[Blog] Exit Strategy: Is there one?

With the Covid-19 pandemic bringing the world to an unprecedented standstill and causing havoc all around the world, different strategies are being adopted to dampen the death toll and hamper its spread. Complacency, lack of transparency and inertia to take brave and decisive actions may have contributed to the pandemonium the whole world is enduring now, in my opinion. Whether the rest of the world should have cut all travel links with China in January is debatable. I also believe no matter what stringent precautionary measures a country could have taken, the virus would still greet every nation, anyhow. One must not forget that we live in a global village. The variability in clinical symptoms also means that screening measures are not 100% effective. Doctors and scientists are still learning about the virus as the death toll rises.

The most commonly adopted strategy is a “stay at home approach”  and  is termed differently in various parts of the world. Surprisingly, one of the most developed and forward thinking nations that has adopted a relaxed approach is Sweden, at the time of this article being written.

Despite its remoteness, Mauritius has not been spared. A complete lockdown is now in place and panic is everywhere. I’m certain this panic mode will dissipate later on and be replaced by frustration. A few critical questions have to be asked now to ensure there is an exit strategy and to avoid last minute drastic measures.

The rationale behind a complete lockdown is to thwart the propagation of the virus. This allows health care systems to be able to cope with the number of hospital admissions and provide adequate care and attention. This is a fully legitimate and logical approach. Unfortunately, most healthcare systems are still buckling under pressure. We all have to appreciate this is an unprecedented phenomenon. 

The next question is how many weeks would be considered adequate to contain the spread of the virus. If it has to go on for more than 4 consecutive weeks, how will the concerns of all those self employed  and financially vulnerable be fully  addressed? What will be the long term financial impact?

For the outcome of a lockdown to be successfully evaluated, there should be mass screening to ensure the incidence of Covid19 is coming down. This mass screening should have started by now to get reliable and robust data to be fully confident lockdown is doing what it is expected to achieve. All deaths in the community should be screened for corona, a low index of suspicion for covid19 needs to be adopted and random sampling may add some value.

Now, assume the lockdown achieves its aim in 8 weeks’ time. We will still be left in a “catch 22 scenario”. The bulk of the population may not be immune to the virus and will be prone to another lethal blow, unless the virus mutates to a less virulent member of the Corona family. Only one remaining undetected case can spark the epidemic again given the variability of its clinical presentation. This is how contagious the virus is.

The next scenario will be more challenging. With all the luck by our side, if the virus has been eradicated locally by a complete lockdown of whatever duration, this will still leave the population exposed to the virus if the majority of the population is not immune.
Mauritius is part of the globalisation success. The economy is heavily dependent on tourism, external trades, and travels.

If the population is not adequately immune to the virus, when will it be a right time to open the ports? Not all countries will achieve full eradication of the virus, if it will ever materialise, at the same point in time. There will be an immunity test out soon to tell whether one had the infection in the past. But as with all medical tests, there is no test which is 100% accurate. Tests from different labs and different countries may not be standardised and it will be hard to verify the accuracy of every single test. Doing a reverse transcriptase PCR test is also not viable as by the time the person lands in Mauritius he/ she may be acutely infected, just after the test.  And no tourist will fork a fortune to be quarantined. The crew of all airline companies will be a potential vector of the virus. Hence, there will always be the possibility of the virus being imported again and triggering another outbreak. Does this imply there will be lockdowns every now and then?

How long can a complete isolation from the rest of the world be sustainable? Is the population prepared to be isolated from the rest of the world for an unforeseeable future? Is the population prepared to bear the full brunt of the financial consequences? Is the population prepared to accept huge pay cuts to ensure destitution does not strike a big chunk of the island and loss of lives is minimised?

Different trials are ongoing globally. However, the outcomes of most of the trials won’t be out by August. A few labs are working days and nights to crack a vaccine. Again this won’t be on the market  within the next 8 weeks. If it will, which I doubt, then there will still be an issue of supply given the mass production involved. Light at the end of the tunnel may not be until early next year.

So, an exit strategy will have to be considered from now on. Sacrifices will have to be made. For sure, life won’t be the same again for an unforeseeable future and it will take a while for normality to resume, assuming normality will still preserve its meaning. The other strategy is to isolate the at risk group until a vaccine is out .For this approach to be feasible and safe, hospitals will need to be fully equipped and prepared. Again, this approach may be controversial.

Working on an exit strategy will demand some brainstorming from now on. There is no quick fix solution. The population will need to be explained, and informed of all the potential  consequences of whichever strategy to be adopted. Benefits and risks need to be weighed and an informed choice adopted under the guidance of a panel of scientists, doctors, policy makers and financial analysts. Unfortunately, there is no perfect panacea.

Let’s hope the virus mutates to a less virulent member of the Coronaviridae family.

Dr Rajiv Seechun