COLUMN/ THE WRITE LINE
Dr. Amitav Banerjee
The last three years were extremely disruptive. It was not wrought by the Covid-19 virus, but by the well-meaning but misguided extreme measures by almost all governments around the world on the advice of their expert advisers.
While in the initial stages of the pandemic such harsh measures might have been justified on the basis of the precautionary principle, that is, to err on the side of safety, presently we have adequate hard evidence to guide policy weighing in the risk-benefit of each intervention that can have far-reaching and harmful consequences.
Not doing so would not only amount to public health quackery, but would violate the basic principle of bioethics, that is, first, do no harm.
The greatest harm was inflicted on schoolchildren. Early into the pandemic, data indicated that keeping schools open had little adverse impact on the health and well-being of children as well as their teachers.
In a paper published in Public Health, UK, researchers analysed pooled data from seven countries in Europe that faced the fury of the pandemic. They calculated child mortality from Covid-19 and compared it with deaths from other causes among kids during the study period.
At the peak of the pandemic, there were just 44 deaths from Covid-19 and just 107 fatalities from influenza viruses, while 13,200 deaths were from other causes in the 0-18 years age group, the leading cause being accidents. Covid-19 among children contributed to only 0.33% of all child deaths, while influenza viruses were responsible for 0.8% of all fatalities.
A more recent study from Japan published in Nature Medicine also established that school closure had no impact on the transmission of Covid-19 and had substantial negative consequences.
In India, we do not have similar studies, nor do we have good public health statistics. The latest fad is counting cases of Covid-19, and now adding other influenza viruses in that case count, the latest being H3N2.
Public health is not about one or two diseases, but the overall disease burden in a community. Just highlighting a couple of too common illnesses out of context can be considered poor risk communication to the public, if not outright misinformation.
Just like in the West, accidents are the major killer of children in our country as well. In fact, road traffic accident deaths among the young in India are very high. Over 400 fatalities take place daily in India and many more are maimed for life. Compared to Covid-19 mortality or “long Covid”, the accident statistics can be frightening if these numbers are flashed daily in mainstream news.
Over 2,000 children die every day in India due to preventable causes against the background of malnutrition. Now, school closures increase malnutrition as many children depend on mid-day meals to supplement their calorie and protein intake.
Dengue takes a heavy toll, we do not know how much, as the diseases of the tropics do not get as much attention as the diseases among affluent, westernised Indians.
So is the case with typhoid, which is common among children, and even with treatment, it has mortality of over 1%, which is far more than the fatality from untreated Covid-19 and influenza viruses such as H3N2.
We do have an effective vaccine against typhoid, which is not promoted with as much gusto as the Covid-19 or the influenza vaccine, the latter suddenly finding favour recently.
If we go by these hard data, and evidence-based public health practice, we should be more concerned with major childhood killers such as accidents and dengue. In fact, the vector mosquito of dengue is a daytime biter and cannot be taught to maintain so-called social distancing.
Another breach of evidence-based practice is the insistence on wearing face masks. Before Covid-19 and even during the early days of the pandemic, the WHO (World Health Organisation), and even the great Anthony Fauci, who, according to his own view, represents science, did not recommend masks for the public as there was no evidence that it will prevent viral transmission.
Duly parroting their western academic masters, the then director of AIIMS gave an interview, saying healthy people need not wear masks. Even a high-school student knows that masks cannot act as filters for viruses.
During the course of the study, a couple of good-quality randomised, controlled trials, one in Denmark and another large community trial in Bangladesh, established that masks have very modest impact, if at all. Strangely, defying evidence as well as common sense, the mask mandates spread like wildfire throughout the world.
Even now, the knee-jerk reaction of administrations and their pliable medical advisers is to recommend masking at the slightest rise in seasonal, self-limiting respiratory illnesses, notwithstanding that the latest Cochrane review (considered the final word in evidence-based medicine) has concluded that masks do not offer much protection.
Were these practices by various governments nothing but public health quackery? Or were they a sinister design to control the people using fear as the key?
Recently, leaked messages revealed that Matt Hancock, former British health secretary, wanted to “frighten the pants off everyone” to ensure compliance with restrictions by strategically “deploying” details of a new strain.
One can only hope that leaders all over the world are not following the same modus operandi.
In the context of the above deliberations, it is dismaying to note that the Union Territory of Puducherry has declared that schools will remain closed from March 16 to 26, and so-called experts are yet again recommending masks – the same experts who were parroting at the beginning of the pandemic that masks are not recommended for healthy people.
Not only do these interventions not follow the current available evidence, they will also cause much collateral harm – physical, mental, and social.
Such hypocrisy and public health quackery is also poor education for students who read science and then find that it is not followed in practice.
(Dr. Amitav Banerjee was a field epidemiologist for over two decades in the Indian Army. He led the mobile epidemic investigation team at the Armed Forces Medical College in Pune, India, from 2000-2004. During this period, he investigated a number of outbreaks in the country. He is presently a professor in a medical college in Pune.)
The column reflects the author’s opinions and not necessarily those of Empire Diaries.
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