RAJENDRA PATIL HUNMA

Introduction

A year ago, very little was known about Covid-19 and there was considerable speculation. Many decisions were based on fast increasing numbers of cases and on predictive models, some of which turned out to be faulty. By now a good amount of data has been compiled and can prove useful in guiding and refining policy decisions and in increasing visibility about what may be expected in the future.

What we know

Some of what we currently know about Covid-19 is presented below.

Breakdown of cases

•99.6% of the active cases are mild

•0.4% of the active cases are critical

•97% of the closed cases ended in recovery

•3% of the closed cases ended in death

Source: https://www.worldometers.info/coronavirus/  – accessed on March 28, 2021

We also know that of the 3% who died, a significant number had other underlying health conditions.

The fact that about 99.6% of active cases are mild or asymptomatic is also supported by local PCR test findings.

Distribution of cases and deaths

While the distribution of cases is almost normal across age groups, the hospitalisation and death cases are heavily skewed towards the elderly as indicated in the graphs – figures may differ across countries and depending on sources but the general trends would tend not to differ significantly.

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Source: https://www.who.int/data/maternal-newborn-child-adolescent-ageing/static-visualizations/Cases-and-case-fatality-ratio-by-age

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CFR for South Korea, Spain, China and Italy. Source: https://ourworldindata.org/mortality-risk-covid

Note: the case fatality rate (CFR) represents the number of deaths divided by the number of confirmed cases at a given point in time and place. It does not tell us the true risk of death which is much harder to estimate considering that the number of confirmed cases depends on the number tested and that the exact number of deaths will only be known after the pandemic.

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Vaccines

Vaccines are now available from various suppliers. While efficacy rates may differ across brands, it is generally agreed, based on the limited data available, that they would protect those vaccinated against severe forms of the disease and drastically reduce the need for hospitalisation. It is also assumed that those vaccinated would still be able to infect others.

Living with Covid-19

In spite of the availability of vaccines and of the improving recovery rate, it is generally believed that whatever measures we may adopt, the virus will not disappear in the near future and that we need to learn to live with it.

What we need to do

In the absence of concrete data and at a time when no vaccine was available for Covid-19, governments across the world resorted to large-scale lockdowns in order to limit the spread of the disease and ensure that health systems were not overwhelmed. Assuming that the information we have is accurate and with vaccines now available, the following policy decisions may be considered:

1.We need to ensure that all those above 50 and all those with underlying health conditions are systematically vaccinated AS A PRIORITY, except if otherwise advised by their referring physician. This can be done within two to three weeks and would ensure that the elderly and other clinically vulnerable groups are duly protected. This measure would drastically reduce the risks of severe cases and of an overstretched health system.

2.The vaccination campaign can subsequently be extended to other age groups depending on the availability of vaccines.

3.Soon after the elderly and the clinically vulnerable groups have been inoculated, the frontier may be reopened with the necessary precautionary measures in place. This decision should be announced up front so that economic operators may plan accordingly. Hotels may, for instance, start accepting bookings while informing their future guests of the safety measures to be complied with.

4.Similarly, once all elderly and clinically vulnerable teaching/non-teaching staff are effectively immunised, educational institutions should reopen while enforcing relevant precautionary measures including social distancing and masks in closed spaces. This decision should also be publicised immediately for planning purposes. Occasional positive cases among students would be mostly mild / asymptomatic; these would be treated as and when they occur and should not result in school closures.

5.With the elderly and the clinically vulnerable groups inoculated and with more than 99% of community cases being mild and asymptomatic, we would no longer have to systematically resort to drastic lockdowns whenever cases reappear. These cases are bound to be exposed every now and then in the coming months/years in spite of vaccination campaigns. We need to learn to live with the disease.

6.Large gatherings in closed spaces with people talking loudly / chanting, etc. would remain prohibited until the vaccination rate of the population exceeds 80%.

Conclusion

The above is an attempt to propose a course of action that would enable us to live with Covid-19 while taking into account available data and the need to enhance visibility about the future, and thus generate hope and optimism. Decisions would be refined as more data become available. We should be prepared to act on incomplete data and take calculated risks as we have done with the administration of vaccines yet to be accredited by the WHO or with the running of school examinations during the lockdown even in Red Zones. We may never be completely safe from Covid and expecting this can be misleading. To quote Shakespeare: « And you all know, security / Is mortals’ chiefest enemy » (Macbeth, III.5, 32–33).