The “next day” of the war with the “invisible but also unknown enemy”, SARS-CoV-2, which starts tomorrow is more difficult.
We have won the most critical battle to limit the epidemic, but not the war, says Professor of Social and Preventive Medicine at the Medical School of the University of Athens, Giannis Tountas, to APE-MPE.
The state, he continues, has successfully dealt with the first wave of the epidemic in our country.
It is now called upon to respond to more challenges at the same time, with greater public health assurance.
At the same time, the citizen is called upon to show responsibility by observing personal hygiene measures.
“Now that we’re out of the house, we’re going to get the virus, and it’s up to us not to get infected,” he said.
Mr Tountas did not rule out easing measures to increase the number of cases but said there was no reason for a general alarm as long as the Ro index remained below 1.
“In our country, the RO was recently estimated at 0.47, which is particularly encouraging in terms of the possible completion of the epidemic in May.”
He points out that what this pandemic teaches us is that prevention is a way of life and the most effective way to prevent similar epidemics in the future is to change people’s relationship with animals.
Following is the full text of the interview of EKPA professor Giannis Tountas at APE – BPE and Efi Fouseki.
Q: Is the next day more difficult?
A: The next day, which begins with the first relaxation of the measures, will be more difficult. To date, we have won the crucial battle to reduce the spread of the epidemic to extremely low levels, thanks to the immediate tracking and isolation of the first cases, as well as the timely adoption of the necessary measures, but also thanks to the citizens’ compliance with them. But we have not yet won the war. Now the difficulties begin because now we are called to give multi-faceted battles at the same time. The battle to protect our health without the shield of staying at home. The battle for the reopening of the education system without yet knowing exactly how the virus affects children. The battle to restart the economy without fully healing the wounds of the ten-year crisis. The battle to save part of the tourist season without prior relevant know-how.
Q: What should the citizen pay more attention to?
A: The citizen, as already mentioned, should first of all take care of the triptych HAM: good and frequent washing of hands, observance of the necessary Distances, proper use of the Mask. As long as we were locked in the house we were safe because we had left the virus outside. Now that we are out of the house we will encounter the virus, and it is up to us alone not to get infected. And the only way to protect ourselves is to respect the instructions and the measures taken. The state will not be able to constantly monitor us all. We must show the utmost sense of responsibility and conscientiousness. And because the responsible citizen is the well-informed citizen, we must trust the information coming from the competent national and international bodies and not pay attention to the irresponsibility that is flooding the internet. Only in this way will we be able to prepare properly, physically and mentally, for a possible marathon with obstacles.
Q: Gradually and controlled children return to school. Can contact with grandparents be restored?
A: The SARS-CoV-2 virus is not only an invisible enemy but also unknown. We learn more every day. Certainly, children get sick much less, but we still don’t know how much less they become infected and how much they can transmit the virus. Until these issues are clarified, children should be in contact with elderly members of the family with caution, without exaggeration and with strict adherence to personal hygiene guidelines, especially if they are children who begin to move out of the home in contact with other people. Using the mask in these cases, although difficult for young children, would provide additional protection.
Q: Will the easing of the measures change the curve of the cases and what is the alarm point?
A: The easing of measures is very likely to lead to an increase in cases, as is the case in almost all countries that have already attempted it. The expected increase should not worry us much, as long as it is limited and does not trigger a new epidemic. Monitoring epidemiological data to assess the course of the epidemic is a complex and difficult task, because we do not know the exact number of actual cases, nor are we able to record it on a daily basis. This weakness is due to the existence of many asymptomatic cases, the limited and conflicting views on immunity, and the lack of reliable tests. However, there are indirect epidemiological methods, such as the number Ro, which expresses the number of healthy people infected by an infected person. The epidemic develops exponentially when this number is above 2-2.4. When it starts to decrease, the downward trend of the epidemic begins and when it is below 1, the epidemic tends to complete its cycle. In our country, the RO was recently estimated at 0.47, which is particularly encouraging in terms of the possible completion of the epidemic in May. As long as this number is kept below 1, there is no reason for a general alarm. However, there may be alarms when there are local fires, especially in closed structures, which should be checked immediately. That is why the control over these structures needs to be intensified. But in addition to Ro, we need to keep track of other indicators, such as not the number of cases, but the rate of increase or decrease in diagnosed cases (as long as the diagnostic strategy does not change), the patients, the intubated, the deaths. The doubling time of this data is also an important epidemiological indicator.
Q: What challenges does the state have to meet and what interventions does it need to make to ensure public health?
A: The state has successfully dealt with the first wave of the epidemic in our country. It is now called upon to respond to more challenges at the same time. The biggest challenge is to further ensure public health, for the whole population and especially for the most vulnerable groups, including the unemployed. The hospitals of the NSS, despite the timeless problems of underfunding, understaffing, anachronistic administration, managed to strengthen in time and, thanks to the admirable self-denial of their executives, were able to offer the necessary care to the sick. But now that the epidemic is likely to go into an endemic phase, the burden of health policy will have to shift to the community, where the virus will be circulating for some time to come. To this end, the aforementioned Primary Health Care should be strengthened immediately, new public health institutions and services should be created (the public health law passed shortly before the epidemic is not enough) and the education of the population on health issues should be upgraded. Today’s NSS, with its pathogenesis, is not able to adequately respond to the data of the new era. We must move forward with the creation of a “new NSS”.
Q: Do we need to learn to live with the virus until a vaccine is found?
A: Until the vaccine is found, we must adapt to the new reality. This adjustment requires several changes in our daily habits, in the workplace, in education, in transportation, in our entertainment, in our vacations, and in many other areas of public and private activity. We also need to adapt psychologically, because living with a new and largely unknown risk causes anxiety and consequent depression, which, if not treated in time, will pose a serious health threat. We can make the necessary adjustments because the human species has managed to survive and dominate the planet thanks to its exceptional ability to adapt to an ever-changing environment.
Q: Four months later, what do we know about Covid 19 prevention?
A: The most basic thing we learned is that taking timely social action measures saves lives. We also learned that the mask is necessary when we are indoors with other people. At the beginning of the epidemic, the use of the mask was not a priority, on the one hand, because it was not as necessary as when we were at home and on the other hand because the wrong use of it carries additional risks. We also learned that smokers are more at risk, and therefore cigarettes and that those who have had the flu and pneumococcal vaccine are at a lower risk. In other words, we have learned that prevention is a way of life that can be much easier to adopt with the use of new technologies, such as the Long-Term Prevention of Life program, which we have set up at the Institute for Social and Preventive Medicine.
Human-animal relationships affect the development of epidemics
The most effective way to prevent such outbreaks in the future is to change people’s relationship with animals. The 21st century has already been described as the century of new emerging epidemics. The outbreak of new epidemics after 1975, with millions of victims worldwide, is almost exclusively due to the growing demand for animal protein worldwide, the trade-in exotic species, the eating of wild animals and especially the conditions of animal husbandry. Intensive farming systems of the last decades are the most intense change in the relationship between humans and animals for ten thousand years when we domesticated cows and sheep and acquired the measles virus. If this relationship does not change, humanity will not be easily freed from the scourge of epidemics.
(Source of information: RES – EIA)