COVID19 cases are rising in Pakistan steadily for last few weeks. Public was told that Pakistan has successfully defeated the SARS-COV-2 (the virus which causes COVID19). We were further told that World is amazed on our success in controlling the pandemic. Government distributed awards and everyone patted on their backs. For pretty much everyone in Pakistan, pandemic was over and it was business as usual. No one was wearing a mask and SOPs seemed a distant history.
But epidemiologists were observing steady increase in cases for last many weeks. Though the number was still small but for any epidemiologists who have worked on outbreaks in real life that was not a good indicator. However official line was still self-congratulatory but adding a carefully crafted disclaimer of “pandemic is still not over”. But public did not pay any attention to these nuisances and just kept moving toward the pre COVID19 era activities. At that time opposition parties announced a series of country wide protests.
At that moment Government just remembered what field epidemiologists were telling all along. Pandemic does not end until we have a vaccine, effective medicines or developed herd immunity. None of three is still here so we need to be very vigilant. We have to resume our lives but we should be following all public health guidelines. However timing of government realization of the danger and announcement of opposition protest has created a trust deficit for government. A public health issue was used as a political weapon by both sides so political fallout was always expected. When political team dominates technical experts in pandemic decision making, public also loose trust in the process. So now cases though are increasing, opposition consider it as an excuse by the government to get out of a difficult situation.
So is it ok to still organize public protests in the era of coronavirus pandemic? In US both sides have public protests one after another. First there were protests against lockdown and then protests against racial discrimination. Both attracted sizable crowds and public health professionals were also divided on the subject. But here are the key points.
There is no situation with zero risk but everyday life has always been a process of evaluating and balancing risk and benefit of each activity. Many of these decisions are made by our brain with prior learning but without our active involvement
Every time you leave your house and go to your office, shopping or to your friends and relatives you increase your risk of getting infected. We could mitigate this risk by following public health measures like mask wearing, keeping 6 feet distance, washing hands with soap or using sanitizer and preferring outdoor environment than indoors. Crowds similarly increase our risk of getting infected. In this pandemic we need to question our every activity outside the house or opportunity to interact with others to see if that is worth the risk? If we think that activity or interaction is necessary then we need to strategize and plan in a way that risks are minimized. There is no situation with zero risk but everyday life has always been a process of evaluating and balancing risk and benefit of each activity. Many of these decisions are made by our brain with prior learning but without our active involvement.
Without being political and making a recommendation that you should participate in a protest or not lets breakdown this decision step wise. First question you need to ask yourself that is the cause worth the risk? In US example protesters against lockdowns felt that restrictions causes more damage than COVID19. Most public health experts were against this position as it was against their own opinion. Similarly when protesters were out against racial discrimination, even though they werein bigger crowds some felt that risk of getting infected is less than having racial injustice in the society. So you have to make this decision personally if the cause outweighs the risk.
If you are organizer of these protests then please ensure few conditions to safeguard the health of participants.
1. Everyone should be wearing masks. Masks should be worn properly covering both nose and mouth and it should stay there for all the time
2. Arrange protests and meetings only in outdoor settings. Outdoor setting decrease the risk of transmission significantly
3. Plan these meetings in daylight as sun has ultraviolet rays which could kill or damage viruses and add a barrier in its transmission
4. Keep a minimum 3 feet distance (preferably 6 feet distance) between participants
5. Hand sanitizers should be made available freely and participants should be encouragedto use them frequently
6. Discourage chanting or loud speaking in close quarters as many cases are now documented of super spreading of virus by singing or choir practice. These actions help exhale virus more than 6 feet
7. Participants and leaders should not embrace or shake hands
8. Same level of social distancing and masks are required at stage too
9. Keep the duration of meetings or protests as short as possible. If a setting is risky but we limit our presence there then we are minimizing our risk too.
Once you have made a decision as an individual to take the risk then you have to follow same public health guidelines. Wear mask all the time and keep distance from others. If you feel little bit sick, then don’t go the protest as you may infect others. Once you are back from the protest then keep yourself away from elders and observe for any sign and symptoms of COVID19 for next few days
Public protests are part of a vibrant democracy and keeps governments decision making process in check. As other aspects of life are moving on, political processes will also find its way. However, we need to ensure that we minimize risk and do it as safely as possible. We need to balance the risks!
The writer is an Adjunct Professor of Epidemiology at the University of Nebraska, USA and Chief Executive Officer of Global Health Strategists and Implementers (GHSI) a consulting firm in Islamabad. He has worked at the Stanford University, University of Washington and London School Hygiene and Tropical Medicine and with the US Center for Disease Control and Prevention (CDC)