Thu. Jun 4th, 2020

Invest in Demand Side to Limit the Rampant Pandemic


Sultan Karim 

COVID 19 has damaged the world economy and precious human lives are being lost.  The outbreak has turned into a rampant pandemic within no time. This happened because of the non-serious attitude of world leaders and the in decision making.

Pakistan is also suffering because of the pandemic, while the fallout of the epidemic curves show speedy spreading of the disease.

We need to understand the reason for the rampant spreading of the disease. The virus has a very high capacity of transferring to other people.  On average one infected person can spread the virus to 2.5-3.5 people. This is quite high when compared to other outbreaks, like MERS (1.5), EBOLA (0.9). What it means is that CoVID-19 has high virulence, and a little viral load can spread the disease.

Secondly, this multiplies in the respiratory system and takes 8 to 14 days as incubation period before showing symptoms. Meanwhile, the virus spreads the disease to others. These characters make this disease difficult to control, as without symptoms one cannot predict the person has the disease or not. Also, it is not humanly possible to test the whole population for COVID-19.

The good news about CoVID-19 is that 97% of the disease is self-limiting and self-resolving. The remaining 3% is the population needs medical intervention, especially the population having critical illnesses.

These are the vulnerable population including old aged, 60> and also those who are immune-compromised. The people who have weak immune system might be affected more because of co-morbidity or underlying illness, or may be because of any medication use.

There are two types of interventions to combat this pandemic. One is increasing health care facilities and their quality of services which means increasing supply side, while the second one is decreasing the demand, by limiting the spread of disease within community, laterally.

A country like Pakistan needs to work on second intervention, which is cost effective and long lasting, because the first option is less cost effective and challenging to execute in outbreak situation, with scarce resources.

There are two ways to decrease or limit lateral spread of any disease. One is giving immunity to the population through mass immunization, which in this case seems a long way. The vaccine could be available by 2022 as it has to go through multiple levels of trials, safety studies to be conducted before thrown for mass immunization in the commercial market. Second intervention, which is widely being used and literature supporting in outbreaks of airborne, is isolation and quarantining of patients and suspects. Literature suggests CoVID 19 virus travels in the air through a distance of 1.5 meters. So, more than 4 meters is thought to safe distance, from the patient. Moreover, isolating the patient and keeping under observation. 14 days is a safe period when the viral load goes down and the ability to transfer the disease gets minimal.

The above mentioned actions or interventions can be carried out at local level with little resources; quarantine centers could be developed and COVID 19 patients could be shifted to them and monitored with less experienced doctors or health care providers, to see if condition of the patient is stable or not. Secondly, proper triage facility should be developed at each provincial level and serious patient could be sent to the tertiary care hospitals. This will not exhausts our resources very soon, as we can spare more doctors to see critical patients and patients with other illnesses. Allocating 500 beds at provincial level is maximum for critically ill patients. Having been treated, they can be sent back to the quarantine center, once stable. These patients can be replaced by new and more critical patients at tertiary care facilities. This will consume less resources and can be highly cost effective.

On the other hand, we can start ordering more ventilators and start working on improving our health care system or hospitals. This cannot be done in a short period of time, neither we will be able to import more ventilators on such a mass scale in such short time. This will spread chaos among the community and common people will start feeling sense of insecurity and this can cause more damage, socially speaking.

In addition to this Pakistan suffering with double burden of disease, we have high prevalence of infectious diseases (Measles, Tuberclosis, Typhoid, Poliomyelitis, etc ) and Non communicable diseases including  Cerebro vascular accidents, ischemic Heart disease, Diabetes Mellitus, COPD and cancer etc. All of these diseases are serious illness and need tertiary care so already high load on the health care system.  Infrastructure development could be started after pandemic goes down and health budget could be increased in future to build better health care system.

In conclusion, it is always good to invest on demand side during an outbreak situation where people adopt self-safety measures, enabling the outbreak to die out. If we solely focus on investing in supply side, invest to build infrastructure or improve health care facilities, the outbreak will stretch and have more disastrous effects.

The contributor works as a Research Specialist at the Aga Khan University. He is a Health Economist and his area of work is outbreak investigation and control interventions. He belongs to Khyber, Gojal Valley, Hunza. 

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