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-