Risk of accelerating towards Phase 3 of pandemic

Opening of supermarkets

The virus does not spread: it’s people who spread it

By Dr R Neerunjun Gopee

Readers are invited to look up Dr CS Ramdaursingh’s article which describes the Phases of a pandemic.

In Phase 2 the situation is still manageable, that is the health system can still cope though under strain; In Phase 3 the health system begins to be overwhelmed (as is happening in Spain, the US). In Phase 4 the health system collapses, taking the country along with it – pandemic explosion becomes complicated by social explosion.

We must do our utmost to prevent the country from slipping from Phase 2 into Phase 3.

Principles of control of virus spread

These are based on the knowledge that the virus is spread from person to person: either directly (coughing, sneezing, physical contact e.g. handshakes) or indirectly by handling objects contaminated with the virus. Therefore,

  1. Physical contact between people must be avoided or minimized: social distancing;
  2. Healthy people must avoid getting infected by the virus through social distancing and basic sanitation and hygiene measures (frequent washing of hands, etc);
  3. Known infected cases, or those who have been in contact with them, must be isolated from others in quarantine;
  4. People with mild symptoms must self-isolate at home, and see the doctor if symptoms aggravate;
  5. Testing for virus must be carried out to detect disease in the community (in asymptomatic cases, those with mild flu-like symptoms) or to confirm disease in suspected cases (contact cases in quarantine, those with more severe symptoms).

Useful facts about the pandemic

Consensus is emerging on some basics about the medicine and science of the pandemic, based on data and realities from countries that have been hit hard already. Some of the more important and actionable ones are:

  1. Coughing/sneezing can spread the virus particles up to a distance of 6 feet in the air;
  2. Virus particles can stay on objects for a few hours;
  3. Masks of medical standard (N 95) should be reserved for use by only health personnel, because they are in short supply;
  4. Ordinary masks, which can be home-made (preferably of fabric so they can be washed and re-used) do give protection, and therefore can prevent community spread. They should therefore be worn by everybody during this pandemic when they are going about outside their houses;
  5. Testing to confirm disease is mandatory; testing to detect the presence of virus (in the community) depends on the country’s resources and technical capacity, and may therefore have to be selective (Ref. Articles in The Conversation by a) Doyin Odubanjo, Executive Secretary, Nigerian Academy of Science, March 30 and b) Cam Donaldson of Glasgow Caledonian University, April 1);
  6. Treatment for the disease is essentially symptomatic and supportive; no vaccine will be available until at least one year;
  7. People gathering in clusters or crowds can spread the disease very rapidly;
  8. The official figures are always less than the actual number of cases in any country – because many cases which are asymptomatic or mildly symptomatic are not reported;
  9. Given the above realities and constraints, the most effective control strategy currently is social distancing and public health measures, rigorously and strictly enforced through regular and convincing communication to the public who must fully cooperate and assume the crucial responsibility to protect self and family, relatives and friends.

Are we inviting a potential volcano?

The preceding observations force us to consider some issues arising from the opening of supermarkets since yesterday. The good thing is that people are wearing masks, and some wear gloves too. However, the recommended social distance of one metre may not be enough to prevent spread. Queues of up to a km have been seen, and clusters too with people chatting. Police officers having to be posted there takes them away from more essential duties, and is wasteful of their energy. Checking of ID cards and sanitizing trolleys is tedious.

This measure, which in effect is a partial lockdown, leads to two possible scenarios:

  1. Best case: If we are lucky, and people behave themselves throughout these two weeks – a risky assumption since at some stage nerves may get frayed from prolonged waiting, etc., – herd immunity may develop;
  2. Worst case: infection spreads rapidly and we precipitate headlong into Phase 3.

What to do?

Daily monitoring, and revisit modalities to minimize contacts – one suggestion is drive through and collecting pre-prepared packages of essentials to suit different categories (Rs 500, 700, 1000 etc.). People, do come up with suggestions. It’s our lives, our families, our children. And our future.

A tsunami of Covid-19 cases will flatten not the curve, but our health services. Le moment est grave, grave.

* Published in print edition on 3 April 2020

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