The lack of clear messaging during a global pandemic

Yet another month of this wretched virus running havoc all over the place, and now, because of the blessing/curse of the internet, we are forced to go through this even as we watch other countries slowly begin to get back on their feet.
Leaving aside for a moment the horrors faced by those who fell ill, got hospitalised, or began to lose so many of their near and dear to the disease, there seems to be a consistent lack of clear and concise messaging when it comes to effective public health measures. The coin seems to flip back and forth between the pros and cons of imposing a lockdown, and somewhere along the way, we stop asking questions that actually matter — a) what can I do personally to minimise risk of getting infected?; b) my uncle doesn’t believe in vaccinations, how do I convince him?; c) it has been around five months since vaccinations began, are they even working?; d) we have a ‘double mutant’ now, I heard it will break the vaccines into two pieces; and so on. Let us attempt to shed some light on these pressing queries.

  1. I wash my hands forty times a day, I quadruple mask, and whenever I step outside, I try to maintain twenty feet of social distancing. What else can I do?

There has been a disproportionate amount of attention given to hand-washing, social distancing as well as masking. While it isn’t explicitly wrong to encourage good hygiene practices, it becomes problematic when a key piece of the puzzle is almost entirely shunned from public discourse, and that is ventilation. SARS-CoV-2 primarily transmits via aerosols, especially in poorly ventilated settings. Some studies have shown that as much as 99% of cases are transmitted indoors, and this is something that needs to be explicitly publicised. When ventilation is poor, the 6-meter rule of social distancing goes for a toss, as aerosols remain suspended in the air for much longer than just a few minutes. Lack of clear messaging around this key fact allows for a scenario where you, double-masked, would walk by the neighbourhood park that has been sealed off as part of ‘containment measures’, meet a friend at your favourite restaurant that is operating at 50% capacity, proceed to remove your mask(s) and share a pleasant meal over the next hour or two, within the air-conditioned setting that provides great relief from the scorching heat.

Even in close contact, aerosols prove to be the primary mode of transmission
Aerosols dilute over distance and minimise greatly with ventilation

The takeaway from this becomes very clear — ventilation is key. Outdoors are much safer. As the virus transmits via aerosols, duration of indoor contact takes precedence over distancing. I am not here to prevent you from washing your hands, or sanitising your doorknobs. But while you’re at it, please remember that the order of significance goes: ventilation, duration, masking, and distancing. If you can achieve all four, there’s nothing like it.

Useful chart that demonstrates risk according to different settings. Outdoors are always safer. http://tinyurl.com/covid-estimator — can make your own here.

2. Vaccinations: some important considerations

  • On combating hesitancy: forwarding articles from the internet is not going to help. Lack of information is not the problem, there is in fact, too much of that already. What’s required is for you, who has read all of these articles, and is now armed with all of the information regarding mRNA, antibody levels, T-cell immunity and efficacy rates, to step up and take responsibility for at least the immediate members of your family. You don’t need to convince the next person on Twitter to get vaccinated, but instead, focus your efforts on getting your grandparents, parents, siblings and hopefully your maid/security guard to get the shot.
Convince your family members. That is the least you can do.
  • At the vaccination site: I have sadly spoken to too many people who fell ill just a few days after getting vaccinated. Before you even think it, no, it was not because of the vaccines themselves. A crowded hospital with hundreds of people queueing up, standing in line for hours together in close proximity with poor ventilation is the ideal setting for the virus to spread easily. What can be done on an individual level, is to prefer government centres that are mostly outdoors, wear an N95 (or at least double mask), minimise the time you have to spend indoors by waiting outside till your turn is due, etc.
Crowded vaccination sites indoors can pose a significant risk.
  • Post-vaccination: once again, I am sure we all know more people than we care to admit who got infected after taking the first dose. While individual case histories might differ, the message that needs underscoring is to take extreme levels of precaution, especially for the initial 3–4 weeks after the first dose. Antibody levels build up over time, so the individual is not sufficiently protected soon after the prime dose. With an increasing scarcity of hospital beds, I feel it is paramount to stay as safe as possible until two weeks after the booster dose, to minimise the risks even further.
  • Getting vaccinated post-COVID: another common question is the need for vaccination if the patient has already recovered from the disease. While it is true that the risk of re-infection is low, the benefits of getting vaccinated are demonstrably high. Studies have shown that this leads to a more robust, well-rounded immunity against the disease, and also lowers the risk of long-COVID complications.
  • Are vaccines even working?: the answer is a resounding yes. You can see it clearly in places like the US, Israel, UAE, Chile, Uruguay, Bhutan, etc. My favourite story of all, however, is from a small city called Serrana in Brazil, where they designed an experiment called Projeto S, to vaccinate all adults with the Chinese-made CoronaVac vaccine. This one story beautifully refutes all the pseudoscience regarding vaccine efficacy rates as well as scary mutations of concern. The CoronaVac vaccine demonstrated an efficacy of just 50%, and it was matched against the P1 variant in Brazil, which has made enough headlines due to its potential immune-escape as well as being more contagious. What happened next is something you have to read for yourself. (linked below)
We shall get here too. Only a matter of time.

3. Mutations, and how much I need to worry about them right now

Step one, don’t pay attention to anyone who uses the phrase ‘double mutant’.
Step two, know that the current vaccines work very well against this variant.
Step three, these variants are invariably from the same virus, causing the same disease. Nothing changes when it comes to safety protocols.
Step four (this should be step 1 actually), get vaccinated.

4. Eliminate the stigma

In the midst of everything that has been happening, it is easy to get caught up in the idea of reducing patients to mere ‘cases’. People who get infected are not merely a statistic, and no matter what they might have done to contract the disease, it is simply not okay to grill them regarding where they went, discussing (often behind their backs) possible reasons for why they would have done such a thing, and belittling them for their ‘irresponsibility’. I understand the need to chide people when they do something reckless, but once a person tests positive, he/she now becomes a patient. There’s enough and more that one needs to worry about, without the addition of this excess baggage of becoming an outcast within an apartment complex, a ‘case’ in the household, or a topic of conversation within gossiping circles. This kind of stigma can have real-world consequences, where an individual might decide against informing others about their condition, which could even prevent them from getting timely help when required.

People who test positive are patients too, not merely a statistic.

Take all the precautions you possibly can, but when you hear about a friend or a family member who has tested positive, please remember that they are suffering from an illness, and would much rather benefit from your support than your judgment.

5. COVID is not the only disease that demands your attention

As we are all fully aware, the situation in India is really grave, and we have all come to realise the scarcity of hospital resources that continues to affect thousands of people on a daily basis. With several cities already descending into lockdowns, there is a pressing need to emphasise on taking care of your overall health in general. Maintaining a balanced diet, exercising regularly, and getting a good amount of sunlight all sound like health tips that you would have heard back in primary school. However, the importance of this is amplified several-fold in the context of dwindling hospital resources, where it would be better to not fall ill with anything right now, as much as we can.

To conclude on a positive note, it is important to remember that as always, this pandemic too will end. We are seeing it across several countries already, with a combination of vaccinations and sound public health messaging. Trying to remember all of this information can easily be overwhelming for most people, but if nothing else, I think that sticking to the basics (good ventilation, masking, avoiding indoors etc. as much as possible) can be a great place to start.

It is only a matter of time, but I am confident that our country shall bounce back, as she always has.

Links for those interested in further reading:

Aspiring to write about the several rabbit holes I find myself burrowing down the internet.