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Monday, June 27, 2022

To tackle Covid, lessons from flood preparedness

K Srinath Reddy writes: We need to move from a heightened pandemic response to a steady-state endemic response, being ready to shift gears as needed

Written by K Srinath Reddy |
Updated: May 16, 2022 8:29:31 am
Despite its mild reputation, Omicron infected a very large number globally and claimed many lives. Most of those who became severely ill were either unvaccinated or not fully vaccinated. (Express Photo/File)

The Indian count of Covid infected persons, as identified by tests, has risen since April. The actual numbers infected or reinfected would be much higher, as many who were asymptomatic or mildly symptomatic would not have gotten tested. However, it was reassuring that most of those who were infected by a member of Omicron’s extended family experienced mild illness. This variant clan’s inability to penetrate deeper into the lungs and blood vessels may be partly responsible for this feature. Prior immunity, acquired from earlier infection or recent vaccination, may also have been protective against adverse outcomes.

Despite its mild reputation, Omicron infected a very large number globally and claimed many lives. Most of those who became severely ill were either unvaccinated or not fully vaccinated. Even the definition of who is adequately vaccinated is shifting with one or more boosters being added to the earlier two doses and the interval between vaccine doses being reduced as new variants exhibit their enhanced prowess at infection and immune evasion. Mask mandates, withdrawn when Covid appeared to recede, were reintroduced as case counts started a fresh ascent.

In this ongoing match of wits with the virus, will we reach a state of equilibrium where the virus becomes endemic, with manageable seasonal outbreaks that do not steal lives and seal society? Though some commentators have declared that the virus has already become endemic, it is not yet fully predictable in its evolution, behaviour and impact as new variants keep arising. There is presently no global steady state that can be confidently called “endemic”. All we can say is that the virus is here to stay and appears to be moving in the direction of endemicity. However, the possibility of new recombinant viruses birthing from the womb of global vaccine inequity and a worrisome potential for recycled animal to human transmission creates uncertainty about whether and when a steady-state will be reached.

Even as we keep vigil, restrictions have to be withdrawn in stages. The lifting of mask mandates cannot be whimsically hasty, while the imposition of travel bans and school closures should not be knee-jerk responses. A calibrated response is needed, which provides the right balance of confidence and caution, both in policy measures and personal protection at each stage of an undulating pandemic. Situationally adaptive responses must be dynamically enacted against the constant backdrop of health system capacity buildup for prevention, surveillance and patient care.

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Perhaps flood protection measures can provide a model of endemic preparedness. We get rains seasonally every year but don’t experience floods annually. When there is a threat of recurrent floods, we raise the level of our embankments to prevent the surge of floodwaters into our cities. We build dams upstream to control downstream water levels in rivers. We create efficient drainage systems to prevent waterlogging in the streets.

We monitor weather patterns to anticipate the threat of floods during extreme weather events. If such events are forecast, vulnerable groups of people are evacuated to safety and people’s mobility is restricted to essential services. If not, life proceeds without disruption even when rains arrive. We leave it to routine municipal services to deal with rainwater clearance and sanitation. Even then, we use umbrellas to protect ourselves from getting wet when we are exposed to rain.

Such adaptability is needed when we move from a heightened pandemic response to a steady-state endemic response, while being ready to shift gears when needed. We need to get early alerts of new virus variants, much like warnings of changing weather patterns. When there is a threat of a surge in serious cases, we restrict mobility, continue essential services and pay special attention to the safety of the elderly and those with comorbidities. A multi-sectoral response to a public health emergency, prioritising public safety, would be in order.

In an endemic state, routine health services will suffice for testing and treating cases while maintaining a watch on case counts, clusters and clinical profile of cases. People’s mobility will not be restricted but masking in public and crowded indoor locations may be advised when seasonal outbreaks occur. Vulnerable groups of people will be specially protected with vaccine boosters. The general public will be advised of personal protection measures but life will be near normal during times of seasonal spikes which do not become dangerous waves.

Cities will get flooded even without storms if rainwater drainage and sanitation services are poor. Even a seasonal spike in endemic Covid can pose a serious threat if our health services are inadequately resourced and poorly managed. We need greater investments for strengthening our health services through better infrastructure, workforce, public health expertise, information systems and management. This requires constant attention, not just a crisis response.

While flood prevention and control require planning and action at multiple levels of government and society, much of the responsibility lies at the municipal level and involves the active engagement of the community. In endemic Covid too, urban local bodies, panchayats, community-based organisations and citizen volunteers must form a coalition that conducts situational analyses and responds with context-relevant prevention, control and relief measures. Health communication must be effective through community networks to prevent panic and protect against misinformation. Community based mental health services will help to allay anxiety, prevent illness.

Timely vaccine protection must be provided to all who need it without coercion but by building confidence. Still, there will be some who will be highly vulnerable to serious illness during a seasonal outbreak. Civic sensibility must be fostered so that all persons who have any symptoms suggestive of a respiratory illness voluntarily mask up during a seasonal outbreak to protect others. Infected persons must isolate, with the assurance of medical and social support during the period of illness.

If cases build-up, masking outside home must be mandated, so that asymptomatically infected persons do not pose a threat. As we walk in the rain, we take care not to splash water on others. Likewise, in endemic Covid, it will be our civic duty not to infect others.

This column first appeared in the print edition on May 16, 2022, under the title ‘Endemic Covid’. The writer, a cardiologist and epidemiologist, is president, Public Health Foundation of India (PHFI). Views are personal

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