COVID-19 Wave III: Were the lessons learned from last year implemented?

This article was exclusively written for The European Sting by Ms. Mehak Zarif, a medical student from Pakistan. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

We fall asleep under the same sky, wake up in the same world and suddenly, the charm of Disney land has faded. Paris is no longer romantic. Human contact is poisonous and staying away from close ones is a token of love.

Nature continues to test humanity with different waves of different contagious diseases and humanity continues to learn, thrive and surf with TB, influenza, dengue and now covid-19. Even beginning to trace the lasting impacts of the COVID-19 pandemic can be overwhelming. Yet this is the meaning of a pandemic: the virus has got into everything.

Covid-19 is an air borne disease which relies on its transmission by respiratory droplets with higher risk of fatality for people with co-morbidity while mask is its only one-man-army to effectively fight it from entering the territory of human body. The World Health Organization (WHO) officially declared coronavirus disease 2019 (Covid-19) a pandemic on 11 March 2020 (1). The pandemic of 2019-2020 coronavirus (COVID-19) has no parallel in recent times as a rapidly evolving catastrophe. When the coronavirus pandemic began, experts wondered if there would be waves of cases, a pattern seen in other virus pandemics by calculating Rt (time-varying reproduction number). Often, the first wave (herald wave), is followed months later by a more severe second or third waves of infection, as seen in the influenza pandemics of 1918 (H1H1), 1957 (H2H2), 1968 (H3N2), and 2009 (H1N1).The Spanish flu pandemic of 1918 was not eradicated swiftly and lasted 2 years spreading in successive waves. With the little knowledge of pandemic with no approved standard therapy and the lack of any effective vaccine, major non-pharmaceutical intervention was adopted(2), with a coordinated global response trying teleworking as a tool for reconciliation of work and family life, imposing national scale lockdowns, limiting travel and use of masks and strengthening personal hygiene especially that of hands. For all countries, interventions were assumed to have had the same relative effect and are informed by mortality data across all countries. (ref image below).

Left, daily number of infections. Brown bars are reported infections; blue bands are predicted infections; dark blue, 50%

credible interval; light blue 95% credible interval. The number of daily infections estimated by our model drops immediately after an intervention, as we assume that all infected people become

immediately less infectious through the intervention. Afterwards, if Rt is above 1, the number of infections will start growing again.

Middle, daily number of deaths. Brown bars are reported deaths; blue bands are predicted deaths; credible intervals are as in the left plot. Right, Rt. Dark green, 50% credible interval; light green, 95% credible interval.

1st wave provided information to deal with future waves. Health experts claimed that our behavior and conduct would influence future outbreak. Lack of a stringent policy and lockdown gamble paved the way for covid-19 wave II spread through social, political, religious and regular business activities, transport and tourism, as an attempt to balance controlling COVID-19 transmission with ensuring stable economies and livelihoods. A second wave refers to a subsequent serious increase in cases of a pandemic infection after the original wave has been repealed. Some locations that saw a high number of coronavirus infections early on, followed by a decline, have had a “second wave” of increased cases (3) When a person is exposed to the coronavirus, it can take up to two weeks before they become sick enough to go to the doctor, get tested and have their case counted in the data, thereby exposing other people and their becoming ill and the like cycle. (4) As Ernest Dimnet said: “The happiness of most people is not ruined by great catastrophes or fatal errors, but by the repetition of slowly destructive little things.”

During 2nd wave, population’s perceptions and seriousness towards disease were changed, their initial concerns and fears about the novel unknown were allayed by false information about disease and various controversial and conspiracy theories that always follow the new curiosities in the society. Another thing that might have paved way for more waves of covid19 was government strategies could have failed to reach the population and low trust in government institutions limited interest of population in the information provided by the government.

It was due to the reckless attitude of people and their understandable desire to go back to normal life that they violated SOPs like their actions won’t have consequences which has now landed us into the 3rd wave of covid-19. The third wave is the effect of virus on the social determinants of health, and its effects on the next generation (4). The virus will worsen health inequalities through severe economic injury (5) It is the sectors that rely on low-paid staff (often women, young people and Black, Asian and minority ethnic (BAME) people) that will take longest to recover from the predicted deep economic recession. The health impacts caused by this worsening of economic conditions will be complex, but it is likely that groups that are at the intersection between poverty and poor health that will suffer most.

The new wave is wreaking havoc in India at the present moment. The condition in the country has debilitated to such an extent that the country now is at the verge of death. (7) Crisis looms large over major hospitals in Pakistan as they approach saturation due to rising Covid-19 cases.

(8)

From the above discussion, and keeping in view the current wave of the pandemic, if we evaluate the implementation of lessons learned during initial two waves, the opinion can be boiled down to one loud point: NO. Due to reckless behavior of people, government policies failed to curb the growth of virus. Control of pandemic depends on individual’s individual behaviour. With the discovery of scientific knowledge and development of vaccine, we fought another pandemic along with covid-19 and it was: reckless stupidity of people. As Harlon Ellison rightly said: “The two most common elements in the universe are hydrogen and stupidity.” The mutants and variants of virus, in my opinion, have little effect on the subsequently substantial waves than the individual behaviours. If everyone continues to wear masks, wash their hands and practice social distancing, reopening will have a much lower impact on transmission of the virus than in communities where people do not continue these safety precautions on a widespread basis. These individual behaviors depend upon, as per Health Belief model, the literacy of population and, their seriousness towards disease, actions that can prevent it, benefits of its prevention & their mode of living and working.(9)Control of pandemic depends strongly upon effective communication which must be grounded on population’s knowledge and perceptions. The countries easing preventive measures should thoroughly revisit the situation, assess critically their health care system capabilities, and make preparedness plans. The window of opportunity to prepare for a future waves may be small and the implications for health employees, organizations and economy can be more serious. We must anticipate, plan and prepare ourselves to deal with it pre-emptively as the 6 Ps rule says: Prior Proper Planning Prevents Poor Performance.

And also Dr. House very firmly believes that the disease can be cured or treated but there is no cure or treatment for stupidity.

References

1.World Health Organization. WHO Coronavirus Disease (COVID-19) dashboard. Accessed 1 October 2020. Available at:

https://covid19.who.int/ Google Scholar

2.Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe

3.https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/first-and-second-waves-ofcoronavirus)

4.Major LE, Machin S Covid-19 and social mobility [Internet]. London, UK: London School of Economics and Political

Science, 2020. Available http://cep.lse.ac.uk/pubs/download/cepcovid-19-004.pdfGoogle Scholar

5.Banks J, Karjalainen H, Propper C Recessions and health: the long-term health consequences of responses to the coronavirus [Internet]. London, UK: Institute for Fiscal Studies, 2020. Available https://www.ifs.org.uk/publications/14799Google Scholar

6.Structural Vulnerability in the U.S. Revealed in Three Waves of COVID-19

7.https://www.worldometers.info/coronavirus/country/india/

8.https://www.hindustantimes.com/world-news/pakistan-faces-third-covid-19-wave-low-oxygen-chokes-islamabadhospitals-101619170172690.html

9.L. Cragg, M. Davies, W. Macdowall Health Promotion Theory (second edi), McGraw Hill, Berkshire, England (2013) Google

Scholar

About the author

Mehak Zarif, an assistant in IFMSA Pakistan AMC LC’s publications support division, has a myriad of viewpoints on different topics owed to her passion for reading. Therefore, she can be found reading other books, out of which mostly thriller and crime fascinates her, but she has a big heart for philosophy also. Alongside this, she is also found cracking bad jokes and obsessing over witty characters from seasons and occasionally, bettering herself at her lost skills for painting. Currently, she can be found trying to find a balance in her life.