“Without supplementary strategies and proper monitoring, confinement may end up being nothing more than a hit-and-miss exercise”

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Weekly spoke to Dr Deoraj Caussy, epidemiologist, just over a week before the first cases of coronavirus were announced. He had warned about the high probability of the pandemic reaching our shores and the asymptomatic carriers. Weekly speaks to him again for his views on the government’s subsequent response to the pandemic. In a frank and candid interview, Dr Caussy analyses the situation in the country.

When Weekly first interviewed you before the official announcement of the first coronavirus cases, you seemed very worried about the casual way we were handling such a terrifying situation. Are you more satisfied now that things are under control?
Things will be under control when we have zero death and zero infection in the community and frontline workers including medical, paramedical, police, immigration etc. Sadly, the actual figures do not support this conclusion. How can I be satisfied when people are dying and my colleagues, students, friends and family are getting infected?

Sorry to hear that. As it happens, we have had nine deaths so far. In Reunion and the Seychelles next door, none yet. Any hypothesis you would like to put forward for that?
The authorities are trying to brush the comparison off by pointing fingers at the Reunion island protocol. This is a political and scientific gaffe. People die because they do not get access to quality health care in a timely manner. Let’s face it, there are glaring defects in our treatment protocol as has been amply alluded to by the authorities in Reunion. Oddly enough, the government consultant, Dr (Catherine-ed) Gaud, chose to stay silent when this issue was broached during a press conference. What does this say about the integrity and reliability of such a consultant paid by our tax money?

“Unfortunately, the authorities chose to live in denial in those times. So, when they wake up, we have to encourage them and show them that confinement is just one measure that has to be supplemented by aggressive mitigation measures.”

Were you disappointed that you were not called to help out instead of the government having recourse to a foreign doctor in the person of Dr Gaud?
No.  Absolutely not, because I am already helping my country by educating and raising awareness on a large scale and am shielded from contracting coronavirus at the Ministry of Health. But I am disappointed by the way our income tax revenue is being misspent. It is clear that the director general of health, who exhibits inadequate knowledge and experience of basic virology and epidemiology, had tunnel vision by focussing only on symptomatic cases as drivers of this epidemic. In so opting, he has wittingly or unwittingly misguided the persons in higher authorities and taken us all on a cliff-hanger from which there is a grim chance of escape. Events to date corroborate the fact that his assertions about having adequate protection measures and the means to combat this contagion stem from faulty strategies that fail the veracity test. This has resulted in widespread infections among frontline workers and put the life of the population at risk. It is timely and pertinent for  public and the higher authorities to reassess the competency and integrity of such a person.  Any self-respecting person with a sense of responsibility should voluntarily resign to avert further unwanted deaths and stop embarrassing the authorities by his ignorance and arrogance.

Is the situation in the rest of the world any different?
Managing the Covid-19 epidemic reflects a national government vision, policy and forward planning: the pandemic has illustrated a variety of strategies in use by governments around the world. It is a learning curve for all governments and there is no one-size-fits all solution that incorporates the prevailing social, economic and political considerations. However, governments like those of New Zealand, Norway and Singapore, who have been more proactive in planning for this health, economic and social disaster, have been able to mitigate the negative impacts of the pandemic. Other governments, like Italy, Spain, the US, etc, who have trivialised the problem by dismissing its gravity and failing to take proactive measures, are paying a heavy price in human lives, economic and social disruptions. Other governments have taken a cosmetic cover up of ‘too little, too late’ policy, where they simply put up a show and act to convince the population that they are proactively protecting them; when in reality, they are jeopardising human lives. Our local policy is a hybrid approach of the last two. In moments like this, we need seasoned virologists, epidemiologists and infectious disease specialists to spearhead the containment and mitigation strategies and communicate in local vernacular. There is a complete dearth of this in our present Covid task force. Instead, the job is relegated to cardiologist, internal medicine and immunologist whose vernacular is beyond the grasp of most of us. Is this the correct way to squander our income tax contributions?

“The authorities are trying to brush the comparison off by pointing fingers at the Reunion island protocol. This is a political and scientific gaffe.”

You congratulated the government for having taken the decision of a total sanitary lockdown, followed by a curfew. To what extent has that helped?
We must hand it to the government that has taken a brave decision to institute national confinement. However, this measure would have been much more effective if it had been implemented in the beginning phase of the epidemic. Unfortunately, the authorities chose to live in denial in those times. So, when they wake up, we have to encourage them and show them that confinement is just one measure that has to be supplemented by aggressive mitigation measures or else we run the risk of a bigger and more impactful calamity. It appears that the government is steering in that directions, but without a clear policy or plan. It’s difficult for anyone to assess the situation.

The controversy was not so much around the lockdown as around the closure of supermarkets without warning. Aren’t supermarkets one of the worst places to be to catch coronavirus?
Supermarkets, if not properly disinfected and practising environmental hygiene, may potentially become a Petri dish for the amplification and spread of the virus. Extra care should be exercised by the public, the owners and the authorities: the public should observe all the gestes barrières, the owner should clean the supermarket and promote social distancing and the authorities should monitor the level of hygiene.

As we speak, nearly 30 staff members of the Ministry of Health have been tested positive for coronavirus. Does that surprise you?
Surprise is not the word. Rather, I am consternated and saddened. The very emblem of health protection, who so relentlessly convinced many, day after day, that they have a plan, the consumables and trained manpower to deal with the epidemic, have themselves succumbed to the contagion. This is not very convincing that they are competent for the tasks at hand. For sure they will lose credibility amongst even the most die-hard partyliners. This is not a surprise but a rude awakening for many. I am saddened because of the health consequences of my near and dear ones, my colleagues, my students and vulnerable groups. 

Many of our compatriots are asking how long the lockdown will last. The leader of the opposition, Arvin Boolell, is asking for an extension until June. How long do you think it should last?
I have already alluded in my publications to the fact that a confinement must be monitored at all stages from the beginning, middle and  end point: we must monitor  the number of existing cases by wide-scale testing to be able to deduce if the incidence of disease is going down. This will enable us to calculate when we will reach the peak and when to stop. We should also monitor the attendance in flu clinics and  excess mortality due to Covid-19 to assess the impact of the epidemic. Without these strategies, confinement may end up being nothing more than a hit-and-miss exercise and laying the blame on a recalcitrant segment of the population.

There is worrying news coming from countries like China and Singapore that we thought had recovered. There is a new wave of infections in China, involving 123 imported cases and 137 asymptomatic cases, according to state-run People's Daily, Singapore, on 10 April, reported 287 new cases of the virus and even in Hong Kong, there has been a similar spike in cases after it relaxed restrictions, with many infections imported from overseas. What are the implications of that for us?
This all means that we are still learning as the epidemic is unfolding and we should not blindly believe the numbers published by all countries, without our personal epidemiological assessments.

What is the outlook now, according to you?
We have to remember that there is no vaccine in immediate sight or clinically proven drugs, so our best protection is our own behaviour as individuals, family, community and as a nation. It’s time to cooperate and collaborate at all levels, because as long as the virus is around and there are people with no immunity to the disease, the virus will transmit until it reaches its biological equilibrium.



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