Express News Service
KOCHI: Covid has made the common man familiar with terms such as R0, transmissibility, mutations, variants, hand hygiene, physical distancing, PPE, isolation, herd immunity and antibody-mediated immunity. Masks have become part of our attires, a kind of must-have when you step out of the house. It is becoming more and more clear to everyone that there is no ‘elimination’ of Covid, but only ‘control’ is possible. Now, if we are to live with the pandemic, how do we do that?
Apparently, vaccinations can be rendered less effective by new variants. These new types are inevitable mutations part of the natural evolutionary process of the virus’ life cycle. Newer drugs are promising in clinical trials while we await more real-world data on their utility. Also, Covid might not be the last of the viruses with pandemic potential. Globally, experts believe that emerging infectious diseases are a constant threat and we could be seeing more of these respiratory viruses causing pandemics in the future.
Respiratory viruses — and bacteria too — can spread easily from person to person through multiple routes. They can transmit through surfaces (a minor component as evidence suggests), droplets (thus the six-feet rule) and most importantly through air. Our lives ahead, with Covid, should include preventive measures that can limit the spread of new/old respiratory illness. And while we could do a hundred things to prevent the infection, it is important to understand the basics — the hierarchy of infection control measures. This means, we understand and focus on the measures that have the greatest impact on prevention instead of wasting our resources on multiple less-effective measures. Developing a uniform preventive strategy is likely to create a pandemic-proof future.
The hierarchy of infection control/prevention measures consists of four strategies — elimination of the pathogen, engineering controls that reduce the risk of exposure of the pathogen to the vulnerable, administrative controls that modify work-practices or behavior to prevent exposure, and finally, appropriate use of personal protective equipment (PPE). Now, elimination of pathogens (eradication of SARS CoV-2) is not immediately feasible, so we have to rely on the other three measures. These three key strategies can be broken down further into three actionables proven to reduce the transmission of even highly transmissible respiratory viruses like Measles and common viral and bacterial infections. These include engineering controls to enable adequate ventilation, administrative controls to prevent crowding in all community settings and finally, appropriate use of masks.
What does the ideal world look like post Covid? Just like how attention to sanitation and hygiene in the developed world has resulted in a reduction of diarrheal diseases, I hope that focus on air quality would reduce the burden of respiratory illnesses and reduce the risk of similar pandemics in the future!
Following would be ideal steps towards that:
- Every indoor space would have a display of ambient Carbon dioxide levels reflecting the ventilation status and highlighting the impact of crowding.
- The government would implement and monitor indoor air quality standards in all closed/centrally air-conditioned buildings including hospitals and schools
- Strict administrative controls are in place to prevent crowding at malls and public recreation spaces
- Common man is educated on the appropriate use of masks. This will reflect in better health indices, the incidence of multiple respiratory illnesses including TB and Influenza should drop
The author is the chief of infectious diseases at Aster Medcity, Kochi