“Lockdown or Not to Lockdown – That Is The Question”

(Further Harangues of a Layman [COVID]- 3)

(photo credit- webmd.com)

May 30, 2020

(This is a long article)

Since my last “diatribe” on this topic (https://dinshawavari.com/2020/04/19/imitation-is-the-sincerest-form-of-flattery-further-ramblings-of-a-layman-covid-2/), we have opened a lot of our lockdown sectors, retail outlets, business, etc. 

Now comes the question- has lockdown helped or not.

Personally I believe that lockdown was an important strategy at the outset of this pandemic- however, it should have been all encompassing and stricter.  Our businesses have been closed for last two months instead of 2-3 weeks – and that is due to a “hybrid” system instead of “total” lockdown.

However, dynamics have changed.  Two months without income cannot sustain any economic band of society- it’s just not possible.  Giving credit where it’s due – to the State Bank and the Federal Government for supporting companies and businesses – is important but it isn’t enough for someone to feed 4-5 mouths on a daily basis in a population of 250 Million!

(1) Part of the problem lies in partisan politics. 

Australia, with its diverse political structure and strong provincial autonomy, banded together like no other in this crisis.  Partisan politics were set aside for a country-specific policy.  Consensus-based decision making was the norm.  The PM and the coordination committee with representatives of all provinces made JOINT decisions.  This is not so in Pakistan!

(2) As long as citizens of a country do not cooperate with the government, no amount of the “stick” or “carrot” will work.  The administration can beat their head against the wall creating SOPs but if in our own heart we don’t follow them, then it’s as good as a failed policy.

Sweden’s “partial lockdown” system worked due to the Swedish people’s sense of responsibility in social distancing.  They took it upon themselves to ensure they followed the government’s policies in return for a more open society.  This is not so in Pakistan!

(3) Successful countries have followed the advice of scientists and doctors.  Government policies, politics, [maybe] some personal freedoms have been set aside to listen to, and implement, actions recommended by “virus experts”.

Here again, Australia, Korea, New Zealand, etc followed what experts in this field advised them.  It may have run contrary to their own thinking or policy but they listened to people who knew what they were talking about.  This is not so in Pakistan! 

(4) I do not support pollution or lack of hygiene & sanitation!  However, can a fair case be made that in countries like Pakistan, India, Bangladesh, while there is a high Corona Virus count, the death rate [to overall COVID cases] ratio is not as high as in the developed world?  Why?

Let’s look it like this- the pollution, smog, vehicular emissions, sewerage, slums, lack of sanitation, etc in the general populace is the “norm” unfortunately; food is prepared over open sewages; generations are born and die in slums in the center of our cities; 50% of the population drink polluted tap water directly; flies are our regular lunch & dinner dates; mosquitos thrive on our blood … whose immunity will NOT be built?  These are the living standards in Pakistan!  However, this should not be the case in Pakistan!

All these factors and more – cash economy, daily wagers, population density, public transport, education levels, etc – play their share on a macro basis in determining whether to lockdown a country or not.  We lack in so many of these areas that I do not believe Pakistan can afford to lockdown the country further. 

Smarter policing is required – political partisanship has to be shunned – geographical and economic aspects should be accounted for – and based on these aspects an all-inclusive, sustained policy be devised.

Can Pakistan please band together!?

(photo credit- sciencemag.com)

No Two States are “Cut From The Same Cloth”- (Yet More Ramblings of a Layman [COVID]-3)

May 2, 2020

To arbitrarily attack the World Health Organization that it “flip flops” is unfair. 

As WHO puts it- “What it has done differently is it has very much relied on its relationship with its citizenry and the ability and willingness of its citizens to implement self-distancing and self-regulate” (https://nypost.com/2020/04/29/who-lauds-sweden-as-model-for-resisting-coronavirus-lockdown/).   Besides this, Sweden has issued rules for social distancing and encouraging working from home- they haven’t arbitrarily opened up their society.

While that strategy seems to work for Sweden, Australia & New Zealand’s strategy of lockdown has worked for them (https://www.nytimes.com/2020/04/24/world/australia/new-zealand-coronavirus.html).

So, WHO’s statement on Sweden’s strategy should not be taken out of context.

Practically speaking, none of us alive today have EVER faced a pandemic like this in our lifetime.  Nations, leaders, scientists are all feeling the waters, testing strategies, changing guidelines…there’s nothing wrong with that.  None of us will get it right.  We will falter and that’s where our leaders & scientists have to learn, amend strategies and move on.

Philosophically speaking, I believe we are being tested so that we are ready for the real disease yet to come!

Even the most educated of us do not follow guidelines and rules laid out by our governments, so how can we be trusted (unlike the Swedes) to follow protocols a government would lay down similar to Sweden’s? 

The concept of “Herd Immunity” (first time I ever heard of it!) is a practical one- and I truly believe that countries like Pakistan, India, Bangladesh are ahead of the game as far as this immunity is concerned due to the environment our people live in.  However, like all strategies, in my mind, it would be incorrect to practice herd immunity willy-nilly.  WHO is also learning through this pandemic and it’s a thankless task with 7 Billion eyes on them, so let’s not be too hasty in passing judgement.  A combination of face mask, social distancing, contact tracing & “smart”, geographic lockdown is the correct way to go.

Who are we not to give WHO a chance!?

“Imitation is the Sincerest Form of Flattery” (Further Ramblings of a Layman [COVID]- 2)

April 19, 2020

Well, we are in a Pandemic and it’s not really about “flattery”- it’s more about …

COPY WHAT SEEMS TO WORK from past and current experiences, regardless of personal or political conflict, geographical boundaries or religion!

So, what seems to be working?

  1. Mitigation strategies-
    1. Scale up COVID tests & diagnosis- doing large number of lab diagnoses allow authorities to slow the spread of the infection by isolating known cases while they are infectious, enabling treatment to be administered at a far earlier stage
    1. Increase easily available, random & free testing
    1. “Test and trace for the high-at-risk groups”, which means increasing the manufacture of local test kits
    1. Continue to maintain social distancing
    1. Limit contact with older people, they being more susceptible to the Virus
    1. Two types of testing is required-
      1. Serology tests- which will identify infected patients with antibodies (this will help determine who is immune and help people get back to normal life)
      1. Rapid-antigen test- to diagnose those who carry the virus (without or with minimal symptoms)
  2. Open testing & drive-through centers in each of Karachi’s – as an example – 178 Union Councils to screen as many people, as quickly, as possible.  All tests would be recorded through their CNICs, immediately tested with temperature scan and throat swab.  People who may have interacted with an infected patient should report to testing centers for checking.
  3. “R-0” (R-naught) is the number of new infections an infected person passes on.  Only when R0 is less than 1 will the pandemic start reducing.  So, all mitigation strategies should continue “one month after you drive down the R-naught to zero”.
  4. Increase LOCAL supply chains so as to provide protective gear, supplies & equipment to front line health workers & hospitals; and going hand-in-hand, continuous monitoring and protection of all medical and other essential workers.
  5. Contact Tracing- tracking travel history & all movements of every COVID patient so as to find & test every person in contact with the patient.  This will identify transmission networks and preempt possible further carriers.
  6. Use of Modern Technology & Communications-
    1. *An accurate communication system that disseminates the movements of potentially infected people, in which geographical areas, etc.  There should be ONE SOURCE of this information and all you need to do is push it out to each of the Telco carriers in the City for onwards distribution to the public.  This will enable less contact between possible affected and those not. 
    2. My brother’s suggestion was to use “easy-paisa” & other such portals to disseminate the Federal & Provincial funds to the needy & poor instead of cash payouts.  With almost 80% mobile subscribers in Pakistan, majority of the recipients will be documented, leading to less fraud.

A macro shift is needed from a patient-centered model to community-system care that offers pandemic solutions for the entire population (with a specific emphasis on home care).  As mentioned in my earlier article (https://dinshawavari.com/2020/04/07/a-laymans-thoughts-on-mitigation-strategies-covid/), self-quarantine & home care should not be discounted- it will relieve the strain on hospitals & health workers.

As before, the views in this Paper are personal, from a series of publications I recently studied-