WHO calls for 'intermittent' lockdowns in Pakistan as virus surges

May 30: Warning of the tightrope walk ahead as governments battle the coronavirus crisis, Nobel laureate Peter Charles Doherty has expressed concern about densely populated countries such as India relaxing lockdown norms while also describing a complete shutdown as “an economic and social impossibility”.

The Australian immunologist, who cautioned that the number of COVID-19 cases will rise in the coming days, said the earliest time frame for an effective vaccine “going into large numbers of people” is nine to 12 months.

"If all goes well with testing, we could know if some of the candidate vaccines are both safe and effective as early as September/October. Then, rolling a vaccine out will depend on the type of product and how quickly it can be made, put in vials and so forth," Doherty told PTI in an email interview from Melbourne.

The novel coronavirus, he added, does not change fast like influenza and, from what is known so far, “the same vaccine should work everywhere”.

Doherty, who is with the Department of Microbiology and Immunology at the Doherty Institute, University of Melbourne, won the Nobel Prize for Medicine in 1996 for his discovery of how the body’s immune system distinguishes virus-infected cells from normal ones.

Discussing the lockdown, he said, "If it was purely a matter of hard science, everywhere should stay locked down. But that’s pretty much an economic and social impossibility.”

The expectation, he said, is the numbers will rise and limiting spread will depend on people acting responsibly and the capacity for rapid response and extensive contact testing.

“And in a densely populated country like India I think that it will be very difficult," the scientist said.

Several countries, including India, began relaxing lockdown norms in mid-May despite the WHO’s warning about a second wave. India’s lockdown began on March 25 and has since been extended. The fourth phase ends on Sunday.

Asked whether there are any alternatives to a lockdown, the 79-year-old said, "There is no other option other than closing borders. South Korea, for example, conducted massive, intensive testing and contact tracing in a wealthy country with a very disciplined population. Otherwise, not till we have effective vaccines."

He added that he personally doesn’t see the point of closing borders for people coming in if there’s already a high incidence of disease in the community, “unless it’s to avoid the need to care for them and use scarce hospital beds".

According to Doherty, the coronavirus "is a new virus which has come straight out of nature".

“It (the virus) has moved so rapidly across the world because of people travelling on international planes as well as tourist ships," he added.

The immunologist also warned against the use of hydroxychloroquine to treat COVID-19, and said current and planned trials of the anti-malaria drug should be stopped.

“My understanding is that the use of the drug in severe disease is definitely contra-indicated, but it’s not yet clear whether, if taken under medical supervision, it could have some useful effect if taken early on, or as a preventive. Those trials just haven’t been done properly," Doherty noted.

The Indian Council of Medical Research (ICMR) has backed the use of hydroxychloroquine as a preventive against COVID-19 even after the WHO suspended clinical trials of the drug citing safety concerns.

Asked whether plasma therapy can be an effective treatment for COVID-19, Doherty said, "We lack good properly controlled trials but, especially if the plasma has been tested for antibody levels and there’s evidence of good activity, it could be helpful. If I had the disease and was offered plasma therapy I would certainly accept, but I would not take hydroxychloroquine."

Doherty is also very optimistic about herd immunity developing against the SARS-CoV-2 infection.

"We think that (herd immunity) will cut in and have an obvious effect when, say, 60 per cent of people have been infected. Best hope is to boost herd immunity with a vaccine," he stated.

Herd immunity is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through vaccination or previous infections.

The number of COVID-19 cases have crossed 5.9 million and the fatalities 3,65,000, according to the Johns Hopkins University on Saturday. 

In India, the death toll has risen to 4,971 and the number of cases to 1,73,763, according to the Union Health Ministry on Saturday.

Several states, including Bihar, Uttar Pradesh, Madhya Pradesh, Jharkhand and Chhattisgarh, have reported a rise in number since lockdown norms were relaxed in early May and migrant workers reached home.

In Uttar Pradesh, for instance, the number of infections rose from around 3,000 on May 4 to 6,532 on May 26. Similarly, Bihar’s numbers increased from around 500 to over 2,700 in the period.

Washington, May 27: Most viruses and other germs do not spread easily on flights, the US Center for Disease Control and Prevention has said in its COVID-19 guidelines which do not recommend following social distancing between two passengers inside a plane or keeping the middle seat unoccupied.

As a result of coronavirus pandemic, air traffic inside the US has come to a near halt. Air traffic is said to be down to about 90 per cent. For all travellers coming from overseas, the Center for Disease Control and Prevention (CDC) has recommended 14 days quarantine.

"Most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on aeroplanes," the CDC has said in its set of COVID-19 guidelines for air travellers.

However, it noted that the air travellers were not risk-free especially in the time of the coronavirus pandemic and recommended Americans to avoid travel as far as possible.

"Air travel requires spending time in security lines and airport terminals, which can bring you in close contact with other people and frequently touched surfaces," it said.

"Social distancing is difficult on crowded flights, and you may have to sit near others (within six feet), sometimes for hours. This may increase your risk for exposure to the virus that causes COVID-19," the CDC said.

But instead of recommended social distancing inside commercial planes, the CDC has advised a series of preventive and hygienic measures to be taken by the airlines pilot and crew to prevent the spread of coronavirus.

The US Department of Transportation and Federal Aviation Administration in its latest safety alerts for operators on May 11 said that air carriers and crews conducting flight operations having a nexus to the US, including both domestic and foreign air carriers, should follow CDC's occupational health and safety guidance.

The CDC issued its guidelines in first guidelines for the airlines and airline crew on March and again in May.

The CDC, which has issued an exhaustive social guideline measures in various sections, is silent on keeping the middle seat of a plane unoccupied so as to maintain the six feet distance between two passengers.

It calls for the plane crew to report to the CDC a traveller with specific COVID-19 symptoms like fever, persistent cough, difficulty in breathing and appearing unwell.

Asking the airlines and cabin crew to review infection control guidelines for cabin crew, the CDC recommends several measures for cabin crew to protect themselves and others, manage a sick traveller, clean contaminated areas, and take actions after a flight.

Prominent among them include washing hands often with soap and water for at least 20 seconds, particularly after assisting sick travellers or touching potentially contaminated body fluids or surfaces and use of alcohol-based hand sanitizer (containing at least 60 per cent alcohol) if soap and water are not available.

Airlines should consider providing alcohol-based hand sanitizer to cabin and flight crews for their personal use, it said.

The CDC guidelines do not recommend following social distancing inside a plane between two passengers or keeping the middle seat unoccupied. But it asks to minimise contact between passengers and cabin crew and the sick person.

"If possible, separate the sick person from others (by a distance of 2 meters or 6 feet, ideally) and designate one crew member to serve the sick person. Offer a facemask, if available and if the sick person can tolerate it. If a facemask is not available or cannot be tolerated, ask the sick person to cover their mouth and nose with tissues when coughing or sneezing," said the CDC guidelines.

If no symptomatic passengers were identified during or immediately after the flight, the CDC recommends airlines to follow routine operating procedures for cleaning aircraft, managing solid waste, and wearing PPE.

"If symptomatic passengers are identified during or immediately after the flight, routine cleaning procedures should be followed, and enhanced cleaning procedures should also be used," it said.

Clean porous (soft) surfaces (e.g, cloth seats, cloth seat belts) at the seat of the symptomatic passengers and within 6 feet of the symptomatic passengers in all directions, it added.

For the first time in the 15 years of the Global Risks Report, the climate change and environment risk has occupied all the top five slots.

According to the 15th edition of the World Economic Forum's (WEF) Global Risks Report, the top five risks in terms of likelihood are extreme weather, climate action failure, natural disasters, biodiversity loss and human-made environmental disasters. They all fall in the one category of climate change and related environmental disasters.

WEF President Borge Brende said the world was feeling long-mounting and interconnected risks.

The report also points to how citizens are protesting across the world as discontent rises with failed systems that are creating inequality. The citizens' discontent had hardened with systems that had failed to promote advancement, it said.

"Disapproval of how governments are addressing profound economic and social issues has sparked protests throughout the world, potentially weakening the ability of governments to take decisive action should a downturn occur. Without economic and social stability, countries could lack the financial resources, fiscal margin, political capital or social support needed to confront key global risks," it said.

Listing the grim scenario, Borge said the global economy was faced with "synchronised slowdown", the past five years had been the warmest on record and cyber attacks were expected to increase this year.

The report warns that while the myriad risks were rising, time was running out on how to prevent them.

Borge said the growing palpability of shared economic, environmental and societal risks indicated that the horizon had shortened for preventing "or even mitigating" some of the direst consequences of global risks.

"It's sobering that in the face of this development, when the challenges before us demand immediate collective action, fractures within the global community appear to only be widening," he said.

The report points to grave concern about the consequences of continued environmental degradation, including the record pace of species decline.

Pointing to an unsettled geopolitical environment, the report said today's risk landscape was one in which new centres of power and influence were forming and old alliance structures and global institutions were being tested.

"While these changes can create openings for new partnership structures in the immediate term, they are putting stress on systems of coordination and challenging norms around shared responsibility. Unless stakeholders adapt multilateral mechanisms for this turbulent period, the risks that were once on the horizon will continue to arrive," it said.

Calling it a "an unsettled world", the WEF report notes that powerful economic, demographic and technological forces were shaping a new balance of power. "The result is an unsettled geopolitical landscape in which states are increasingly viewing opportunities and challenges through unilateral lenses," it said.

"What were once givens regarding alliance structures and multilateral systems no longer hold as states question the value of long-standing frameworks, adopt more nationalist postures in pursuit of individual agendas and weigh the potential geopolitical consequences of economic decoupling. Beyond the risk of conflict, if stakeholders concentrate on immediate geo-strategic advantage and fail to re-imagine or adapt mechanisms for coordination during this unsettled period, opportunities for action on key priorities may slip away," the WEF said.

In a chapter on risks to economic stability and social cohesion, it said a challenging economic climate might persist this year and members of the multi-stakeholder community saw "economic confrontations" and "domestic political polarisation" as the top risks in 2020.

The report also warned of downward pressure on the global economy from macroeconomic fragilities and financial inequality. These pressures continued to intensify in 2019, increasing the risk of economic stagnation.

Low trade barriers, fiscal prudence and strong global investment, once seen as fundamentals for economic growth, are fraying as leaders advance nationalist policies. The margins for monetary and fiscal stimuli are also narrower than before the 2008-2009 financial crisis, creating uncertainty about how well countercyclical policies will work.

The strategic partners for the WEF report included Marsh & McLennan and Zurich Insurance Group. The academic advisers were National University of Singapore, Oxford Martin School, University of Oxford and Wharton Risk Management and Decision Processes Center, University of Pennsylvania.