Fragments of Reality
Objectivity in complete elimination of coronavirus
The Scientific Advisory Group for Emergencies (SAGE), who provides scientific and technical advice to UK government during public health emergencies, published a report recommending that the UK aims for zero reported cases of Covid-19 within the next 12 month. This means the complete elimination of coronavirus. However is it the best approach to tackle coronavirus? The essay explores this matter.
SAGE report suggests that 'achieving elimination would allow all social distancing measures to be lifted, schools to be fully open, the hospitality and entertainment industries to reopen fully, revitalisation of the economy and a sense of much needed normality for the population.' It has been recognised that 'a sense of normality for the population' is of paramount importance, but the nature of coronavirus is such that it can change its characteristics. People who have been infected with Covid-19 are getting infected again.
Even if we develop immunity, it won't last and a vaccine could make the disease worse in certain circumstances. Also we should consider the side effect of any policy decision about complete elimination. For example, during the last recession, from 2007-2009, the rise in unemployment led to a spike in suicide rates in the United States and Europe. Also it has been observed that lockdown has significantly affected other areas of healthcare provision. In the UK different medical procedures have been delayed, cancer screening has been put on hold and many people have avoided seeking care for serious health issues because of the risk of contraction of virus in hospital.
Reading the SAGE report, I am of the opinion that we might eradicate coronavirus in a particular geographical area for a certain period, but complete elimination of coronavirus is not a good objective for a country, because without tackling it globally we would not be able to achieve a zero case situation. Elimination of coronavirus globally is a big challenge. In this regard, the lack of global political will and transparency are clearly evident.
One approach I can think of is to consider the concept of a risk threshold that we use for other area of environment and public health risk assessment. For example, unacceptable risks to human health and the environment from past land contamination are being addressed in the UK by the Environmental Protection Act 1990. Implementation of the Act provides the opportunity to develop a framework for the risk assessment of different carcinogenic substance in the soil. Currently virus or bacteria are excluded from the Environmental Protection Act. However, in case of chemical contaminants, there is technical guidance in place. For example, think about the petroleum fraction of different aliphatic hydrocarbons in soil. We try to understand the toxicity and pharmaco-kinetic behaviour of the substance and then develop a threshold based on their toxicity and human health risk. In case of human, toxicological maximum permissible risk level for petroleum fraction for aliphatic equivalent carbon fraction (C5-C8) tolerable daily intake is 2 mg/kg body weight/day. There are several carcinogenic substances in the environment. These could not be eradicated completely from the environment and it is not practicable also to do so. So, public health approach is to setup a threshold limit value based on the chemical's toxicological properties and their dose-response characteristic.
In case of coronavirus, we can follow five simple steps for risk assessment. First, identify the hazards. Try to approach this in terms of what areas one would make contact with. In case of office setting consider what tasks staffs are completing in certain areas, what equipment is being used and what personal protective equipment is currently provisioned. This should give a good idea of the hazards posed by a potential coronavirus infection. Second step is to find out how would this then affect the none-infected person. So, in this step decide who may be harmed and how. In this step create a clear picture of who could be harmed and how, including to what level - consider individuals who are at a higher risk due to the tasks they carry out or their health such as being immune compromised or having pre-existing medical conditions. Third step is to assess the risks and control them. A competent person should then go through each risk and assess how likely they are to occur and how potentially severe. Follow this up by establishing how to control each risk in a reasonable manner.
Control measures should include cleaning procedures, use of personal protective equipment and measures such as allowing staff members to work from home if possible. Fourth step is to record the findings. In this step, create a method statement and share it with the workforce if it is for an office setting. Ensure it is seen and understood by every member of staff it affects. Keep a track of everyone that has acknowledged the documentation. Fifth step is to complete reviews. Should the risk of coronavirus change then procedures should also be reviewed and updated if necessary. For example, as more information is known about coronavirus, then all risk assessments and method statements should reflect these changes.
In fact this approach follows source-pathway-receptor linkage model. Pathways consider all possible route such as direct contact and inhalation route. Taking into account this approach, we can suggests that if one case per million people in a population carries coronavirus, then we may define it as 'under control'. This is a public health approach and an alternative path that would have been suggested by the SAGE.
Even we setup a threshold for the virus contraction on the basis of a risk assessment, some precautionary measures such as the use of face covering is needed. Large randomised trials show that people who cover their face are less likely to catch the virus than those who don't. A study examining a coronavirus outbreak on a US aircraft carrier showed that those who wore face coverings had a lower chance of infection than others, at 56 percent compared with 81 percent. There is also clear evidence that face coverings stop people from spraying droplets into air when talking. Royal Society in UK concluded that good quality face coverings are effective at protecting both the wearer and those around them from transmission. So, a new rule has been adopted in England from 24 July 2020. People will have to wear face coverings inside shops and supermarkets. People who break the rule could face a fine of up to hundred pounds. This rule is also applicable in public transport and in hospitals.
Above all, we need to enlarge our collective intelligence for finding a solution for the eradication of coronavirus first, but in order to do this; we need to eliminate our unconscious bias towards a particular scientific technique. Complete elimination of virus might not be achievable in a short timescale, but reduction of it's' likelihood of contraction and severity is possible through a risk assessment and risk management.
The writer is an Academic, Environmentalist, Columnist and Author based in UK