress to keep the virus out, but it did find its way in. At the other extreme, Sweden decided to have no restrictions, hoping that herd immunity and vaccines would do the trick, but they were tricked by an ever-mutating virus. These extreme responses are best avoided.
SHORTAGES, DEBT, INFLATION HIT ECONOMIES: All that most restrictions and frequent lockdowns have achieved is soaring national debt, supply shortages and economic ruin. Pandemic restrictions have led to shortages galore of food and essential supplies, test kits, vaccines, medical supplies and facilities, silicon chips and essential electronics. Education and social interactions of children were severely restricted. Educational institutions, hospitality and many industries and tourism were dealt a death blow. Expansionary monetary policy of central banks and pump priming by governments to stimulate the economy only stimulated the stock markets as people were unable to spend due to lockdowns and instead invested in equity due to financial insecurity. All financial woes were finally blamed on health authorities eager to recommend lockdowns. These multiple disasters were eminently avoidable with some foresight and lessons learnt from past pandemics.
HELP THE INDIVIDUALS TO HELP THEMSELVES: Having learnt from previous SARS, H1N1 and other influenza outbreaks, WHO and other health agencies should have had no doubts about human to human airborne transmission and what needed to be done to stop the spread of the virus. Free or subsidised supply of N95 masks through dispensers like what was done with condoms for HIV-AIDS control and mass education about their efficacy and proper use should have been the first priority right from the start of this pandemic. Non-essential travel and crowding should have been discouraged. Celebrities, influencers, leaders of all kinds—political, religious and social—and health insurance companies should have been roped in to promotion of proper masking and social distancing. Certified N95 type masks, targeted testing, unbiased scientific data based vaccine policy and general health improvement education about lifestyle modification, pollution control and nutrition especially to improve natural immunity should be first priority. Every person has to fight the virus at the individual level. Common sense tells us that simple clear-cut guidance with supportive information and health supplies is the best way of gaining public trust and cooperation in dealing with both the pandemic and the panic.

Dr P.S. Venkatesh Rao is Consultant Endocrine, Breast & Laparoscopic Surgeon.