Covid outcomes ‘deceptively mixed’, make collective strategy impossible, Devi Sridhar says

In an article for Nature Medicine, public health expert Devi Sridhar highlighted certain aspects about the novel coronavirus that have flummoxed health experts.

Devi Sridhar, a public health expert and professor at the University of Edinburgh | Commons

New Delhi: SARS-CoV-2 does not kill as frequently as its brethren, the SARS (Severe Acute Respiratory Syndrome) virus or the MERS (Middle East Respiratory Syndrome) virus, and this unpredictability is among the most challenging things about the virus, said Professor Devi Sridhar, professor and chair of Global Public Health, Edinburgh University Medical School in Scotland.

In an article published in Nature Medicine journal Monday, Sridhar noted that while many things about the pandemic panned out as expected, there were five things about the novel coronavirus that left health experts flummoxed.

The first was the fact that the earlier viruses SARS and MERS had far higher case fatality rates than Covid-19. SARS killed one in ten persons that it infected and MERS killed a third of all its infections.

The fact that SARS-CoV-2 kills a fraction of that — 2.28 per cent globally and 1.45 per cent in India — meant countries had to do a balancing act while planning its management.

“If COVID-19 killed as many people as SARS (with a case-fatality rate of 10%) or MERS (with a case-fatality rate of 33%), it would have been easier to have countries all heading toward elimination together, because it would have been impossible to let SARS-CoV-2 spread within populations. Yet because SARS-CoV-2 is deceptively mixed in its outcomes instead we have a patchwork of mitigation, suppression and elimination strategies being pursued by governments and an absence of global cooperation, coordination and a collective strategy,” wrote Sridhar.

The ‘best’ turned out to be the worst

The US and the UK were traditionally thought to be the best prepared to handle a global health crisis like the pandemic. And yet, the US is the worst-hit country in the world and the UK struggled with the virus early on with its herd immunity experiment.

The US has reported a total of 1,53,69,046 cases and 2,90,443 deaths while the UK has reported 17,37,960 and 61,434 deaths till now.

“This can be chalked up largely to poor leadership, following an influenza model of letting the virus spread, and lack of humility in the face of an infectious disease. Viruses do not suddenly disappear because ‘silver bullets’ such as herd immunity magically happen,” highlighted Sridhar.

The public health expert added that it was “surprising” that despite years of warnings from the health community about the importance of prevention and the need to build healthcare capacity, several European and North American countries did not focus on the “preventive approach”.

“The public-health community has always argued that investing in public-health capacities, and preventing large outbreaks, would be cheaper and better for the economy than reactive and late responses. Unfortunately, this has largely fallen on deaf ears in government, who consider public health as a drain on money rather than an engine of growth,” she said.

“The prevention of infectious disease is about all the steps put in place to stop someone from becoming infected and arriving at the hospital. Surprisingly, European and North American countries did not focus enough on a preventive approach and instead focused on making health services their front-line response to the pandemic,” noted Sridhar.

Not a choice between economy and Covid

The purported “choice” between keeping the economy afloat and managing the Covid-19 pandemic in a country was also scrutinised by Sridhar.

She argued that it was not the ultimate choice that it was made out to be as minimising Covid-19 harm would also reduce harm not related to the virus and vice versa.

“In fact, economic analysis of the first half of 2020 clearly shows that countries that suppressed COVID-19 effectively also experienced the smallest losses in gross domestic product and, in some instances, even experienced growth. In the medium to long term, it is clearly the virus, not the restrictions themselves, that is hurting the economy,” she noted.

The pandemic, she said, has also highlighted important lessons on the efficacy of border control as a disease control measure and called for a review of the International Health Regulations.

IHR by the World Health Organization is an overarching legal framework that defines the rights and obligations countries have to follow during public health emergencies, such as the pandemic. It is legally binding on 196 countries.

Praise for WHO

While the WHO has been criticised by various quarters over the course of the pandemic, especially by US President Donald Trump, Sridhar was all praise for it.

The global health body, she said, took crucial lessons from the Ebola outbreak to provide effective leadership even if countries turned a deaf ear to their prescription of following an East Asian model of virus elimination where aggressive testing was the key.

“It (WHO) started technical briefings by the Director-General and the strong emergency-response team in mid-January and alerted the world to a public-health emergency of international concern (its highest alarm bell) on 30 January. It shared information, communicated clearly and tried to bring countries together to form agreements,” wrote Sridhar.

She added: “In February, the outbreak on the cruise ship Diamond Princess hinted at asymptomatic transmission and aerosol transmission, and the WHO mission to China in February laid out clearly why a SARS approach to COVID-19 was optimal and caused New Zealand to pivot away from an influenza strategy.”