Covid Island: Grim Realities

We cannot think of vaccines as panacea. No. Sanitary protocol is still mandatory, for self-protection as well as for community protection

By Dr R Neerunjun Gopee

A guest who was present at a marriage said that he walked away in disgust because there were nearly 300 people, none of them wearing mask and not observing social distancing at all. One video posted on social media shows a woman shouting at a policeman who had asked her to wear her mask. She was challenging the officer to book her – saying that she had already done prison and couldn’t care less.

Another video shows police officers embattled with a woman of a certain age, possibly a tourist or an expatriate, who was without a mask in a parking. She was probably walking to her car, and when requested by a policeman to wear a mask she first shouted and then pushed him on the chest, rushing to get into the car. As she sat in the driver’s seat, a lady policewoman approached her, and probably asked for her licence and for her to wear the mask, and she became more abusive. She came out and physically assaulted the lady officer, who tried to restrain her, at which she became even more aggressive and started to scream.

Other videos show flocks of people in close proximity at the beaches, not all using masks.

The police officers were only doing their job. In the case of the local person, we are more or less used to such scenarios. But as regards tourists, it is clearly impossible to anticipate individual behaviour and reactions or that such unpleasant incidents would arise. Herein lies a responsibility with the hotels, to brief their foreign guests about the gravity of the local situation, and the absolute need for their own sake to start with to strictly follow sanitary protocols which are in place in the country – whether or not they do so in their own countries. For we know that in several of these source countries, there is resistance about wearing masks amongst other things. 

What price the opening of frontiers? Hoteliers have been expressing satisfaction at bookings and occupancy rates, and are looking forward to even more arrivals as the end of year approaches. However, the onus of such unintended consequences as the one described above will fall squarely on the authorities who took the decision to open up, never mind where the pressures were coming from, and whose management of the deteriorating Covid situation is already under heavy scrutiny and criticism from many quarters, both inside and outside Parliament.

The contradicting views expressed from the government bench in Parliament – the latest one being about the situation in schools, besides the many other earlier ones about e.g., real Covid-figures,etc. – have been the subject of comments by other parliamentarians and politicians, to wit that there seems to be a lack of internal communication or coordination, and citizens will have their own take on these.

But the undeniable fact is that the lived realities on the ground are hugely concerning, tragic and confirm the apprehensions that had been expressed about the possible fallouts of reopening of borders unless all the necessary measures had been taken to prevent them. The events on the ground are telling a different story, where they are compounded by crowd misbehaviours as regards sanitary measures.

The most ominous feature of this Delta variant is that it is largely asymptomatic. Bluntly, this means that anyone who is infected and is going about, especially without complying with the sanitary protocol – is a walking live superspreader of the virus. That is because its reproductive or R0 number is 5: that is, that is one person spreads the bug to 5 others, who each spreads it to 5 more, making 25, then 125, then 625: an exponential progression.

Within a short time, it’s at least from 1 to 625 infected people in a crowd. And if this is in a closed space such as a cinema hall – where people are neither wearing masks nor sitting away from each other – then a jump in infections is the natural outcome. Multiply this scenario several fold across the country, and we get the kind of numbers that we are witnessing currently. Unless we course correct, things are only going to get worse. Indeed, that’s already been happening.

We have already reached a stage where almost everyone knows or is aware about some friend, family, relative, neighbour, or even stranger who in turn knows one or more persons in these categories who have been infected, are either in self-isolation, in isolation ward at hospital, in ICU at ENT Hospital –or have already succumbed. And many of them have gone to a rapid death with few warning symptoms or following a brief but severe illness.  Worse: all age groups are involved.

There is no silver lining in this dark cloud.

We had pinned our hopes on vaccines, and according to initial data they seemed to be effective. But that was quickly belied by new data showing that efficacy waned by six months, necessitating booster doses. More so, the argument went, because breakthrough infections, that is infections in those already fully vaccinated (two doses) were being recorded in a significant proportion of them, across several countries that had already achieved a comfortable level of control when they were first hit, such as Singapore, Israel, etc.

It had been surmised that vaccines would be the panacea, when viewed in light of experience with the known infectious diseases caused by viruses (e.g., polio, measles). However, not only is Covid-19 a possibly tweaked natural virus, the fact is that there has not been enough time to field test the vaccines on the large numbers that are required as for previous vaccines. It is no secret that genetic technology aiding, the new vaccines have been developed in record time, and that may be part of the problem. In other words, vaccines efficacy is a work in progress and the final word on the issue may well be a matter of years away. 

However, as for all medical problems, it is usually a combination of modalities that is required for solving them. So too is the case with Covid-19. We cannot think of vaccines as panacea: because I have had myvaccine, I can do whatever. No. Sanitary protocol is still mandatory, for self protection as well as for community protection. And medicines will come when they will come, for they too are still in the early stages of clinical use, and much more experience is required.

But there are also considerations of supplies, availability and cost – in which regard rich countries and those with manufacturing capacity will have a clear advantage over poorer ones. In a panel discussion on Indian TV two nights ago, this matter was under consideration, and it was pointed out by one of the experts present that for the drug from Merck – molnupiravir – as soon as the regulatory bodies in India (final call; DCGI or Drug Controller General of India) gave clearance, the country could very quickly swing into production, at a cost of around Rs (Indian) 3-4000 per course of five days, but that would come down fairly rapidly with because of more demand and more supplies.

As far as we are concerned, though, we must brace ourselves up for harder times ahead.

* Published in print edition on 12 November 2021