The starting principle is that prompt detection isolation and treatment (as needed) of people with COVID-19 is key to reducing outbreak intensity and associated suffering. This means enabling people to have easy access to rapid COVID-19 testing so that those with the disease can quickly be diagnosed, isolated comfortably and cared for. Their recent contacts must be traced and the close contacts must be isolated or quarantined too: this painstaking work helps break the chain of transmission, reduces the intensity of an outbreak and benefits society. We must remember that the COVID-19 virus is easily transmitted, spreads quickly and makes people ill: 20% have severe or critical disease and 2% die.
Every community should be expecting a COVID-19 outbreak to start at any time: all communities are at risk even if there are strong screening facilities at ports. Experience to date suggests that travel restrictions can make the situation worse. Everyone who is thought to have COVID-19 must be treated with the fullest respect and no stigmatization: we may well count on those who recover to provide care in future outbreaks as they are expected to be immune from reinfection.
Once an outbreak starts it can double in scale every 3 to 5 days: most people will be scared, some will be ill, a proportion will be found to have COVID-19 and a few will die. Hospitals will quickly get overloaded. Hence the need to focus on reducing the intensity of transmission, suffering and hardship, especially at the start of an outbreak, and to diminish the chance that one outbreak leads to others. That is why bans on public assemblies, accompanied, sometimes, by movement restrictions, can be helpful too. They are best applied in ways that take account of people’s needs, making every possible effort to avoid exacerbating other illnesses or making people’s lives even more difficult.
As is so often the case, the interests and concerns of poorer people should be heeded with a view to no-one being left behind. Why do we encourage isolation of people with COVID-19 and quarantine of their closest contacts? Any one individual can quickly infect many others and the likelihood can be reduced if an infected person is more than 2 metres away from others. Isolation and keeping a distance from each other can reduce the number of people an affected individual infects. And there should be sustained readiness even as an outbreak in a specific location diminishes as it can easily restart and affect people who were fortunate the last time.
There should be no reduction in vigilance until there is confirmation from WHO that the threat has subsided. Readiness planning is urgently and immediately needed. It helps leaders to ensure that when outbreaks start, those concerned know what they need to do, can act and adapt quickly and seamlessly, and are ready to do this at scale. This calls for organizing, scaling up and promptly rehearsing public health functions (eg finding people affected by the virus and transporting them safely; tracing and quarantining close contacts) planning major adjustments to hospital capacities and services, and getting the required materials in place. The materials are important – protective equipment to create safe working environments especially in hospitals and clinics, reagents for lab tests, and all that is needed to enable best quality intensive patient care (including oxygen and ventilators) so as to maximise the likelihood of recovery.
Making sure that the essentials are ready involves a huge effort across government. It requires temporary changes in roles of officials, repurposing government so that focuses on the multiple dimensions that need attention – people’s well-being, societal cohesion, and economic stability – when a COVID-19 outbreak takes root. This can only be done through involving people to the full at all levels – individual, household, community and nation.
Leave a ReplyWant to join the discussion?
Feel free to contribute!