Covid-19: fortifications and new wars

Back in 2018, I submitted an idea for a special session of “TED Talks” in the United States. I raised the issue that today’s public health is still stuck in the methods of controlling outbreaks which are more than a century old. The world is much different now and measures which were effective then may not produce the same results today. With the Covid-19 pandemic we also saw that these measures were not so effective or practical and as a result many leaders lost trust in public health. It was not public health leaders who steered the Covid response in most countries and that resulted in more chaos and directionless efforts.

In 1850s, Dr John Snow (a royal anaesthesiologist) tried to figure out why people were dying of cholera in a certain area and not in others. He identified a water pump as a possible source of disease. That was before medicine learned about the existence of bacteria and viruses and their role in human diseases. The methods he developed to identify, and control outbreak are still used and are effective.

One of these concepts is quarantine or “lockdowns” in the Covid era. Quarantine was an effective measure to stop outbreaks spreading to widespread areas. Even before we understood the dynamics of disease transmission it made sense to hold the ship away from the port and see if any travellers were sick or if they were coming from an area of outbreak. Most infectious diseases have a short incubation period (time from exposure to disease to development of disease) and in roughly two weeks, most diseased persons have visible symptoms. Travel was slow then and keeping travellers away made sense. With small towns and villages and little populations, it was practical and effective to lock down areas.

It’s still effective but not that much. Travel is extremely fast and even before the world knows about an outbreak, the infection can spread thousands of miles away. Researchers estimated that way before China placed travel restrictions on Wuhan in January 2020, many cities around the world were already infected.

One other mostly useless method of screening is temperature scanning. Research studies have shown that it does not identify infected people in a meaningful way but remains widely popular among countries. Relying solely on these measures when a pandemic in spreading is like France relying on its famous Maginot Line during WWII. Germany’s fast-moving panzer mobilised units clearly showed that defense strategies needed to be updated with changing time. In Pakistan, I expected multiple clusters of cases in different cities brewing before even our first case — just strengthening border fortifications eventually has limited value.

The best defence in this highly connected and fast-moving world is to be ready with our crack units of disease detectives, army of contact tracers, and advanced health intelligence systems. This requires the best talent recruitment and resources. Unfortunately, when any little additional resources are available, they are directed to hospitals. No amount of increase in hospital beds would be sufficient if we do not invest in preventive strategies.

The era of forts and siege warfare is gone. In public health too, it is time to improve our defense strategies. The SARS-CoV-2 virus is fast changing with multiple dangerous mutations. It is now more infectious, and some variants may be more lethal and could evade vaccines. Are our defense strategies keeping the pace? Or are we just relying on more lockdowns and travel restrictions instead of trying to understand local dynamics of disease outbreaks and coming up with local and effective solutions? One year in the pandemic, it’s time to pause and refresh our strategies of disease mitigation, control, and possible elimination.

Published in The Express Tribune, January 31^st, 2021.

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