By Dr. Muhammad Afzal Khan
Winning the war against this pandemic depends on our decisions. decisions made in fear and haste can lead us down the wrong path, whereas the decisions made on facts and figures can lead us down the right path. Following are the facts and figures of this pandemic in our country. We will be entering the 12th week of COVID-19 disease on 17th MAY 2020. We will probably be touching the peak of this pandemic on 24th May. approximately 10 % of our population is already infected as of today’s data of total number of people tested and confirmed cases. We are a country where the frontline is most affected by the disease. Unfortunately, the peak of this current pandemic in Pakistan coincides with the Eid ul fitar.
he burning question is, will it be wise to relax the lockdown for this eid at a time when we will be passing through the plateau of this pandemic in Pakistan? I personally believe in going ahead with smart lockdown which is the most appropriate approach that finds a fine balance between the two pans of this pandemic carrying the economical loss on one side and the loss of lives on another. Despite being a strong supporter of smart lockdown to manage this pandemic I believe it is the timing of relaxing the lockdown that can change the game. Countries around the world that are easing their lockdowns are ones that have seen their peaks and active COVID-19 cases are declining and declining consistently. Easing lockdown before touching the peak and sliding down could be one of the biggest sins in decision making.
Following are few more burning questions and their answers. WHEN, will this lockdown end?
Ans: when we flatten the curve.
HOW, many of us would be infected?
Ans: Almost everyone who is not following preventive measures
WHO, will survive the disease?
Ans: Mostly those who are below the red line of COVID-19 curve and blessed with herd immunity.
WHO, are below the red line of COVID-19 curve?
Ans: people who are blessed with good immunity, following preventive measures and those who have access to qualify healthcare facilities. We can find our answers to the above questions once we understand the Pandemic curve by CDC and understanding the situation with our own perspectives.
The CDC believes in two major factors playing a vital role in morbidity and mortality of this pandemic. I believe they are ignoring the most important factor that i call the UMBRELLA OF BLESSING which is protecting the majority of people from this disease. where we are joining hands together to save lives. The virus has been playing havoc with the lives of people in many countries for the last few months, since the first case was detected in Wuhan, on the last day of the last year.
While it has been showing mercy in some parts of the world. The convoluted part of this COVID 19 pandemic was that it was difficult to ascertain how the virus would affect an individual person in the beginning of the disease. Now we have an opportunity to utilize the available data and translate it into probable prognostications. The global data shows that the spread of this disease is very slow in the initial four weeks following the detection of the first case in a country, which then gradually increases over the next four weeks. It is from the 8th week that it shows a regular increase in number of infected cases along with increasing morbidity and mortality before it reaches its peak around the 12th week.
As we all know that in Pakistan, it was 26th February when the first case was tested positive. Since then, the same trend with some low intensity has been observed as of today. Now as we are passing through the 11th WEEK from where the disease starts the devastating period of its course.
Luckily we have been among the few countries where the disease reached later than the countries who are experiencing the peak now. We should take advantage of this blessing and focus on the two major factors playing an important part in reducing the number of deaths in our country.
Following are the 2 major key factors,
- Healthcare system capacity.
The COVID-19 curve by CDC can be used as an important tool to save thousands of lives in the coming few weeks before it reaches its peak. The million dollar question is how to practically take advantage of these two vital factors to flatten the curve and save maximum lives above the red line by imposing this powerful force comprising of community mitigation measures and improved health care system capacity.
This crucial goal can only be achieved by taking the present preventive measures to the next level where their are minimum defects in the nonpharmaceutical interventions and increasing our healthcare system capacity on war basis. Although we are a little late but still we haven’t missed the train. The only way to improve the HC system capacity in our present circumstances and with the available resources is by involving private healthcare sectors to flatten the curve wisely and timely.
The private health sector in Pakistan serves about 70%of the population and this makes them a major stake holder and game changer for improving our healthcare system capacity. There are 261065 doctors registered with PMDC and millions of healthcare workers across the country including paramedics working in private HC sector that can increase HC system capacity within few days and arrange fast track COVID-19 fighting short courses to improve the efficiency and capability of the private health sector.
PMDC could have played an important role in this regard but unfortunately its performance has always been poor since it was established in 1974. Sadly, the current status of the PMDC has added further insult to the injury. The leading global healthcare agencies and leading organizations including our leaderships have been working night and day since the first case was reported in the world. They have been assiduous in analyzing data, providing advice, coordinating with partners, helping countries prepare, increase supplies and managing expert networks.
But unfortunately the above mentioned steps and federal government’s collaboration with provinces and institutions to help build their capacity to prepare and respond, Provide accurate information and fight the pandemic, Ensure supplies of PPE for healthcare workers, Train and mobilize health workers, and accelerate research and development have not been enough to alleviate suffering and saving lives. One wonders where did they go wrong?
In my opinion, they forgot the fundamental rule to manage a pandemic like this and win this war for for our people. The fundamental requirement to win this war is to rise above political, religious and cultural interests. We expected the leadership to lead us from the front and protect us from the political and media’s freewheeling. THE MASTER KEY to win this global war is involving general public and also accepting them as one of the major stakeholder and key player. The government actually did not utilize the vital bridge between itself and citizens i.e. the MEDIA to its full capacity and capability.
The important questions in this regards are,: Are the PSAs ( public service announcements) or non- commercial advertisements enough to educate people about community mitigation measures to prevent the spread of disease? If the majority of general public is not following preventive measures or the measures being followed are defective then isn’t it the time to revisit the approach?
The electric media has the capability and capacity to take the prevention measures for this disease to the next level where people are not putting the virus in their pockets along with protective mask or carrying viruses to their home on their faces, contaminated with lethal showers form cough, sneeze and speech by the infected people and on their clothes and shoe soles besides the “deadly shake hands” and poor adherence to the community mitigation measures.
The greater goal of containing this monster can be achieved by producing innovative, effective and convincing PSAs using CGI and programs to increase public awareness and keep people’s mental health in balance. Our government is trying it best to reduce the economical damage as much as possible by relaxing the lockdown off and on but this can further increase in the disease spread.
They need to balance the concessions in lockdown with more effective preventive measures before the society goes into total panic disorder or the resistors and political opportunists mislead our nation to a total chaos. What I fear is the saddest thing ever said” IT MIGHT HAVE BEEN ” by the people who will survive this pandemic.
As I mentioned earlier that the novel pandemic is being kind on some parts of the world as compared to the countries where it took many lives in just few weeks of time. There is also a possible threat to many other countries where the damage is slow, only their prevention strategies will determine the end result along with different factors like herd immunity, role of HCQ, more number of young people in the total population and the blessing of low morbidity and mortality from the disease which i called the umbrella of blessings.
As we all know there is no universally accepted treatment of the disease and the physicians all over the world are divided on management of the moderate to severe cases regarding aggressive mechanical ventilation, antimicrobial role, blood transfusions and use of anti inflammatory agents like steroids. Moreover individuals are further confusing people with their own remedies and misleading information.
We also got baffled by health agencies with their previous guidelines regarding protection efficiency of masks where they showed it up to 95% both for N95 and surgical mask against virus and 0% for cloth mask. They later changed their stance for cloth masks and accepted it to be effective to some degree.
The latest guideline on covering our face with a piece of cloth or scarf is based one the fact that it slows the spread of the disease.
Similarly, the guidelines about who needs to use a mask by professor Dale fisher an Australian infectious disease physician in his famous speech balloon graphic presentation which gained enormous popularity in west needed to be modified with rapidly evolving situation of the current pandemic.
Furthermore, president Trump advising public to use cloths and scarves which some people thought is madness, in my opinion there actually is some scientific method behind this madness. I appreciate such U- turns for the benefit of people as a believer in unlearning our ignorance and re-learning the facts and skills.
Now, when we are in the middle of this pandemic crisis and have no idea in which direction will it go, the only ray of hope is following preventive measures religiously that is the only universally accepted remedy to prevent the disease and its spread.
The old adage ” an ounce of prevention is worth a pound of cure ” is actually the master key. I appreciate media’s present role in educating people by promoting hand washing and staying home but prevention form this menace is much more than that. The words like lockdown and social distancing are being used without understanding the consequences and creating more mental stress than the disease itself. Some better words like safekeeping and physical distancing can achieve the goal in a better way.
Our people are innocent like children who would fetch a balloon from other side of the road without knowing the risks involved there. Our health authorities should play a parents like role here but unfortunately I see some serious DEFECTS in the COMMUNITY MITIGATION MEASURES as i mentioned in my previous posts.
Its time to take the prevention approach to the NEXT level by
1: Identifying defects in the current preventive measures and processes by conducting GEMBA.
2: Ensuring sustainability of what we have already achieved by convincing people to use mask, maintain hygiene, follow SOPs and maintain physical distancing, so entropy doesn’t happen and we lose the apparently winning situation against this war.
3: Educate people without any relaxation about the role of mask in prevention of the disease ( mask prevent droplets which is major the source of disease transmission), on one hand and chances of getting the disease from contaminated mask itself on the other hand. ( mask is a double edged sword)
4: Clear the confusions about this menace created by individual healthcare experts and promoters of the different theories like gain of function- GoF studies and biological war on social media.
- Identify more adverse effects in our community mitigation measures like already identified dangers to our fragile economy and mental health.
6.Engage the influential resistors of preventive interventions and counter their narratives by evidence based knowledge both in the science, political and religious fields.
- High level of collaboration between WHO and accredited health agencies across the globe.
8: Translate evidence into practice
- Promote .safe, realistic, achievable, measurable and timely preventive practices.
- Make safety measures easily understandable for common people.
11: Develop safety interventions commensuration with current scientific knowledge, social and religious cultures without endangering the social, cultural, mental, religious and economic fibers of the humankind.
Another important aspect of this complex issue is that the healthcare organizations and agencies of the world are led to a general skepticism by freewheeling of the electronic and social media. ” The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn. ” – Alvin Toffler. May Allah protect us all from this deadly pandemic.