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What an epidemiologist has gathered as we complete a year of the pandemic

That health is intrinsically linked to jobs, economy, social well-being, climate change and education

Written by Chandrakant Lahariya | New Delhi |
Updated: March 21, 2021 7:28:08 am
What an epidemiologist has gathered as we complete a year of the pandemicMoving mountains: Doctors and medical staff attending to a COVID-19 patient during the pandemic. (Express archive)

Experience can give a false sense of confidence. The world had faced the last pandemic — caused by the swine flu (H1N1) virus in 2009-10. Yet, most people — including those working in the health sector — do not have much of a recollection of the events of that period. In India, at that time, the core of the health sector response to the H1N1 pandemic was centred around converting one or two in-patient wards in key government hospitals into isolation wards. The cases occurred over a period of months and had remained in a manageable range. India had prepared a H1N1 pandemic vaccine deployment plan, in which this author was closely involved; however, by the time vaccines became available, the swine-flu cases had petered out. Soon, the pandemic faded from our collective memory as well.

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In the last two decades, there have been outbreaks and epidemics due to a number of viruses: Severe Acute Respiratory Syndrome (SARS), avian or bird flu; Zika, Ebola and Middle East Respiratory Syndrome (MERS). Though the infectious diseases experts have regularly warned of possible pandemics, the preparedness for one seemed low on priority in nearly all countries. In late February 2020, a novel coronavirus was spreading rapidly in a few countries, yet, till that country itself was affected, the response arguably seemed to have followed the “it will not affect us” and “we have sufficient readiness” approach. In March last year, a series of rapidly evolving events resulted in COVID-19 being declared a pandemic, all international and domestic air travel being halted and many countries, including India, going into lockdowns.

The viruses and I seem to have a close and personal association. From my childhood till a few years ago, I used to get severe and debilitating common cold — which, for the majority, is a mild disease — nearly two to three times a year. In what in hindsight could be termed as returning the favour, a lot of my work in the last 20 years has been focussed on chasing viruses away, which include my long engagement in polio and measles elimination, responding to the chikungunya outbreak (2005-06), the swine flu pandemic as well as working on India’s preparedness and response for avian flu, Zika and Ebola viruses. My first articles in newspapers were on the SARS outbreak (published in 2003), and, in 2006, my first ever paper published in a medical journal was on avian flu and the possibility of a human pandemic.

For the COVID-19 pandemic, when the unprecedented lockdown was declared on March 24, in the days and months to follow, the phone became an important tool to stay connected. College-time friends, acquaintances and many with whom I had not interacted for a long time began calling up. Some were worried, others dismissive of the virus and the pandemic threat. For the first time, I did not have to answer what my area of specialisation — epidemiology and public health — means. Some of my friends were more conversant than me in what R-naught is and how Indian states are doing in doubling and recovery rates. But, there were apprehensions on a wide range of issues, including prevention, symptoms, treatment, and a lot of interest in when a vaccine would be available.

The challenges were very different at various stages. In the initial period after the lockdown, worried relatives would call up, concerned about everyone but more so for the elderly and for children. Among my peers and doctors who were working in hospital settings, in a short period, the narrative shifted from COVID-19 being an “unnecessary” hoax to a real threat and risk, a matter of concern. People struggled to find ways for routine health services — which were largely disrupted — for pregnant women and chronically ill people; the long-awaited surgeries and appointments at hospitals that were cancelled; the outpatient facilities that were functioning to less than optimal capacity. Then, starting early June, the narrative shifted. The struggle of health systems in every setting and every town was widely reported. It revealed how ill-prepared our health systems are for surge capacity. I don’t know a single doctor friend who doesn’t have at least one (most often many) incident of being approached to help find a COVID-19 bed to get someone admitted.

However, a pandemic is not just another health situation or disease condition. It is also not merely about what the virus does to a person’s physical health. A pandemic is as much about mental health as it is about social, economic and political impact. The migrants on the highway were not affected by the virus, yet they were more impacted by it than those who tested positive for COVID-19.

For me, from the second week of March, the first few hours of the day would be spent in updating myself about any new epidemiological information that might have come up since the time I went to bed. Nearly every single day for many months, by 8 am I would be ready with the updates. For health policy response to pandemic, the up-to-date information was sine qua non. But that did not seem enough either. The stigma and discrimination against those tested COVID-19 positive, against people of specific ethnic appearance and those working in health facilities were rampant. Then, a few weeks into the pandemic, it became clear that unverified, wrong information — the “info-demic” circulated mostly through “WhatsApp University” — was as big a threat as SARS CoV-2 itself.

In late April last year, I received a call from a member of my extended family, a young engineer working in a small town in central India. During the conversation, he shared his dashed hopes about the potential COVID-19 vaccine. To my ignorance, he mentioned that the first participant in a COVID-19 vaccine trial in the UK, had died. He had read about this in a WhatsApp forward. Later, I learnt that Dr Elisa Granato, a microbiologist who had volunteered to become the first participant in the trial, had woken up to the internet abuzz with (the mischievous, and, of course, false) news of her death. There has been lots of information sharing with no way of ascertaining which one is correct. Twelve months on, we have witnessed it all. The world is still in the middle of the pandemic, but the marvels of science have assured that there are more than 12 licensed and/or approved COVID-19 vaccines available. Though there appears to be a fresh wave of cases, with the vaccines being administered, there is hope of halting the virus.

No two outbreaks, epidemics and pandemics are similar. If you have seen one pandemic, you have seen one pandemic. Yet, each provides some lessons. COVID-19 has reminded us that while pathogens (viruses and bacteria) do not differentiate between the rich and the poor, the impact is worst on the poor and the marginalised. We have recognised that society needs not just medical care but healthcare (which combines medical care with public health). The interlinkage of health with other spheres of life — jobs, economy, urbanisation, climate change, deforestation, indiscriminate use of antimicrobials, battery farming, social well-being, children’s education, women’s health and all other spheres of life — has been underscored. The need for stronger, well-functioning, government-funded health systems based upon a foundation of preventive health services and primary healthcare, has been widely deliberated and recognised one more time. However, some of the promises and commitments to strengthen the health system, made less than a year ago, appears to have been forgotten.

The year behind also reminded us that had we paid more attention to the warnings from epidemiologists and infectious-disease experts and prepared health systems for such eventuality, the impact could have been less. We had clearly missed a few opportunities. Will COVID-19 pandemic end up being another missed opportunity or will we learn from it? Only time will tell. Experience is useful only if the learnings are put into practice.

Dr Lahariya is a public policy and health systems expert. He is the co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic

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