Coronavirus: a fourth wave

When the Covid-19 pandemic started, many newly discovered epidemiologists and mathematical modelers predicted that once a Covid case enters a country, it will infect the population exponentially, killing millions, until the population reaches herd immunity. These prophets of fear were loved by the media, and it was challenging to see the otherwise professionals of repute in other disciplines making governments and the public afraid of a false scenario and forcing them to make irrational decisions. Many countries opted for herd immunity or moved toward hastily declared strict lockdowns. It was quite lonely then when, as a member of the federal core committee on Covid-19, I made a case for sanity to prevail and to focus on public health measures instead. Yes, despite the millions of deaths, we never saw the projected doomsday scenario. However, that does not mean that this pandemic is over or not dangerous.

All outbreaks have a rise and fall even if we don’t do anything. However, if we don’t do anything, the number of diseased and dead will increase. By prompt action we could save our populations from misery. When we look into any country’s numbers, we see different populations getting infected at a different time scale. As the number of infections increases in a country, the next wave has a higher starting point and bigger successive waves. Vaccination with RNA vaccines is changing this pattern in developed countries. As they have vaccinated most of their population, the new waves have seen low hospitalisation rates. The only unpredictable factor is the role of new variants which can break the defenses of these otherwise good vaccines.

In our part of the world, most countries have dangerously low levels of vaccine coverage. Few small countries which have comparatively high vaccine coverage have also shown an increase in Covid numbers. Apart from vaccine efficacy, inequity in vaccine coverage could be a factor. South Asia, except for Pakistan, has seen a major surge after India. Bangladesh’s previous waves were in sync with Pakistan, and yet recently its numbers of daily infections and deaths have increased exponentially. While other South Asian countries have declining trajectories after the second and third waves, Pakistan’s daily Covid numbers are increasing after a decline in June. I was hoping for the declining trend to continue in July, like last year. Two factors were in favour. One, the weather, which may have small but relevant effects; and second, summer vacations which meant less mixing of people. However, the government decided to lift restrictions, and the public believed that as cases were declining, Covid-19 is over.

We need to understand that the pandemic is not over yet, especially in Pakistan, where the vaccination rate is so low. Public messages need to be carefully phrased before they are shared. Businesses need to re-open to make a living, but we need customised SOPs which minimise the risk of infection and are practical. The SARS-CoV-2 virus is continuously evolving, and we need to be ready for any new attacks. We need to vaccinate the most vulnerable groups first as death and serious disease is predominant in these groups. Less than 4% of Pakistanis are fully vaccinated. The only defence we have at this moment are public health measures. We need to focus on improving ventilation of public and private offices, factories, and schools. We need a risk communication strategy with foresight. We need to depoliticise the pandemic response and avoid premature celebrations. We are going through a vulnerable phase and our fourth wave has probably started. We could still reverse the course by accepting that Pakistan is still in danger.

Published in The Express Tribune, July 10^th, 2021.

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