Need for professional, truthful Covid-19 SOPs
For those who never considered a possibility of a pandemic disrupting our lives and social order, everything happening now in the coronavirus pandemic is something new and mind-boggling. For a few of us who were working on detecting and controlling ongoing outbreaks and epidemics around the world, this was all preparation for an imminent epic war (aka, a pandemic). Over the years global health experts developed strategies and methodologies which were ground-tested in outbreaks and previously less devastating epidemics. But when the pandemic arrived, years of work was ignored and those with zero experience in outbreak and epidemic controls started to invent the wheel. Leaderships around the globe decided to ignore the science of outbreak control and started to listen to those eminent scholars which unfortunately had no relevant experiences. As a result, we saw a major mess out of the pandemic in most countries.
Infectious disease experts and epidemiologists have learned over years of working in illegal drug use and sexually transmitted diseases that public health advice should consider all issues holistically and then be based on evidence and harm reduction. The exchange of safe needles programmes made people angry by just thinking that the government is paying for syringes for drug addicts to use. Many argued that the government should only penalise and prosecute them as criminals and not start subsidising their criminal behaviours. After decades of this emotional debate, there is evidence by multiple research studies telling us that a simple clean syringe could reduce the rates of HIV, hepatitis and other blood-borne diseases, two to three times the original. So if community spread of any infectious disease is lowered the benefit goes beyond those who are engaged in illicit behaviours.
I have worked as a family doctor for a few years before moving to public health. I could tell that people share their intimate details with their family physician as they develop a trusted bond over the years. As a medical doctor, we not only need to tell patients how risky their behaviours are but also provide harm reduction advice. No matter how much they trust and respect their doctors, only a handful may change their ways. But as a medical professional, we should be using that opportunity to give some comparatively safe alternatives too. In public health we are not just thinking about one patient, we are planning for whole populations. We have learned over decades that castigating the public for not following SOPs does not help and we need to actually sit down with different communities and come up with an agreeable solution.
For populations sometimes social and political issues are much bigger problems than the ongoing Covid-19 pandemic especially if these grievances are directed towards governments. Outlawing popular protests does not stop them from happening. But by criminalising it outright, the government loses an opportunity of harm reduction and to protect its population.
So if you expect a population to follow your advice, you need to be professional, truthful, and unpartisan and respect their concerns. We can’t cherry-pick one risky behaviour and ignore all others that may be worse. In most scenarios, we are seeing political leadership coming up on the stage and criticising people for not following up the government issued guidelines. In the last 10 months we have seen that this does not work. The face of the pandemic should be the country’s public health professionals in order to have a more balanced approach and trust with the citizens. Yes, every time you leave your house for any purpose, your risk of getting infection goes up. But indoor activities are much more dangerous than outdoor activities. Spending 30 minutes in a badly ventilated office is riskier than spending hours outdoor. Governments should work with opposition parties to come up with mutually agreed upon and practical SOPs. Keeping protests outdoors in the daylight and the provision of hand sanitisers is a doable strategy. Requesting protesters to stay in small groups even in a bigger crowd, and following social distancing, including refraining from chanting slogans where possible, should be requested. SARS-CoV-2 is a matter of national security and national unity is required to effectively combat it.
Published in The Express Tribune, November 29th, 2020.
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