The Conundrum of the Pandemic’s Race to the Finishing Line.

The pruned flora was rejuvenating with a vengeance, even as humankind is preoccupied with many of the worries of this world. It would be hard to write this piece one week earlier or later without having to wrap our heads around new discoveries that drives our thinking from week-to-week, nay day-to-day.

If we treat this as an exercise in planning the next steps, how do we proceed?

Fundamental question: Is this a race to zero or a race to 100? In other words, do we endeavour to suppress the transmission of Sars – COVID 2 to zero or to encourage its controlled emergence on a sizable proportion of the population to achieve post-infection immunity, and at what cost to the vulnerable population groups.?

That decision is determined in turn by a series of parameters:

1. What are the infectivity characteristics? Is it possible to halt the transmission completely? Answer: The virus is easily transmissible, even in the asymptomatic or unknowing individual. It is probably not possible to halt its transmission in a country without a massive and indefinite series of measures to prevent socialization and the isolation of the country to foreign visitors.
2. What is the likelihood that countries will be able to respond to this pandemic in a way that would create uniform conditions for reciprocity? Answer: Unlikely as the capacity and motivation of different countries to respond appropriately together in unison is difficult, determined by their own policies distinctions, the level of trust and transparency, and the financial costs of mobilizing resources to deal with many facets holistically.
3. Why would that be important? Answer: It would be virtually impossible to pursue a “race to the zero” strategy if you have to close your borders and be self-sufficient indefinitely since the infection is just a visitor away from re-infection. The economic cost will be unsustainable
4. Why indefinitely? Why not a sustainable period of 24-36 months? Answer Yes that is possible if a vaccine can be found in the medium term, that would protect the reminder of the population from infection, especially in countries that have successfully implemented a virtual “eradication” of the infection in their own country (e..g, New Zealand and its PM advocate, Ms Jacinda Ardern). But the economic cost of isolation will be enormous.
5. What about a race to 100? Answer: That is a possible strategy if we can protect the elderly or vulnerable population without concomitantly overwhelming the capacity of the hospital systems for treatment. The conditions that would make this tenable is if the infection confers immunity, there is no risk of reinfection or reactivation that is transmissible, and if the mortality figures that suggest a broader population rate consistent with the common influenza virus (0.1%) holds true.
6. What is the social compact needed for this to happen (race to 100)? Answer: Society has to accept the risk of premature deaths in the elderly and vulnerable. Sweden is the prime example and its poster boy, Dr Anders Tegnell backed by his equally inscrutably stoic mentor Dr Johan Giesecke. While the verdict on the Swedish model is largely colored by criticism of its poor mortality outcome thus far, due to the high fatality toil on the nursing home facilities residents in Stockholm (the rest of the country does not seem to be faring so badly), the Swedish experience is perhaps just the vanguard for the larger more liberal democratic initiatives being played out throughout Northern Europe with a relatively lower rate of mortality, morbidity, and political cost to experimentation.
7. Why is there a conundrum? Is there potentially a unifying approach to the problem? Answer: Yes, In many ways, there is perhaps one common pathway in the final analysis, given the nature of a virus that will not disappear until it has swept through its course and bestowed upon the world a population that is no longer susceptible to infection, and with the development of a vaccine after the appropriate period of safety trials. Thus the endpoint of the various mitigating measures of repeated lock-downs and relaxations versus a liberal approach to the disease may in fact be identical, and early lives saved may translate to late lives lost (and vice versa).
8. Wow, that sounds dismal. Is this fatalistic determinism the endgame despite the great minds attending to the problems in the think-tanks of the world? Answer: That is a particularly good question and requires that countries have a keen sense of dealing with the big picture and the long-term outcome and consequences, without descending into emotional diatribes largely drawn from situational reactions to bad news.

What is most likely to occur is a matter of conjecture. The various activities to lock ourselves down, to socially distance ourselves from those we need to live with, has bought some time for countries and communities to prepare for the next onslaught of transmission. There has been early casualties of countries, cities and health systems whose healthcare services have been overwhelmed. These come at great cost and sadness and serve as a cautious reminder of the ultimately cost to be borne together, balancing the race to the finishing line with a sturdy respective for life and acknowledging our limited capacities to preserve it.

I believe that the outcome of efforts by countries will gravitate to normative outcomes, in accordance with their capacities to respond to the needs of people who fall sick. Many of the livelihoods & businesses that drove economical activities before the pandemic will be permanently lost. People will lead simpler lives but the struggle to bring food to the table will drive the return to vestiges of past offerings.