There needs to be a paradigm shift in the war against COVID-19 ; a war that has to be and can be fought with success mostly by citizens hereafter. If there is a wider awakening, the novel coronavirus can be handled by citizens. But how is one to raise that level of civic sense is the moot question.
Initially, we never thought that a calamity in Wuhan, China would reach our doorstep. Though the bad news was confirmed as an international emergency since the middle of January, it was only on March 11 that the World Health Organization (WHO) declared it a pandemic. Initially, all nations looked to WHO to be the technical lead, but once there was a reluctance to admit the droplet and aerosol mode of transmission, WHO lost its credibility. Even as doctors and scientists were getting to know the enemy virus, it landed in their midst.
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Gradual change
Using memories and experiences of conquering earlier viral outbreaks such as bird flu, Ebola, the Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome, technocrats were using a mix bag of approaches. Gene sequences were shared and testing methods and kits developed and shared. Epidemiology is now better understood, with treatment modalities and experiences in reducing morbidity and mortality getting published. New approaches are being tried. No scientific tool has gone unutilised in the quest for answers. The war is on to save the infected.
Myths and misconceptions prevail despite WHO’s campiagn against “infodemics”. But we do have a better understanding of the virus and how it spreads.
Governments have been blamed for lapses such as having delayed stopping international flights, for the dynamics of the lockdowns, for job losses and poor management of migrant workers returning home, for a plummeting economy, for inadequate testing and contact tracing, and for lack of transparency in reporting of cases and deaths.
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Helping governments
In all this, people have learned one big lesson — of the need to look after and take care of themselves. We cannot depend on the government to do everything. We cannot rely on the predictions of technocrats. And, we should be able to interpret the assurances that politicians make. The novel coronavirus is still peaking in India and there is no evidence of the flattening of the epidemic curve in sight promised a few months ago. We need to be objective about debate on testing strategy, the accuracy of reporting deaths, the case load and the recovery rate, and the claims of success in the race for vaccine development. We need to focus on what to do by ourselves.
What matters to all of us is to stay away from the virus as far as possible and prevent it from infecting us. This responsibility lies squarely on us; not on the government. Such a realisation will not only aid us but also the government in the overall fight against COVID-19. The government can then concentrate on strengthening the health system to test and diagnose the infection and take care of those who are infected. The government can concentrate on hospitals and the related infrastructure.
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Our individual responsibility begins with self-protection. Mask wearing is the most important protection shield we have. In the fight against tuberculosis for example, doctors have been advocating its use for TB patients to minimise droplet spread of the TB bacteria. But very few have taken this advice seriously. In some areas, the police check two-wheeler riders for helmet-wearing and also for face masks. Our newly acquired cough and sneezing etiquette is going to stay as a habit to stop aerosol transmission. We are not going to clear our throats and spit anywhere, including from the windows of a moving vehicle. We have also been educated on washing our face and exposed areas of the body once we reach home and before we sit on furniture.
People are now observing handwashing. They even use sanitizers which are expensive. But in all this, not only can the spread of COVID-19 be stopped but also that of water-borne diseases such as diarrhoea, dysentery, jaundice, typhoid and even cholera. The novel coronavirus has taught us how to stand in a queue patiently. Physical distancing is now new social behaviour. We avoid crowding, festivals and processions, air-conditioned malls and shopping arcades, movie halls, displays and exhibitions. Even if all of these are allowed as an unlocking step, it is better we observe caution. We can go on a holiday or tour once it is safe to do so.
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Community vigil
Though we were compelled to close places of worship, our attitude has changed to one of caring for the needs of others. But there is a need for changed behaviour by neighbourhood and social groups to prevent transmission. Virtual platforms must be used frequently to discuss the technical and administrative aspects of pandemic control by community groups. Volunteering for such community initiatives must be encouraged by elected representatives and members of local self government bodies. Self-administered and monitored epidemic prevention and community vigilance must be sustained. Monitoring of ground realities and learning from overseas experiences using smartphones, web connectivity and use of need-based new apps will all enhance the efficiency of this community empowerment.
Kerala had 45,000 registered community volunteers to run information desks and carry out screening at airports, railway stations and bus terminals and border check posts apart from carrying out contact tracing, and monitoring quarantine centres, running community kitchens and sanitation facilities. Odisha has its Gaon Unnayan Samitis and Andhra Pradesh its health link workers at the ward level. More States must emulate such initiatives to rope in the community. Reverse quarantine and the protection of the elderly, cancer patients and people with co-morbidities need to be exercises with more community involvement than of enforcement by health, revenue and police authorities.
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It is high time policymakers and officials realise the potential of such an approach of decentralised pandemic control. What we have now is patriarchal and technocentric, with unilateral information dissemination and enforcement of strategies either through health staff, the administration and the police. Now, the import of cases has been reduced and nearly 90% cases are through contacts. Finally, enable communities to take control of their own protection and stop community transmission. Invest time and budget for this process. Let their civic sense be the biggest armamentarium to flatten the pandemic curve.
Dr. K.R. Antony is an independent Public Health Consultant from Kochi who has served UNICEF, the State Health Resource Centre, Chhattisgarh and the National Health Mission. The views expressed are personal
