Mess of pandemic!

Two years into this pandemic, I am now exhausted by eminent scientists driving us into the jungle where variants are fighting off vaccinations and wizard of Oz misdirecting the travelers to a magical hill of herd immunity. Yes, these scientists are on the top of their fields but unfortunately their field is not public health. Some know very well how viruses spread in laboratory settings or how to understand spread in highly complex mathematical models, but they have never managed any real-life outbreak or pandemic. With hundreds of scientific publications in most illustrious journals under their belt, their word matters in the corridors of power and in the court of public opinion. But as a commoner, I dare say that if after two years since the start of the pandemic, more than dozen effective vaccines, clear understanding of how virus is being spread, identification of most vulnerable groups and with new and improved treatment protocols and experienced healthcare staff, if still close to 2,000 people are daily dying in the US due to Covid-19, then we have a problem.

In the beginning of the pandemic when I raised the issue of global absence of those who are qualified and experienced, I was told that no one had the experience of a pandemic. True but it’s like saying at the start of the World War that as no one has an experience of fighting a “world war”, there is no difference between battle-hardened veterans and new recruits. Worst, we could have passed on war strategy to gun makers, military doctors, military engineers, or similarly well-respected related professionals. Unfortunately, we did the same in the coronavirus pandemic. I can’t remember a single person with a solid public health background with track of epidemic control in the top advisory body in the US. I still think the situation has not changed. With some exceptions this is a global problem and it’s a fair question to ask why those with knowledge and experience to control this pandemic were not consulted.

Profession has a major divide. Most of the public health officials who do disease surveillance, identify outbreaks, and control them, work in financially constrained public health departments. As their day job is to protect the health of populations they serve with meager resources, they get less time to plan big scientific studies and apply for big fundings. Contrary to working in academic institutions where you could leisurely plan a study in months and execute the way you may want, public health work on the ground requires immediate understanding of problems and producing workable solutions. All this is done with community engagement as they are seeing them in their houses and localities. But that also means you have fewer scientific publications and less repute in academic circles.

One of the lessons for “outbreak investigations” is to “talk with patients, local staff and communities”. That is where you get the best intelligence on how disease is spreading and what could be the best interventions. This was absent in this pandemic as people sitting in universities started the process with mathematical modeling which was way off the reality. Instead of looking at clues at the ground we wasted precious time in make-believe world of computational power, forgetting human behaviours. Then everyone started running toward herd immunity without realising the time it will take to infect or immunise 85% of seven billion. Why did no one think about immunity evading variants? Why now, after the highly infectious but milder disease of Omicron, are we so sure that there could not be another variant which may be more lethal? Those who never handled disease surveillance are now arguing that because Omicron infections are milder, infection should not be counted at all, and we just focus on hospitalisations. Hospital indicators always lag three to four weeks. Missing that much preventive opportunity will decrease the effectiveness of any public health intervention. That also means a surrender to the virus. Now with their theoretical knowledge not showing any results and them raising their hands, maybe it’s time to consult your public health officials and learn a few real-life lessons from them. To safely steer out of this pandemic quickly we need to improve our health intelligence and not abbreviate it.

Published in The Express Tribune, January 18^th, 2022.

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