Expert View: Govts jumped several red lights while dealing with Covid

Discoveries of Robert Koch and Louis Pasteur in the nineteenth century relating diseases to germs had caused considerable euphoria. It was soon realized though that besides bacteria and viruses, there were social offshoots of infectious diseases. Diseases have social causes, social pathologies and social consequences. The road to social welfare consists of ethical red lights as safeguards from collateral harm.

Equity: Equity or justice means that each person’s interest should count equally. This by logic should also imply that all diseased persons, irrespective of the diagnosis, should have equal and easy access to health services. Each disease which is a public health problem should get equal attention.

In India we have a large burden of communicable diseases and an unacceptable level of maternal and child health problems. Every year, eight lakh under-five children die in India from preventable diseases. The risk of a new born dying before the first birthday in India is 3%. This is higher than the infection fatality rate from Covid-19 which recent estimates put at far less than 0.1%.

Most of the neglected and endemic diseases and child mortality are diseases of the poor while the perceived threat of Covid-19 is felt more by the upwardly mobile globetrotting middle class. There is a clear demarcation between the diseases of the poor and the diseases of the rich. The principle of equity is ignored.

The roll out of the much-awaited vaccines further reveal these inequities. Rich countries have unlimited vaccine supplies while the poor countries are struggling to procure adequate supplies. Within the country, there is the urban- rural divide. There are reports of people from cities going to villages to get vaccinated depriving the uninformed rural residents of access to the vaccine.

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Beneficence and Non-malfeasance: Beneficence implies that people should benefit from any intervention and risk-benefit ratio should be acceptable. Lockdown has been the most major intervention. For the poor, the risk of fatality from contracting Covid-19 was far less than the risk of fatality from any of the other diseases of poverty which are endemic in India. Lockdowns push people to extreme poverty and misery. Child malnutrition and child deaths would rise exponentially; no fancy models from overrated foreign universities are needed to predict this.

Non-malfeasance means do no harm. This is an important ethical principle in any intervention. The greatest harm in the lockdown with hardly any benefit is imposed on the marginalized section of the population.

According to the latest census, more than 6.4 crores of the Indian population live in slums. This is almost equal to the population of UK or France. Anyone who has visited a slum in India will know that social distancing or frequent hand-washing is just not possible for these marginalized people. Most of them share common community toilets with scant water and hand-washing facilities. Cooped up 24 hours in crowded living conditions would be the ideal situation for spread of respiratory infections besides other communicable diseases.

A feature in New York Times, dated May 26, 2021, reveals how the Center of Disease Control (CDC), USA misinterpreted a scientific paper to conclude that risk of Covid transmission outdoors is 10%. This led to advice to stay indoors and wearing of mask when stepping outdoors. Subsequently, one of the authors of the paper tweeted that risk of outdoor transmission was less than 0.1% and not 10% as reported by CDC, which overestimated the risk of outdoor transmission hundred-fold!

This fundamental error led to restriction of outdoor activities worldwide, and caller tunes urging us not to step outdoors, the American CDC being the bellwether for global mandates on Covid-19. The co-author of the misinterpreted paper, Nooshin Razani tweeted, “…People should spend more time outdoors to enjoy nature and be active. Being outdoors is essentially the best ventilation one could ever imagine, as particles have the space to infinitely dilute, disperse, and eventually disappear.”

In a subsequent interview she mentioned that the outdoors is the best resource and we should find ways to undertake most activities outdoors. In spite of this clarification by one of the authors of the paper on which the CDC based its recommendations to stay indoors, the august body and global consensus continue to treat outdoor activities as a major risk.

Had CDC followed science correctly, it would not have continued to recommend restriction of outdoor activities and businesses. The cascade effect made other countries to follow suit and shut down all outdoor activities and businesses whenever there was a surge in cases. This leads to severe economic hardships particularly in developing countries where most people in the unorganized sector work outdoors.

The irony is that in developing countries, poor workers were pushed indoors in their crowded living conditions where they were more exposed to infections, and to add insult to injury lost their livelihoods most of which were pursued in safer outdoor environments. These include hawkers, small traders on the roadside, open street food restaurant owners and so on. If we follow the Science, we can ensure interruption of transmission which occurs predominantly indoors and also preserve livelihoods which depend on outdoor work.

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Autonomy or informed choice: The greatest lockdown in the world was announced, with good intentions, at a notice of four hours. Economists, social scientists and others were not given an opportunity in the public forum to voice their concerns. There was no public debate of the pros and cons of this draconian measure on such a large scale. Hundreds of lives and livelihoods continues to be at stake and vulnerable to the ravages of unemployment, hunger and starvation deaths.

The Epidemic Disease Act 1897 from the colonial times enacted to fight the plague was enforced giving enormous powers to the state and suspension of many basic human rights. This is being used to tackle a 21^st century disease which should have been addressed by science and evidence rather than converting most countries into police states.

Once the pandemic is over, these ethical oversights need to be deliberated so that future pandemics do not evoke such clumsy and crude responses with the remedy worse than the problem.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune)