Don’t criminalise the disease!
As the ongoing pandemic tests the limits of healthcare across the globe
PHOTO: REUTERS
As it’s a new virus, we still don’t know much about the disease it causes i.e. Covid-19. The control strategies are also evolving. In Pakistan, we are now witnessing special area lockdowns on top of the general lockdowns. It’s not clear though how a decision of a lockdown is made. What are the thresholds for an area to close or reopen? Punjab has promulgated a legal act which gives the provincial government sweeping powers. There are already stories of healthcare staff who, if infected, are forced into quarantine or isolation centres. According to some reports, whole families are being forcefully moved to quarantine centres too. The new act has added prison and fines for this enforcement.
Why force a healthcare provider who is positive but symptom-free, or their families, into quarantine centres? It is beyond my understanding of public health. Our quarantine centres and hospitals already have a space constraint and if we overstretch them it may cause more harm than good. We also know that 80% of the infected will not need hospital care. Now with the increasing number of positive cases, this current policy is unsustainable. Those positive for the coronavirus but with no or mild symptoms can isolate themselves even at home (if they have enough space). Those who do not have the facilities at home should be provided accommodation in isolation units but with dignity and respect. Tests results are now available within 24 hours so there is no need to move families immediately. If there are enough positive cases in the family, even then they should be allowed to self-isolate at home for two weeks given they have sufficient space. The government should provide them basic necessities and a system of verification could be constituted.
If we do not allow home-quarantine and isolation, soon people will not opt for testing even if they have symptoms. The disease will not go away but will go underground. Then we will only discover cases once community transmission has already occurred on a large scale. As a physician, if I am worried about my family’s forceful removal from the house, why would I endanger my life by treating patients? In New York, people are actually being encouraged to stay home in isolation, even if they think they’ve caught the virus and haven’t been tested. US CDC former director Tom Frieden gave six reasons for not going for testing if one is asymptomatic: “You use up medical equipment and tests others need more. You might infect others as you travel to seek care. If you don’t have the infection, you could get it in the process of traveling and getting tested. It’s not going to change what you should do — stay home. The test can be negative even if you have the virus, leading you to expose others because of false reassurance. Right now, testing positive won’t lead to useful action or meaningful data.”
Alongside citizens, decisionmakers are also afraid. Contrary to us who have studied past pandemics and were trying to educate the world for the next one, they had no idea. This never factored into their national security paradigms but decisions made under fear are not helpful. Criminalising disease will make it go undetected until it’s too late. We have seen this with HIV. Even in Pakistan we can change the tide with enhanced surveillance, contact investigations, identification and isolation and communicating with the public in real-time. We also need to protect our healthcare providers. If they get sick, there will be no one left to provide treatment. All government officials should stop using the N95 masks for their tours and give them to healthcare workers.
Published in The Express Tribune, April 12th, 2020.
Why force a healthcare provider who is positive but symptom-free, or their families, into quarantine centres? It is beyond my understanding of public health. Our quarantine centres and hospitals already have a space constraint and if we overstretch them it may cause more harm than good. We also know that 80% of the infected will not need hospital care. Now with the increasing number of positive cases, this current policy is unsustainable. Those positive for the coronavirus but with no or mild symptoms can isolate themselves even at home (if they have enough space). Those who do not have the facilities at home should be provided accommodation in isolation units but with dignity and respect. Tests results are now available within 24 hours so there is no need to move families immediately. If there are enough positive cases in the family, even then they should be allowed to self-isolate at home for two weeks given they have sufficient space. The government should provide them basic necessities and a system of verification could be constituted.
If we do not allow home-quarantine and isolation, soon people will not opt for testing even if they have symptoms. The disease will not go away but will go underground. Then we will only discover cases once community transmission has already occurred on a large scale. As a physician, if I am worried about my family’s forceful removal from the house, why would I endanger my life by treating patients? In New York, people are actually being encouraged to stay home in isolation, even if they think they’ve caught the virus and haven’t been tested. US CDC former director Tom Frieden gave six reasons for not going for testing if one is asymptomatic: “You use up medical equipment and tests others need more. You might infect others as you travel to seek care. If you don’t have the infection, you could get it in the process of traveling and getting tested. It’s not going to change what you should do — stay home. The test can be negative even if you have the virus, leading you to expose others because of false reassurance. Right now, testing positive won’t lead to useful action or meaningful data.”
Alongside citizens, decisionmakers are also afraid. Contrary to us who have studied past pandemics and were trying to educate the world for the next one, they had no idea. This never factored into their national security paradigms but decisions made under fear are not helpful. Criminalising disease will make it go undetected until it’s too late. We have seen this with HIV. Even in Pakistan we can change the tide with enhanced surveillance, contact investigations, identification and isolation and communicating with the public in real-time. We also need to protect our healthcare providers. If they get sick, there will be no one left to provide treatment. All government officials should stop using the N95 masks for their tours and give them to healthcare workers.
Published in The Express Tribune, April 12th, 2020.