The coming two weeks will see a significant jump in the number of positive cases and deaths unless strict measures are taken and adhered to
By Dr CS Ramdaursingh
It is futile to go back and blame right and left for what should have been done and what has not been done.
If we examine the graph below, we can see that our country will be in real trouble if prompt actions are not taken.
Stages of Covid-19 and the implications
The graph shows that in the next few weeks we might become the champion of Africa in the number of Covid-19 positive cases.
Let’s start by defining the stages (or Phases) of a pandemic.
Stage 1 – cases are imported
In this stage, the disease does not spread locally. Cases reported are usually people who have had a travel history to an already affected country.
Stage 2 – local transmission by contact with imported cases
Stage of local transmission: people who have brought the virus into the country transmit it to people they come in contact with, usually friends and family. At this stage, it is easy to trace spread and quarantine people.
Stage 3 – community transmission
The third stage is when the source of the infection is untraceable: people who have no travel history get infected by the virus. Spread is extremely contagious and difficult to control.
Stage 4 – multiple clusters across country
Spread is practically uncontrollable and there are many major clusters of infection all over the country. China was in that stage and currently, Italy and Spain are in this stage. USA also is heading towards this stage. In Mauritius we are already in Stage 2 and we are heading deep into Stage 3.
Learn from other countries’ experience
Learning from others is not necessarily copying or doing something bad. Experience about how the disease spread and deaths increased in other countries can help in applying certain preventive measures which were not applied in these countries.
For example, why are there fewer deaths in Germany compared to other countries?
In Italy, 9.5% of Covid-19 positive patients died. In France, the percentage is 4.5% but in Germany, it is 0.4%.
The main reason for the low percentage of death in Germany is it started tracking, testing and containing infection clusters at the very onset of the outbreak. This death rate will fluctuate with time — as in South Korea, where the death rate is 1.3% in spite of using the same method as Germany, i.e. early testing, tracing of contacts and containing.
The main reasons for the fluctuations are: (i) age of the infected persons, (ii) timing of the outbreak, and (iii) number of tests performed, i.e. the diagnostic capacity of the country.
Italy did not have enough time to prepare to combat against the virus. This explains the rapid increase of positive cases and deaths as well as incapacity to hold back the epidemic there. They also had inadequate health support and hospital care, and lack of ventilators. They did not have time to prepare themselves. Those who die are typically infected about 4 weeks earlier.
In Mauritius, though we are already late we can still prepare ourselves. Government has instituted a lockdown which is a priority right now.
The lockdown will take time to show its effect in the daily death toll. The reason being that during quarantine, many persons especially the elderly, do not pay heed and transfer the infection to others.
What should be done?
* Everybody should take this pandemic seriously.This is of paramount importance. We have to be selfish and at the same time generous. Selfish in staying alone and not meeting others. Generous in ensuring that the virus is not being transmitted and hence decreasing the infectious process, thus preventing others from falling sick, though there will still be deaths.
* Increase the number of tests on a daily basis. Extensive testing is the most important priority. South Korea and Germany have shown that testing many people does help in identifying positive cases and tracking their contacts. The earlier we put this into practice the faster we shall contain the disease.
* Tracing of contacts. Tracing of contacts is the key to contain the disease. Any means should be used. Airport documents, CCTV footage, hospitals records, police help. The faster contact tracing is done, the earlier the disease can be contained.
Legal framework to enable authorities to collect data from positive Covid-19 cases to be able to reconstruct their recent whereabouts should be enforced rapidly.
* Isolate the infected cases. Isolation of positive and suspected cases is of paramount importance. Laws should be enforced to ensure safety of everyone. We are a small country and we can adapt these practices easily provided the authorities ensure that the law is being enforced on an impartial basis.
* Practise social distancing.This is considered to be the best way of contain an outbreak. Social distancing is ensured by government decisions to ban gatherings or to close schools and certain works. But it mainly depends on the people willing to take part.
* Precise and continuous communication with the public. The public should be made to understand that policies taken are based on scientific evidence, and in the interest of their families and children. Public should be informed on a daily basis on the number of tests available, number of tests performed and number of deaths.
Residents should be made aware of areas where cases are being found.
The government’s message to the public should be clear and non-contradictory. And the example must come from the top – asking people to go into quarantine and then visiting them without protective gear sends the wrong message. In doing so the trust of the people is broken and the importance of the epidemic is diluted.
* Emphasise importance of individual responsibility. How each person in our country feels responsible in containing the disease is essential to contain the infection. The individual sense of responsibility will be enhanced if the government gives correct and precise scientifically-based information to the public. For example, clear information should be given about whether wearing masks is effective or not, whether it should be worn only by health personnel or positive cases only, or by the whole population while going about outside their houses.
Similarly, clear instructions should be given about hand washing as well as how to wash articles being brought home.
Self-quarantine should be the responsibility of each individual when they think they might have been in contact with a suspected case or a positive case. They should inform the concerned authorities also.
It has also been noticed that Covid-19 affects mainly the elderly, the male gender and smokers. Hence, it is of paramount importance that these high risk people ensure that they adhere to the set protocols.
In certain countries, the government is “sanitizing” areas where many positive cases have been detected. It will be a good idea if fumigation or water spraying could be performed in certain areas like the surroundings of hospitals and supermarkets as well as in areas where many positive cases have been identified.
It will definitely create in the public a sense of awareness and responsibility.
I personally do not think that we have done enough testing and tracing.
Looking at the trend elsewhere and bearing in mind that there is no proven cure, I fear the worst is yet to come.
We also need to bear in mind that we have a large number of elderly. And we still have many extended families. We have a limited number of beds (less than 5000) as well as a limited number of ventilators and testing kits. Our population is dense, concentrated in certain areas and this can lead to rapid propagation of the disease.
In my opinion, the coming two weeks will see a significant jump in the number of positive cases and deaths unless strict measures are taken and adhered to.
I sincerely urge and hope the government and opposition as well as each of us will put aside our political ideologies, own fights, and egos, and join hands to fight our common enemy, the Covid-19.
Dr CS Ramdaursingh is Consultant Obstetrician & Gynaecologist in the private sector and Lecturer at Sir Seewoosagur Ramgoolam Medical College, Belle Rive. He was a gold medalist in Obs-Gynae in his MBBS examination in 1987 and did specialization at the Benares Hindu University. As Consultant in the Ministry of Health & Quality of Life he was National Co-coordinator for the National Cervical Cancer Services and Program Manager for WHO (Make Pregnancy Safer) Mauritius.