‘Community ownership of SOPs critical to curtail COVID-19 transmission’

ISLAMABAD: The government needs to get rid of its paternalistic approach when working on containment of Covid-19. Excellent SOPs may have been delivered to restrict transmission of the contagion, but unless these guidelines are framed through meaningful consultation with the communities on which they are to be applied, the challenge of poor compliance and rising COVID-19 cases is likely to persist. At present, community ownership of the SOPs is zero.

Eminent public health specialist Dr Rana Jawad Asghar expressed these views during an exclusive interaction with this scribe here Monday. Dr Rana, who is one of the six Pakistanis to have worked with the Epidemic Intelligence Service of the Centres for Disease Control-Atlanta, urged the government to consult professional groups and then frame mutually agreeable SOPs which can effectively be practiced in their respective work environment to reduce COVID-19 transmission. “For instance, if shopkeepers have a problem with closing at 6 p.m., technical experts must sit with them to arrive at a solution that will reduce transmission while minimally affecting their earnings. Such consensus building measures will ensure greater adherence to SOPs,” he stated. Dismissing the confusion about why SOPs have to be followed even after vaccination, Dr. Rana said, “Just as wearing a seatbelt can protect a driver from fatal injuries but is no guarantee for prevention of a road accident, vaccines also significantly reduce your risk of advanced disease and death, but there is no 100 percent safety bubble around you, so you have to follow reasonable SOPs.” The epidemiologist said, two fully vaccinated families can freely interact with each other, have dinner together, or even establish physical contact without wearing masks. “It is not that there will be no change in SOPs for those who have been vaccinated. Certain relaxations will be permissible if the group you are interacting with is also vaccinated,” he stated.

According to Dr. Rana, it is not the number of people but the environment in which they are interacting that distinguishes a high-risk event from a low-risk one. “If you are meeting 5-6 people in a poorly ventilated room, the risk of transmission will be way higher than if you are meeting 50 people outside in the open,” he said, blaming the holding of high-risk events like weddings in marques as a key driver of the pandemic. Dr. Rana has never been a proponent of blanket lockdowns for a country like Pakistan. Terming it the most destructive formula for transmission control, he said, unless the government can offer monetary compensation to all daily wage earners and communities with poor spending capacity, lockdowns cannot be an option. “

Responding to a query, Dr. Rana agreed that some countries which enforced effective lockdowns have had very high death rates and complications as compared to Pakistan and other developing countries. Age, he said, is a major factor that determines the proportion of deaths in the developed versus developing countries. “Twenty to 25 percent of the population in the developed countries, as opposed to just 4 percent in the developing countries, where the majority of the population is young, is vulnerable to Covid-19,” he explained. Dr. Rana said, case fatality rates have declined around the world; they started high and came down. “I am amazed to see that the case fatality rate (CFR) in Pakistan is static at around 2.1% for more than a year; this defies all logic. I am not sure if we are manipulating our CFR to show that it is neither decreasing nor increasing, but one thing is certain, this is not possible,” he pointed out.

“In Pakistan, why are hospital outcomes for Covid patients, particularly those admitted in ICUs, so poor,” Dr. Rana was asked. He said, there has been a 30% decline in mortality of hospitalized patients worldwide, largely due to due to better understanding of disease management, improved hospital protocols, and greater medical insights about which medicines work better. Asked if the Covid-19 vaccine is safe for old persons who are bedridden, suffering from multiple health conditions, and have zero interaction with the outside world, Dr. Rana said, “Yes, they must be vaccinated. Unless they are in a space station, they are bound to have interaction—be it just with a caregiver. The government or private vaccination centres must initiate home vaccination services for such people because since their immune systems are already weak, they are way more vulnerable than healthy persons.”

“Did the government do enough to protect Pakistanis from the UK variant? Wouldn’t the situation have been less precarious if it had implemented stricter quarantine rules for incoming passengers,” Dr. Rana was asked. He replied, “No government can stop a variant unless it is an island country with strict border controls and a limited population.” Dr. Rana claimed being no fan of quarantine measures. “In today’s age of fast travel, people travel via different countries, and before we know, they have acquired a disease. Once a variant comes in a set of population, it is only a matter of time before it spreads and replaces the old variants,” he said. Asked when the third wave can be expected to subside, Dr. Rana said, “It all depends on us. When do we want it to subside? If we start following

the SOPs, if we disallow entry into mosques, shops, and offices without face masks, improve ventilation inside buildings, and remain indoors unless absolutely necessary, we can control the third wave within two weeks, if not earlier,” he concluded on an optimistic note.