Alfred Dawes | Cassandra or Chicken Little?

The question is not if but when will the delta strain of COVID-19 arrive on our shores. I will share a bit of knowledge on the virus, knowing quite well that my warnings are merely perfunctory. Forgive my nihilism but far too many times have warnings in this and other spaces I inhabit gone unnoticed only for them to come to pass. My public advice on mandatory mask wearing was ignored and the mandate only took effect when the gods of PAHO/WHO changed their stance that masks should only be worn by those displaying symptoms. That the election would be the source of a spike in cases was, of course, ignored with the resultant increase in cases coming exactly on the date I predicted. Those instances drove home the point that my column is purely for entertainment of my readers.

We are well into our second year of lockdown measures characterised by shifting curfew hours and highly selective enforcement of the restriction of movement and gatherings. Initially, with cases surging and no significant increases in the number of hospitalisations, it was obvious that the measures implemented were aimed at flattening the wrong curve. From the outset of the pandemic, I had advocated flattening, instead of the number of positive case curves we should focus on the hospitalisation and death curves. It made sense to do so as the end point of flattening the curve was to limit the rate of hospitalisations so the health facilities would not be overwhelmed, NOT to stop the spread of the virus. That would allow us to enjoy some semblance of normality in a lockdown-weary population and to prevent the collapse of the health sector under the burden of severely ill patients.

Had we eased and squeezed the lockdown measures, the population would have been much more compliant with stricter measures when hospitalisation rate increased. Instead, we were guided by case counts and positivity rates when we were not testing enough and testing mostly symptomatic patients with a higher pretest probability of testing positive. Added to this were the panics driven by the massive dumps of positive results on some days caused by the inexplicable backlog of samples to be tested.

The truth is that far more Jamaicans have contracted COVID-19 than reported because many never bothered to get tested and many who tested positive were never reported in the official numbers because of how we went about testing and reporting. The persistence of the curfews and double standards in applying the Disaster Risk Management Act has forced the hand of the Government to finally accept that it is the hospitalisation curve that must be used to guide lockdown measures.

With low hospitalisation rates, it makes sense to relax measures and allow citizens and the economy some breathing space. The million-dollar/thousand lives question, though, is whether this is the right time to relax measures with the deadly SARS-COV-2 strains wreaking havoc in countries with high and low vaccination rates. There are two ways to look at this scenario.

1. If a dirt a dirt

We can’t hide from delta. We have closed our borders before with disastrous economic consequences before. Countries that tried to hide from the original strain are still faced with continued stringent measures to combat the emerging strains. We cannot be like the Cayman Islands or New Zealand in that approach. We can’t afford it. We can also forget about herd immunity through vaccination. We cannot procure enough doses needed to reach the critical percentage of vaccinated Jamaicans within the time frame when the expected antibody levels of the vaccinated would be high enough to result in herd immunity. Even if we did, there are enough people here who don’t want vaccines to result in wasted doses. So, if we can’t lock out delta or vaccinate enough to blunt its effect what can we do? Let it come and try to limit deaths as much as possible. Unfortunately, many will die with this approach because of the poor state of our healthcare system, but it will get us to natural herd immunity. A focus should then be shifted from prevention to treatment and mitigation of serious illness and death.

2. Slow burn

Limiting as much as possible the rate of spread of the disease seems to be the only practical approach to save as many lives as possible. This will, of course, be disastrous for the economy and the ‘big pants man dem’ will not be pleased. The lockdown measures cannot be fully implemented because of the large informal economy that feeds the most vulnerable in our society. In fact, the riots in the streets, were we to do so, would cause far more damage than the closures themselves. With only incremental improvement in our Intensive Care Unit capacity that still leaves us significantly below the beds required per one hundred thousand persons and human resources strained even at baseline, we are only a few weeks from our hospitals being a war zone if we do not try as much as possible to limit the spread of the delta variant.

The delta variant of the SARS-COV2 virus was responsible for the massive surge in cases and deaths in India recently. It has replaced the Kent variant as the most common strain in the United Kingdom and is well on pace to be the most dominant strain in the United States. The variant is already in 85 countries and with a transmissibility rate of two to three times the original Wuhan virus and a much higher rate of hospitalisations. When it gets here it will make our second wave seem like a joke.

Cassandra of Troy was a priestess cursed to utter true prophecies but never to be believed. She warned the Trojans to be careful of the Trojan horse, but her warnings were unheeded. Chicken Little, on the other hand, thought that the sky was falling down and caused the deaths of so many followers. Only time will tell where on that spectrum this columnist lies.

- Alfred Dawes is a general, laparoscopic, and weight-loss surgeon; Fellow of the American College of Surgeons; former senior medical officer of the Savanna-la-Mar Public General Hospital; former president of Jamaica Medical Doctors Association. @dr_aldawes. Email feedback to columns@gleanerjm.com and adawes@ilapmedical.com.