Breathe a sigh of relief, but don’t take a breath of death

for we are still in pandemic mode

By Dr R Neerunjun Gopee

After a seemingly interminable period of sanitary curfew – starting on March 20 – the announcement was made before the weekend that the lockdown would finally be lifted with effect from midnight on Saturday last, May 30. Many restrictions have been removed, for example there is free movement with no need for WAPs (Work Access Permits), shopping at supermarkets will no longer be according to alphabetical order, bazaars will open, etc. On the other hand, congregations such as religious gatherings, at beaches, sports and racing events and others are still not allowed for they are potential hotspots for transmission of the virus.

“We are frail humans – as Covid-19 has so powerfully demonstrated – and one great weakness is that we tend to relax at the slightest inkling that a threat may be going away. But Covid-19 is going to be around for quite a while yet, how long nobody really knows; a reasonable timeline is up to two years. Until the pandemic is officially declared to be over…”

However, in the excitement that is palpable about the easing and opening up of more areas of activity across several sectors — and the foreseeable surge in volume of movement of both people and vehicles (surely a tragedy if it comes back to the previous or ‘old normal’ level) – hardly anybody is talking about what is perhaps the most important aspect of this release of the pressure they have been feeling for over two months now. I am referring to the conditions attached to the resumption of more activities which accompany the official communiqué, which are based on the sanitary measures that are still mandatory in this new phase of our national life, the so-called ‘new normal’.

These few simple precautions are in fact our lifeline in this continuing pandemic situation, and are worth reiterating – because it is human nature to want to forget the unpleasant and get on with life. They are well-known:

1. Wear a mask in public spaces;
2. Avoid touching your face;
3. Wash your hands frequently with soap and water or use alcohol-based hand sanitiser;
4. Keep adequate physical distance from the next person.

The cynic might well ask – what’s so difficult about doing that? The answer is – nothing really. But we are frail humans – as Covid-19 has so powerfully demonstrated – and one great weakness is that we tend to relax at the slightest inkling that a threat may be going away.

But Covid-19 is going to be around for quite a while yet, how long nobody really knows; a reasonable timeline is up to two years. Until the pandemic is officially declared to be over, steps 1-4 above will continue to be relevant.

For our own safety to begin with, and for that of our fellow humans – that means, therefore, protection of ourselves and of the community and society at large, that is, the country.

Who would have thought that the simple washing of hands and wearing of a mask would someday be construed as being simultaneously a selfish act (protection of oneself) and a selfless or altruistic gesture (protection of others). And what a paradox: standing (or sitting) away from each other adds up to a united strength against spread of the disease, a sort of reversal of the well-known dictum: ‘United we stand, divided we fall’.

As fellow humans are being infected and succumbing massively to the invisible microscopic enemy, Covid-19 has not only revealed our vulnerability, but it has also dramatically reminded us of the capital role of basic hygiene and sanitation in the effective control of infectious disease – even if there may be as yet no specific treatment available, or a vaccine to prevent it, which as everyone knows is actually the case for Covid-19.

This is a medical truism which as clinicians, that is, doctors focused on treating individual patients, we tend to be oblivious of in our daily practice, until an epidemic or a pandemic jolts us into re-acknowledging that reality. What to say of laymen whom we tend to mesmerize with highly publicized accounts of what we nowadays call high-tech interventions or operations, which are not entirely free from an element of self-promotion, an unethical conduct in medicine.

Medical history abounds with examples of infectious diseases being brought under control by sanitary measures, well before it was even known what was causing them. It was only towards the latter half of the 19^th century that through the work of Louis Pasteur and later Robert Koch it was established that infections were caused by microbes, organisms that could only be seen with a microscope, and thus was born the ‘germ theory’ of disease.

Before that the prevalent thinking was that such diseases were caused by miasma, a noxious form of ‘bad air’ emanating from rotting organic matter. Miasma was considered to be a poisonous vapour or mist filled with particles from decomposed matter (miasmata) that was identifiable by its foul smell. The theory posited that diseases were the product of environmental factors such as contaminated water, foul air, and poor hygienic conditions. Such infections, according to the theory, were not passed between individuals but would affect those within a locale that gave rise to such vapours.

Nowadays we know of course that although ‘environmental factors such as contaminated water, foul air, and poor hygienic conditions’ may not be the cause of infectious disease, they definitely are significant in the transmission of the microbe and thus the spread of the disease. Further, contrary to the ‘miasma theory’ whereby the disease cannot pass from individual to individual, the germ theory has proved that this does happen, and hence the measures that prohibit or limit contact between individuals.

A notable historical example is the cholera epidemic of 1854 in London, which was traced to a public water pump by Dr John Snow, and removing the handle of the pump to prevent people from using it resulted in a sharp fall in the number of cases of cholera among the people who had been drawing water from it.

Locally there is the eradication of bilharziasis – which infects the bladder and results in the passing of blood in the urine – which was endemic in Pamplemousses district in the vicinity of Riviere Citron, which harboured the snail that carried the infecting parasite. And of course our flagship success story is the elimination of malaria, decreed by WHO in 1972.

In Sub-Saharan Africa, a potent example is the almost complete elimination of a crippling condition known variously as dracunculiasis, guinea-worm disease or river blindness which is caused by the dracunculiasis worm that is hosted by a tiny snail found in the rivers of mainly West Africa, whose water was used for drinking and washing by the inhabitants thus infecting them. The implementation of sanitary measures has reduced the prevalence from nearly 3.5 million in the 1980s to less than hundred today in the affected regions.

So, lesson learnt – while we breathe a sigh of relief at the freer movement allowed, let us not take a breath of death and risk catching the virus – a potential danger if we don’t mask up and keep safe distance.

* Published in print edition on 2 June 2020