Pandemic planning – Faizaan Qayyum


WE finally have confirmation: at the time of writing, there are at least four confirmed cases of Covid-19 in Pakistan. One of the patients travelled to Iran and was exhibiting symptoms before travelling back home. Six days had passed by the time this patient was diagnosed and isolated.

This may seem like time to worry, but the simple fact is that epidemiologists have almost unanimously concluded that it is impossible to contain the spread of Covid-19. A Harvard study estimates that most of the world’s population would have an infection within a year. Because of how this particular strain has behaved and can potentially mutate, public health professionals are also preparing for it to become a seasonal occurrence: much like the flu, we can expect it to go from a pandemic to an endemic. A mass global spread of Covid-19 is therefore inevitable and imminent. It is not a question of if, but of when.

Several characteristics make Covid-19 a particularly unique global health emergency. While we don’t have a consensus on the incubation period for the virus (current estimates suggest 14 days), it is nevertheless contagious even when infected individuals are not displaying any symptoms. Even when they do, symptoms may be mild — so much so that infected people may feel healthy enough to continue with their daily routines, and they may infect others in the process. Because global statistics mostly measure people who report symptoms and get tested positive, it is likely that the total number of infected people is many times higher than reported.

Yet this is neither the time nor reason to panic. A higher total infection count means the actual mortality rate is significantly lower than what we already know. In fact, the virus is difficult to contain precisely because it can spread without exhibiting its symptoms which, in turn, can be quite mild or even nonexistent. It means that if a healthy individual gets infected, it is likely that they will recover without much cause for alarm.


How can we prepare our response to Covid-19?

This is useful for how we should plan our public health response. The virus is not deadly for the general public, but millions of people will probably get infected at some point in the next several months. Most people will recover, some without even noticing any symptoms at all. Older people, and/or those with weakened immune systems or respiratory problems, will risk more serious conditions, and the weakest segments of our population would be at the highest risk.

The public health response should therefore move to minimise non-essential use of emergency services, encourage mass vaccinations against common infections like the flu, and focus on building capacity to support the most vulnerable people who are likely to get infected in this pandemic. These are critical steps that cities in the developed world are taking; as an illustration, local public health departments around the US are focusing on flu shots to improve overall levels of immunity and preserve system capacity for a more serious Covid-19 outbreak when it happens.

Alongside protecting the population from other diseases, we should plan to preserve capacity for the most vulnerable by encouraging other patients to stay at home, avoid contact with others, and follow a care-regime that minimises burden on our already stressed public health delivery system.

Apart from strategising how our public health system is used, our response should encourage basic healthy habits. We should engage educational institutions and workplaces to teach and encourage practices like frequently washing hands, avoiding touching our face with unwashed hands, and not sneezing or coughing into the air. Sick people should wear surgical masks to keep their illness from spreading through cough, sneeze, or other droplets, and once community transmission is imminent, healthy people should wear N95 respirators to protect themselves — it is important to use the correct type of mask, and the administrative task is to ensure accessibility and availability.

Some of these strategies seem elementary but are enormously effective in containing the spread of viral infections.

Once community transmission starts, it may become necessary to implement general quarantine measures. The public should prepare by maintaining adequate food, water and medication stock for at least several days, and also by ensuring availability of the same for those who cannot acquire it on their own. This is not a call to panic, but prudent preparation.

It is difficult for a country like ours — that frequently bungles common immunisations — to check all the boxes. China’s lockdown in Wuhan was unprecedented and impossible for any other country in the world, and yet it can only buy us a few weeks before Covid-19 becomes a global pandemic. While we too can buy a few days through containment and sealed borders, our real test is of preparation.

The writer is a PhD student in planning at the University of Illinois.

Twitter: @faizaanq

Published in Dawn, March 1st, 2020