Opinion

Wash your hands, prepare for the worst

Wash your hands, prepare for the worst
  • The fact that no case has been positively identified in Kenya could also mean that the virus may have been spreading here undetected!

  • Besides washing hands, social distance and mass testing, we need to prepare for school closures and limited gatherings

  • Sometimes, when bureaucrats say don’t worry, what they mean is, “We don’t have enough resources to act in case things get out of hand."

I am baffled by the overall message on the coronavirus outbreak: Don’t worry; just wash your hands with soap and water and substitute handshakes with elbow bumps. It may be counterproductive to efforts to stem Covid-19 spread.

By telling people to stay calm and not to worry, we’re underreacting to the threat of this highly contagious, potentially deadly virus that disrupts the daily lives of millions of people and derails the world economy, and sending the wrong message. To halt the spread of the coronavirus, everyone must change their behaviour, irrespective of social status – avoiding crowds, staying home and washing hands.

And the fact that no case has been positively identified in Kenya could also mean that the virus may have been spreading here undetected!

Last month, when Iranian health ministry officials raised the alarm about the initial cases, Iraj Harirchi, the deputy minister, denied the reports and promised to resign if they were proved. A day later, Mr Harirchi tested positive for the coronavirus and is in quarantine.

Among the 3,513 Iranians infected by the virus is a senior adviser to the Supreme Leader, a vice-president, 23 MPs, Mr Harirchi and other top government officials.

According to the BBC, 16 million people in northern Italy are to be quarantined.

Iran has one of the best healthcare systems in the Middle East with effective referrals between primary, secondary and tertiary care.

Psychologists distinguish between fear or worry from stress and anxiety. Worry or fear (negative thoughts about something) is an unavoidable cognitive experience inside one’s head in response to external threats. Stress is a physiological (bodily) reaction to external threats. Anxiety has cognitive, emotional and physiological (body and mind) components.

Anxiety and chronic stress can be harmful but worry or fear is helpful because it leads to change or problem-solving. So, when we tell people not to worry or fear, we are inadvertently sending conflicting messages that the disease isn’t that serious and they have the option not to take precautions.

The bottomline is that we prepare for the worst because “better safe than sorry”. Besides washing hands, social distance and mass testing, we need to prepare for school closures and limited gatherings.

When dealing with outbreaks of contagious respiratory diseases, schools are places where people are in proximity to one another and shutting them down early enough slows the spread and ensures that hospitals are not overrun with sick people. It also helps buy time for new treatments and vaccines.

Though highly disruptive, the best time to close schools is before, not after, the outbreak is ‘widespread’.

A study on the impact of three non-pharmaceutical interventions on the 1918-19 influenza pandemic that killed 50 million people recommended isolating the ill or those suspected of being ill in hospitals or at home; banning public gatherings; and closing schools. Closing schools was the most effective move against spread of the pandemic, although for Covid-19, more accurate data on case fatality is needed to make this call.

Employers need to start thinking about paid sick leave or working from home. Those in informal employment should be ready to forfeit that extra income.

We must be prepared for shortage of goods and services resulting from panic buying to stock up. We need to think of other unorthodox measures – like subjecting everyone using public transport or restaurants to  temperature tests using infrared thermometers to rule out fever.

In most cases, although respiratory viruses spread through droplets in the air, a bigger worry is preventing transmission through “fomites” (infected items like doorknobs or shoes). You touch the infected surface and rub your face or nose and – Voila! you acquire the illness.

Also, the simple masks people wear all over don’t seal well and may prove ineffective. The gold standard – N95 respirators – are uncomfortable and make breathing and talking difficult. When worn outdoors, a mask can be contaminated, requiring a new one for each outing.

Although less deadly than other coronaviruses such as Sars and Mers, which kill one in 10 and one-third of infected persons, respectively, Covid-19 seems to spread very easily in homes, hospitals, churches, cruise ships and other confined places and is easily transmitted among people.

Better safe than sorry. Sometimes, when bureaucrats say don’t worry, what they mean is, “We don’t have enough resources to act in case things get out of hand; so we’ll just wait and see. Panicking will make us look bad.”

Dr Obwogo is a medical doctor, public health specialist, author and founder of Kienyeji Kenya Farmers Network Initiative;