COVID pandemic: Lessons learnt and the way forward

The COVID-19 pandemic originated in China probably by September 2019 and swept through all the countries of the world causing a public health crisis, overwhelming even well-organised health care systems of the Western world. In its wake there is a huge economic crisis across the globe which threatens the socio-cultural and economic foundations of mankind.

This is a viral infection that jumped from animal species (bat, pangolin) to human beings and therefore a zoonosis. The proximate cause for infectious diseases that jump from other species to mankind is the rapid pace of modern development which encroaches upon the natural habitats of different animals and brings several animal species to the brink of extinction. The important lessons, yet to be learnt by mankind, are:

  1. how to avoid disrupting Nature’s carefully balanced and fragile eco-systems, and
  2. how to live in harmony with Nature

The whole approach to ‘modern development’ needs to be re-visited and revised on a war footing globally to avert such calamities in future.

The COVID pandemic in India apparently peaked in mid-September 2020 and entered endemic phase by the latter part of January 2021. This endemic phase is a steady state when the daily number of infections will remain low but more or less constant. This number will be roughly equal to the daily number of susceptible subjects added to the population by way of children who survive to age five. This number will be approximately 54,000 per day in India. However only about 25% of the daily new infections will be picked up and documented by the current testing strategy employed in India.

Similarly, the daily deaths will continue at a rate of about 700-800 per day – unfortunately only a fifth of these will be accurately reported as death certification in India is only about 20%. A similar situation probably exists in many medium and small income countries.

In view of these emerging facts, the health care workers in India have two targets to achieve as soon as possible:

  1. achieve 100 % vaccination of all health care workers, and
  2. inform-educate-communicate the public to achieve 100% vaccination coverage of all those above age 55 and those under 55 with co-morbidity like diabetes, hypertension, chronic kidney, liver or lung disease

Vaccination of all frontline healthcare workers is very important to ensure that we have a confident healthcare force, who will not transmit the virus unwittingly to patients and families who need their care. The ready acceptance of the vaccine by the healthcare force will infuse confidence into the general public and ensure speedy and universal acceptance of vaccination by the population at risk.

Countries in which the pandemic has just peaked or about to peak are at the half-way mark: about 30% of the population have been exposed to and therefore are immune to the virus and a further 30% will get infected in the ensuing months before they reach the steady endemic state.

While countries such as India, in which the pandemic has already reached the steady endemic state, need to employ a targeted vaccination strategy to prevent deaths, countries such as the US, UK, Indonesia and Portugal where the pandemic has just peaked or is about to peak, will need to employ a mass vaccination strategy with the twin objectives of curtailing rapid viral spread and preventing deaths.

As none of the currently available vaccines offers 100% protection, those at high risk of serious disease or death from this viral infection will still need to use the face mask, maintain physical distance from others and avoid crowded places even after vaccination.

The emergence of variants of the SARS-C0-V2 virus with greater infective potential in UK and South Africa and the uncertainties of vaccine efficacy against some of these variants underscores the urgent need for pursuing aggressive vaccination globally to get quick control over the pandemic situation.

The transmission of the virus from human beings to minks in Norway and back transmission from minks to humans indicates the potential for the virus to infect other animals and create animal reservoirs. If this happens the virus will not be eradicable. This eventuality has to be pre-empted by systematic global vaccination.

Systematic and carefully crafted vaccination to suit the needs of individual countries under the supervision of the WHO and the public health departments of individual countries with the assistance of all philanthropic agencies and Non-Governmental Organisations offers the hope of global eradication of COVID-19.

A global threat like a pandemic needs a concerted global response for speedy resolution. This is a time for sharing. There is a need for close co-operation and co-ordination between all the countries of the world – rich and poor. The same way different scientific establishments across the globe shared their knowledge, wisdom and experience during the pandemic, the countries of the world need to share vaccines with others with resource constraints in humanitarian interest. India has shared its indigenously manufactured COVID-19 vaccines with its neighboring countries, setting an example and leading the global co-operative effort to eradicate COVID-19.

Dr Mandalam Seshadri MD, PhD FRCP is Former Professor & Head of the Department of Endocrinology, Diabetes and Metabolism, CMC Hospital, Vellore and currently Honorary Medical Director & Consultant Endocrinologist, Thirumalai Mission Hospital, Ranipet, India

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