The long road ahead

What happens after the lockdown ends is not clear since there is no overarching plan to indicate the steps the government proposes to combat Covid-19 other than social distancing and hand-washing

The easing of the lockdown is now set April 28 by the government though one must keep in mind the astute observation made on CNN by Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases and a leading international authority on the subject of communicable diseases, to the effect that it is the virus which sets the timeline, not governments.

In the absence of widespread testing among the population at large, the move to ease the lockdown is fraught with great risk. To wit, testing allows for isolating those who have been infected to stop community spread while facilitating those testing negative to attend to the business of keeping the economy going. The problem is that at least 20-25 percent of Covid-19 carriers are asymptomatic (that is display only mild or no symptoms) and so can infect others. Without testing we can expect a significant bump in infection rates if everyone not outwardly ailing is exempted from self-isolation.

An imperfect solution, which is still better than doing nothing, is that the government makes it mandatory for everyone to wear face masks when outside. Face masks are not guaranteed to protect the wearer from Covid-19 but they are a deterrent to frequent touching of the face that people subconsciously are habituated to doing. More importantly, they prevent the accumulation of aerosol droplets containing the viral load in the air that others breathe.

The cost of buying a face mask has risen ten-fold or more in recent weeks so most of us will not be able to afford one. But almost everybody can use a clean fabric as a scarf to cover their faces when outside.

Since masks can become a source of self-infection if not used properly there should be public service messages on television to raise awareness of how to properly use masks and how and when to disinfect them. Moreover, it should be made clear that masks are an addition to other prophylactic measures like social distancing and hand washing and not a substitute for them. A positive move in this direction would be one that entails more of our leaders being seen in public and in the media as wearing masks since this would be a nudge to the population to follow their example.

The lockdown was inevitable, regardless of its economic impact – and sooner is better than later as experience from around the world so amply demonstrates. Thus, those countries that delayed introducing lockdowns such as Italy, Spain, UK and the US are paying a far higher price in terms of the number of infected patients and deaths per thousand population than those (Taiwan, Singapore) which had previously experienced the ravages of viral epidemics like SARS and were quick to institute mandatory ‘stay in place’ orders.

Economists who have examined the impact of pandemics also highlight the fact that it is better to rapidly institute measures like quarantines and physical distancing when a vaccine is not available. For example, research based on US cities’ data from the time of the Spanish flu pandemic of 1918-1919 suggests that cities that launched aggressive non-pharmaceutical interventions earlier experienced a faster economic recovery than American cities that were slow to introduce similar measures(https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560).

There are however several areas that need to be addressed.

There is the problem of an information deficit. We need authoritative figures with expertise to provide updates about the disease and information about the success of preventive measures so that people are aware that their sacrifices are worthwhile. Having politicians making daily statements to allay peoples’ fears may be useful but are not a substitute for a public health expert’s (such as an epidemiologist, say) viewpoint.

Dr Usama Riaz, who sacrificed his life in the line of duty, would have been better served had he been provided with the kind of personal protective equipment (PPE) (N-95 masks, goggles, gloves, biohazard coveralls) that is normally given to medical staff in epidemics.

The last thing we want to see is more fatalities among our doctors and support staff in hospitals and clinics. It is our health workers, from top to bottom, who need our unstinting support as they are the ones bearing the burden of caring for those afflicted with Covid-19 as well as for administering tests to the wider population.

Besides, we don’t want hospitals or test centers to become sources of Covid-19, as happened in Italy, which will be the case if medical personnel are not provided with high-quality PPE.

Waiting for the infection curve to bend while under lockdown is akin to being on board a train that has just entered a tunnel and nobody knows how long the tunnel is and when the light on the other side will first appear. This is to say that we can only guess as to when the curve’s inflection point will be reached in Pakistan so that the number of new infections ebbs.

Apart from the direct fatalities from the disease, there will also be an enormous human toll on societies at large and on South Asia in particular. Thus, the incidence of mental illness, family breakdowns, and number of suicides will surge since millions will lose their livelihoods and be unable to support their families and/or will suffer from depression because of social and physical isolation.

For better or worse, there are some predictions that one can make about the aftermath of Covid-19.

First, till such time that a vaccine is developed people all over the world will be less likely to travel so the tourism and travel sector will continue to be battered. That is not good news for countries that rely on tourism for foreign exchange earnings or for those dependent on the tourism and travel business for their livelihoods.

Second, developed countries will institute stringent visa requirements for people from developing countries like Pakistan. A ‘medical visa’ will likely be required along with a travel visa so that cost and inconvenience of making a foreign trip will go up significantly.

Third, Bill Gates will be awarded the Nobel peace prize, and deservedly so, for sounding the alarm years ago of a likely future pandemic (https://www.youtube.com/watch?v=6Af6b_wyiwI) and for the financial contributions made for vaccine development through the ‘Bill & Melinda Gates Foundation’.

Fourth, the scientists and researchers who discover a vaccine for Covid-19 will be awarded the Nobel prize for medicine. (Hopefully the new vaccine will be patent-free so that everyone can get it cheaply.)

Finally, governments in developing countries will actively harness Artificial Intelligence (AI) along with the use of the internet to promote the provision of high-quality education to those previously denied such access particularly the poor and those living in rural areas.

The writer is a group director at the Jang Group.

Email: iqbal.hussain@janggroup. com.pk