Dealing with Covid-19: Lockdown may buy time, but social behaviour helps stem virus spread

As the government relaxes the restriction, health care experts urge citizens to follow guidelines

KARACHI: A wide range of strategies provide public health benefits during pandemics such as making facemasks mandatory, restricting large public gatherings, and cancelling school. But health care experts believe forcing citizens to hunker down at home to ride out the Covid-19 crisis is not an effective long term option.

"There is very little evidence that tells us that lockdowns are effective. They instil fear in people. You need to place trust in the public and that is what we did in Sweden," said Dr Anders Tegnell, state epidemiologist at Sweden’s Public Health Agency. "Our strategy was to conduct tests very early on because we saw the epidemic coming," said Dr Tegnell.

While acknowledging the high death toll in his country, Dr Tegnell said the healthcare system is still not overwhelmed in contrast with other countries that have imposed strict stay at home orders. The science behind lockdowns, he said is not very strong, but may have been effective in slowing the disease in worst-hit areas," claimed Dr Tegnell.

With the question of when to relax the shutdowns becoming a hot topic, as economic output shrinks in many countries, the World Health Organisation (WHO) also updated its advice on when to lift Covid-19 lockdown orders.

In a statement last month the agency said: "We should be ready to "change our behaviors for the foreseeable future."

"One of the main things we've learned in the past months about COVID-19 is that the faster all cases are found, tested, isolated and care for, the harder we make it for the virus to spread," said WHO Director-General Tedros Adhanom Ghebreyesus in a post on Twitter as the guideline was released. "This principle will save lives and mitigate the economic impact of the pandemic."

According to the global agency, the coronavirus has claimed more than 274,000 lives all over the world. The disease has also reconfigured society and disrupted life for millions around the world – including 1.4 billion children whose academic year appears to be derailed by shutdowns.

At the moment, Dr Tegnell said, most decisions being taken around the world to control the Covid-19 virus have very little scientific evidence. "There are not many studies that back the ideas at the moment," the epidemiologist said. Lockdowns, he said, are not sustainable in the long run.

Views about the imposition of lockdowns appear to be mixed.  "Adherence to public health measures is critical to reducing transmission. Clear and effective risk communication is one of the key tools for ensuring public adherence, said Dr. Claire J. Standley, Assistant Research Professor Center for Global Health Science and Security at Georgetown University.



In the absence of a preventive vaccine, which according to experts appears to be 9-18 months away, Dr. Claire said: "In the absence of medication or a vaccine, I think we need to expect some aspects of physical distancing to remain in place for quite some time."

Pointing out Germany's approach in controlling the spread of Covid-19, Dr. Claire said: "Germany never imposed a full lockdown, but did close restaurants, most shops, and schools, which are now slowly starting to reopen. Overall, I think it's important not to think of these public measures as binary - it is not a case of "open" versus "closed", but rather a full spectrum of measures that each may contribute to reducing transmission."

"As such, even in the absence of a vaccine, public health measures are important. What type of measures they are, and how they are implemented and enforced, will depend on each country's context," she added.

Until the vaccine is produced and made available for 7 billion people around the world, Dr. Claire said, health authorities should consider other avenues for sharing guidance on the necessary public health measures, to ensure the public understands their importance. "Examples could be engaging community leaders, or respected religious leaders, to help share information about why it's important to adhere to restrictions," she said.

Aside from mortality data, there are a number of countries that effectively controlled the spread of the respiratory virus. It is worth noting that Hong Kong, Taiwan, and South Korea were successful in limiting the superspreader.  None of these countries ever imposed a lockdown.

Questioning the scientific basis of the decision to impose the coronavirus lockdown, Dr. Bushra Jamil, Professor Infectious Diseases, at Aga Khan University Hospital in Karachi and President Medical Microbiology and Infectious Diseases Society of Pakistan said:  "We rushed into this strategy. There was no academic debate before imposing the broad-ranging restrictions and this was an adopted strategy that was being used elsewhere."

The Covid-19 virus, Dr. Jamil, said is a disease and not a crime. "Since the beginning of the pandemic people with Covid-19 have been portrayed as criminals and those who test positive are stigmatized," she said.

Under an effective lockdown, citizens are required to stay at home, assemblies are limited to a single-digit threshold, and even as they do not technically qualify as gathering many businesses are forced to remain shut. Without the strict implementation of all features, experts believe, it’s not a lockdown. Looking back at the effectiveness of the strategy, Dr. Jamil said,  some aspects of the lockdown such as staying at home, canceling school, and banning large assemblies may have helped reduce the impact of Covid-19. "The aspect of closing businesses is a bit controversial because it has not shown historically that the closure of small businesses prevents any infectious diseases," she said.

As the government slowly relaxes the lockdown rules, Dr. Jamil believes it is important to make the people realise that they are responsible for their own health and those around them.  "They have to protect themselves from contracting the infection," Dr. Jamil cautioned.  "It makes perfect sense that people should be made responsible for their own health while the government takes other preventive steps," she added.



Concurring with his colleague's views, Dr. Faisal Mehmood, Consultant, and Section Head for Infectious Diseases at Karachi's Aga Khan University Hospital said: "Lockdowns are always temporary in their usefulness and implementation because of their unintended economic consequences."  Lockdowns, he said, are effective in the short term. "They only allow you to increase capacity and prepare for the crisis," said Dr. Mehmood. In the longterm, Dr. Mehmood said the only way out is a change in lifestyle.

Commenting on the government's guidelines, he said: "The problem with guidelines and any standard operating procedures is the implementation. "We need to follow them for our own good."   He warned the crisis was far from over and the relaxation in the lockdown should not be misunderstood.

With the number of positive cases inching closer to the 26,000 mark in Pakistan, the government is allowing some industrial and commercial activities to begin under safety guidelines.  The move comes after an intense debate over the strategy to deal with the Covid-19 crisis.

Addressing the media, Prime Minister Imran Khan said the lockdown has badly affected laborers, small businessmen, and ordinary people.

"We have decided to open the small markets, shops, and allied industries of the construction sector across the country from Saturday," he said.