By Ahmad Faizal
Since the detection of patient zero in Wuhan, the rapid unrelenting progression of this scourge since December 2019 has been the direct result of a failure in basic public health.
This public health debacle was caused by the dithering of international and national health authorities worldwide which continues to permit “non-medical considerations” to dictate their recommendations to halt the spread of this “new and unknown pathogen” since its onset.
They have universally enabled and implemented recommendations which were and continue to be clearly based on broad political and economic considerations rather than the sound public health measures and proven medical precautions that would have stemmed the rampaging tide of this scourge. They repeatedly compounded their complacency with a series of delayed, inconsistent and non-factual hypotheses that not only failed to stem the spread of the contagion but actually aided in its dissemination around the world.
All the great advances in medicine over the last 200 years lulled our physicians into this stupor of complacency; so much so that they ignored and played down every simple and effective public health and medically effective precaution previously used to combat pandemics in the past.
The successes of isolation and quarantine of affected areas; learnt only from the unacceptable losses in human life from previous pandemics were abandoned in favour of economic, trade and political considerations. International air travel was not curtailed out of Wuhan, let alone the rest of China for many months; and then only with incompetent half measures that enabled transcontinental dissemination of this virus globally.
The simple mask, long established as the most successful and effective weapon used to combat all respiratory pandemics in the pre-therapeutic era was abandoned. This action was justified by the false and illogical unsubstantiated claims that the primary source of spread of this new pathogen was by way of contact and not droplets.
The advocating of frequent hand washing and sanitisation of surfaces as the mainstay precaution proved virtually useless to stem the spread of the virus. Initially combining this with proper masking and social distancing would have resulted in a completely different outcome.
Months of dithering contradictory recommendations, recurrent failures in isolation, quarantine and snake oil therapeutics touted worldwide in lieu of common-sense proper lockdown, testing and isolation resulted in this unprecedented worldwide failure in public health.
Vaccine prophylaxis and herd immunity were the false deities that political prophets around the world falsely clung to as the panacea for this absolute and total failure in public health.
Premature resumption of travel without effective prophylaxis and therapeutics resulted in secondary waves of pandemic and the unmitigated dissemination of more virulent variants of the virus worldwide — as could have been predicted with absolute certainty from the very outbreak of this infection.
Home quarantine despite recurrent quarantine failures from state facilities around the world was inexplicably adopted as a stopgap measure to cope with the inadequate and overwhelmed quarantine and health facilities worldwide, instead of the logical and common-sense action which was to immediately curtail travel.
Clearly, there is only one way to prevent this nightmare roller coaster of one pandemic wave after another that has repeatedly pushed us to the brink of collapse.
The extended economic hardships that have been a constant feature of these failures of repeated inadequate and improperly applied partial lockdowns have yet to convince the powers that be of the marked futility in pursuing this course of action.
It is now well established that most people, especially the young and fit with no other health issues infected by this virus, suffer from mild symptoms or remain asymptomatic. This has been the main method of transmission in populations where mass testing has not been routinely practised.
While concentrating on specific single comorbidities such as age etc, public health pundits have failed to observe that the main glaring indicator for a poor outcome universally has been obesity.
Nowadays, at least 50 percent of the population in most countries are overweight and have respiratory comorbidities and suffer from chronic conditions like diabetes and high blood pressure at the same time. These percentages are observed to be even higher among the elderly and institutionalised age groups.
For any population to attain herd immunity, naturally or otherwise, 70-80 percent of that population must either get infected or vaccinated. The only way to ethically achieve such immunity levels is to vaccinate as many people as possible so that these more susceptible individuals continue to be protected. This way, even if these individuals do eventually get infected; they should theoretically suffer milder effects.
How many more Covid-19 waves with repeated partial lockdowns, ineffective and inadequate movement control orders and other worthless half measures do we have to endure before common sense results in the political will to implement proper fact-based public health measures to control this relentless pandemic and put an end to this scourge once and for all?
This question can only be answered when one fully comprehends each stage that has to be accomplished before proceeding to the next stage.
Hence the correct way forward would be to ensure that each hard-fought advance is consolidated to prevent a reversal or a recurrence to a previous stage of accomplishment; as has repeatedly been the bane of all efforts to fight this pandemic up to now.
It is therefore necessary and logical to proceed with a plan based on the following stages to ensure that our efforts and sacrifices are no longer wasted.
* Prevent the virus and/or new variants from entering the country by effecting a total travel ban to and from the state immediately. Repeated quarantine failures worldwide justify this decision not to permit any travel; not even with mandatory state quarantine. This does not include the import, export and transfer of goods which undergo adequate fumigation and sanitising at points of entry and exit.
* Institute a complete lockdown in all affected red zones for at least one month with no inter-district travel permitted under a strictly enforced MCO. The normal movement and transport of essential items and services will continue unabated under strict SOPs with suitable authoritarian escorts as required to ensure compliance.
* Testing, isolation and treatment of all infected people in the country must be carried out simultaneously.
* Vaccination of all frontliners must first be initiated during the lockdown or MCO period to ensure that breakthrough infections do not occur once the MCO or lockdowns are relaxed or lifted in totality.
* This is to be followed by the vaccination of the most susceptible individuals in the community before normal life can be resumed safely.
* MCOs should not be lifted until the state registers zero new case for at least two weeks. Only when this is achieved, one can even consider relaxing the movement control within the state; but with very strictly enforced SOPs including masking, hand sanitising, testing, contact tracing and isolation.
* Only after all frontliners are vaccinated and considered immune should we even consider attempts to permit travel from outside the country. This must, however, only be attempted with rapid testing at arrival and compulsory state quarantine for 14 days for all travellers with no exceptions; even if they have valid vaccination certificates from out of state. This is the only way one can guarantee that there will be no “leakage” of positive cases in spite of quarantine requirements (failures repeatedly documented in Singapore, Taiwan, Australia and NZ).
* It is prudent that we must take every precaution to protect children when they return to the high-density situations of in-person learning at schools. All teachers and ancillary school staff and nursery staff must necessarily be vaccinated as frontliners, before nurseries and schools are reopened for in-person learning.
To date as no Covid-19 vaccine has been approved for use in individuals under 16 years of age; the only relevant suggestion to protect this vulnerable segment of society is reported in a recent study in the Journal, Science. The study supports the hypothesis that antibodies generated by flu vaccinations and previous flu infections, appeared to offer a significant immunity against Covid-19 in children and could be used as a stopgap measure to immunise children until such time that a suitable child Covid-19 vaccine is made available.
Should the above plan be implemented as directed, it is likely that any short-term economic pain caused by this “final” lockdown will be transient and not recurring as with previous partial lockdowns and inadequate movement control orders necessitated by one pandemic wave after another.
• Ahmad Faizal is a retired medical practitioner who has been having sleepless nights since the emergence of the coronavirus pandemic. He is prepared to join force with the state’s medical and health authorities and offer pro bono services if needed to fight the virus.
The views expressed here are those of the writer and do not necessarily represent the views of New Sarawak Tribune.