Dr Visham Bhimull
AVOIDING a second wave of Covid-19 is not only essential to save lives and protect the healthcare system, but it is also important to allow the people of Trinidad and Tobago to return to their daily lives.
It was hoped that our systems were in place to avoid a second peak when lockdown was being rolled back.
Now that lockdown has been relaxed, over the past week we have been seeing an upsurge in locally acquired cases. Have the fears of those who were skeptical about rolling back lockdown come to a reality?
As our population does not yet have herd immunity, a second wave is a real possibility as lockdown is on phase five, especially if no control measures are in place.
Herd immunity is the point where a significant portion of the population has developed immunity, whether by contracting and recovering or by the development of a vaccine. In heard immunity context, the virus finds difficulty in finding new human hosts to perpetuate its spread. Within such a context, without any evidence of herd immunity, a second wave can be worse than the first.
During lockdown, we were socially distancing and there were less opportunities to pass on the virus. Thus, the infection spread was thwarted temporarily.
But we must remember that:
- Our population by and large has not become immune;
- We have not developed a vaccine yet and;
- We have not been able to change the fundamental nature of the virus.
So now that we are closer to the real world, the fact that more people are becoming infected is no surprise.
Cases, as predicted, will naturally increase. Unless, we develop heard immunity, whether through a vaccine or almost everyone becoming infected.
A vaccine would not be available for a while, so unless we remain fully locked down for months or even years, this is not an immediate solution.
Allowing everyone to become infected as an attempt to achieve heard immunity is also not an option because not everyone who becomes infected is likely to recover, and death is a real possibility.
Thus far, we cannot manipulate the virus or force it to mutate as a measure to try and control the spread.
Hence, none of the criteria are met and this can explain why we now have this rise in new locally acquired cases in the past week.
After reopening the issue was managing the roll back of lockdown so that the case numbers do not overwhelm the healthcare system capacity.
By doing this we can avoid a debilitating second peak. To achieve this by no means is an easy task. The problem is finding the balance. How much can be reopened and how much must remain lockdown?
People have generally supported a roll back of lockdown in TT despite being in lockdown for about four months.
There were fears of a second wave once lockdown was eased, but no one really saw it as an inevitability. A decision to lockdown in March did result in a reduction in spread in TT than the government had originally anticipated.
Although, in theory this is good, in practice it means that fewer people have been exposed to the virus so far. Therefore, fewer people had a chance to develop immunity.
This means a second peak, due to a relaxing of social distancing, has the potential be far worse as fewer people have been exposed to the virus, so fewer people have developed immunity.
The issue of immunity is something that has been far from resolved anyway, as we are still really not sure for how long immunity is conferred after someone has contracted Covid-19 and recovered.
Not sufficient time has passed to determine this as we are only about nine months into this pandemic. We cannot rule out then, the possibility of the benefits of heard immunity fading away if people were to catch the virus multiple times.
Now that we are in phase five of lockdown, many in the population would have acclimatised to relaxed social distancing. Thus, at this stage to reimpose and roll forward lockdown to previous phases, may be particularly difficult for the population to deal with.
Also, now that a general election is upon us, maintaining public trust and order during an impending crisis like a second wave is of the utmost importance for all those seeking election and more so reelection.
The moment people stop trusting a government or feel that the government is being unreasonable, is when the situation will become even difficult to manage.
And as we saw earlier, people will begin, more so, to flaunt the advice. This could make the beginnings of a second wave deteriorate and put the public’s health at serious risk.
This week has seen us reach an unfortunate milestone, as we have a significant rise in cases after just over 80 days with no complicated cases cropping up.
At the same time, we are looking to continue to reopen our society and try and return to a semblance of normalcy. That means that the responsibility falls on us to make smart choices to limit our exposure, and by extension, others’ exposure to Covid-19.
In order for us to limit the risk to ourselves and those around us, we must show social solidarity and continue to do the things that we’ve all been doing to keep ourselves and those around us protected. That means choosing to be responsible and observe:
- Hand hygiene – wash/sanitise hands regularly
- Physical distancing – keep at least six feet from others
- Wearing face masks. Not just use a face mask, but use it properly
We may very well be on the upward climb of a second peak. To not impose the reality of a second wave upon TT, we have to keep making those great choices that we’ve managed to have made so far.
Hang in there, it will all be over soon, once we continue to make the right choices.
Dr Visham Bhimull MBBS (UWI), Diploma in Family Medicine (UWI) is a Primary Care Physician