The SARS CoV2 virus causing COVID-19 infection is adjectivized novel for a reason. The word novel has it origin from Latin word ‘Novellus’, meaning new. Novel nature of SARS CoV2 virus thus reflects the amount of uncertainties and limitations in our knowledge pertaining to the pandemic. Despite the ongoing robust research globally, ambiguities are still abundant several months after the first case of COVID-19 had been reported in China.
Most debated subject currently is on efforts to minimize the spread of the virus in a population. There have been conjectures concerning strategies that worked best and worst in containing the virus spread across globe. We have been too eager to narrate COVID-19 success and cautionary tales. While speculations seeks to reduce uncertainty, it may not necessarily reflect reality. Even though it is the tallest hurdle to tackle currently, mere efforts to minimize the spread of virus is inadequate. There are few other considerations to be addressed in a comprehensive public health perspective.
Dynamic nature of the pandemic: It is important to acknowledge the dynamic nature of disease transmission and severity. The number of people getting infected could greatly vary depending on the initial load of acute exposure, population demographics, immune response, geographic and climatic conditions to mention a few. Stringent lockdown measures have been effective to an extent in curbing the spread. However, it is still unsure whether extreme shutdown measures could keep the virus away for long. New Zealand who declared zero COVID-19 cases in June is experiencing relapse after two months despite ongoing lockdown measures.1 Similar relapses and second surges can be seen worldwide even with minimal relaxation of lockdown measures in place. The pandemic exhibits periods of peaks and troughs in transmission rate. On the contrary, Sweden who imposed much relaxed voluntary social distancing measures was initially the cautionary tale. Sweden initially experienced higher number of cases and deaths (mostly relating to long term care facilities) compared to the neighboring Scandinavian countries. But Sweden’s strategy seem to have contained spread and reduce death rate in the long run.2 However, it is yet to be seen whether Sweden is going to experience a second wave in the fall when weather is more contusive for viral transmission.
Herd immunity or not?: Another dilemma with regards to COVID-19 is whether an infected person develop long-term immunity to the infection. Presence of long-term immunological response could mean that majority of already infected population cannot be re-infected providing a natural barrier to spread of the virus without stringent social distancing measures. Immune response can be in the form of neutralizing B cell antibody or T cell response which directly kill the virus infected cells. Studies have shown that the B cell antibody response especially in asymptomatic individuals have not been rather promising to provide long-term immunity.3 4 However, recent research have noted robust T cell immunological response even to asymptomatic or mild cases of COVID-19. Scientists have postulated that the T cell response could protect against re-infections.5 Even though we still do not have definite answers regarding long term immunity to COVID-19, scientific world is providing quite positive inferences. In this context, it needs to reevaluated if very stringent lockdown and social distancing measures are necessary or overkill.
Public health approach: Public health comprises health and wellness of the community in every regard. Given the current situation, COVID-19 takes priority, but should not be the reason to overlook other aspects of public health. Lockdown measures not only takes a toll on the economy, but also on the physical and mental health of individuals. It can especially be marked among vulnerable populations including children and elderly. Inequities in access to health care, education, safe living, food , digital services, and social collaborations have emerged in newer and more concerning shapes in context of the pandemic.6 While efforts are being streamlined to tackle the pandemic, it is of concern up to what extent other aspects of public health should be risked.
Sustainability: Any public health intervention should be sustainable in a manner that benefits are outweighing the damages. Extreme measures imposes colossal economic, political, and psychosocial implications. Overlooking ethical concerns, penalty based and rigorously enforced interventions may not always facilitate safer health practices. A deeper look into the impacts of rigid vs relaxed interventions in terms of spread of infection, severity of disease, mortality rates, protecting the vulnerable, socioeconomic outcomes etc. is the need of the hour at least until an effective vaccine is available. Initial stricter social distancing measures are essential to prepare the health care system and protecting high risk individuals, beyond which sustainability of such interventions in the long run are to be evaluated.
A comprehensive perspective: It is time we start looking into managing the pandemic in an all-embracing approach. Merely reducing the numbers should not be the criteria defining success of COVID-19 interventions. How long can the numbers be curbed? Is relapses in pockets of population inevitable? What else are we putting at stake focusing only on the transmission and death rate? Are the interventions implemented sustainable? All these are concerns to be addressed before narrating success or failure stories. In a recent interview, Sweden’s chief epidemiologist Dr. Tegnell responded with “Judge me in a year” when asked about the Swedish controversial strategy to combat COVID-19.7 His rather direct and concise response adds broader dimensions to our current thinking. Uncertainties pertaining to the pandemic warrants us to await on how outcomes are to pan out. While this is a tough pill to swallow, over enthusiastic speculations could result in contrary consequences.