Covid-19. Lockdown, wrong intervention laced with good intention

Dr Eke Eke

The news of how Nigeria is implementing Covid-19 lockdown sounds like hammer house of horror.

There are reports of people going hungry for days, business being destroyed, police brutalising people, governors demolishing houses, all in the name of Covid-19 prevention.
The strategy demonstrates lack of knowledge and understanding and, disregard for individual freedom and welfare. It says one thing, Nigerian leaders are insensitive, do not value evidence based decision making and simply cut and past solutions.
The problem is the mindset and basic assumptions with which the pandemic is approached.

The idea that one has to separate the biology from the economics of the pandemic is the fatal error in the current approach to the pandemic.
It is the same mistake medicine makes, when it tries to separate physical illness from mental illness.
Religion also make the same mistake, when it separates body from spirit or soul as if one can exist in the absence of the other.
Once some people lock themselves in this dichotomous dualistic mindset. It is difficult for them to muster the integrative thinking needed to understand the concept.
Illnesses are cured with means and individuals have to first exist before they can survive. People live in societies and not in bubbles.

Therefore, managing or treating illness has always been a function of the means/economics. Few can get the treatment they cannot afford.
The question that every doctor asks is, who pays for the care. The lawyers understand that justice is a function of means. It is harder for doctors to accept that health outcome can often be a function of means. An effective treatment which an individual cannot afford is useless to that individual.
This pandemic would have been approached from a public health angle. Instead, It was approached from Hospital treatment perspective.

For the first time, the world prepared for a pandemic, not by early intervention and aggressive prevention strategies, but by trying to remove the people from the world in which the pandemic exists and preparing for the treatment of its complication.
This is both wrong and intriguing. No one would get malaria, if everyone lives in a mosquito net tents.
If everyone stays home and avoids contact with others, no one would get covid-19 infection. Herein lies the naivety of the current strategy. It has a high dose of magical thinking.

In my mind, this is the fatal error.
From the onset, people would have been advised to adopt any strategy that prevents them contacting infective agent from others. It would have been an opportunity to enlighten the world on the germ theory of diseases.

This includes scrupulous sanitary practices, washing of hands, proper disposal of wastes, including human wastes, wearing masks in public transport, and when in close proximity to others, ensuring that those with temperature do not use public transport or other facilities, where they can come into proximity with others, and avoiding contact sports. All these can be done without locking the economy down and destroying jobs and lives. In addition, to the above, testing and contact tracing.

Any strategy that stops people earning a living is idealistic, magical, extreme, unsustainable and therefore wrong.
Such a strategy tries to create artificial and unsustainable environment, which enables the rate of infection to drop.
It is like pretending the rain has gone away, by running into the house, while unable to carry out the work outside.
It is easy to clear the river bed, if the river is dammed, but what happens, when the dam bursts.
A real solution is one which addresses the problem in the natural environment in which the problem exists. Only such a strategy will ensure lasting, sustainable solution.

Covid-19 is a viral infection with serious complications, why have we forgotten that prevention is better than cure?
There is no easy solutions. Some people will die, and early intervention will stop many people from developing complications.
However. Lockdown is an ill thought out and self defeating strategy. When did cutting one’s nose to spite one’s face become a rational solution?
No country can improve its health by destroying its economy and good healthcare is only possible in a booming economy.
No one can defeat an enemy by simply hiding away. No country can defeat Covid-19 pandemic by destroying its economy, by implementing lockdown, social distancing and worsening poverty and social deprivation.

We have to find that balance in the current approach and it lies somewhere in the middle, where we can implement preventive strategies, protect the vulnerable, and allow people to go about their normal duties.
Whatever we do, some vulnerable people who get the infection would die, either before or after the lockdown.
All we can do is prevent as many people as possible from getting the infection, implement early intervention, when people get the infection and have capacity to offer critical care to the vulnerable from which most death will occur.