Covid-19 can only be defeated through global co-operation, as was seen with the unprecedented effort to eradicate smallpox, World Health Organisation (WHO) officials said at a briefing commemorating the 40-year anniversary of the eradication of smallpox.

WHO director-general, Dr Tedros Adhanom Ghebreyesus, said that “as the world confronts the Covid-19 pandemic, humanity’s victory over smallpox is a reminder of what is possible when nations come together to fight a common health threat.”

It’s over 3 000 years since smallpox plagued the world, but the basic methods for containing diseases have not changed.

Similar tactics

“Many of the basic public health tools that were used successfully then are the same tools that have been used to respond to Ebola, and to Covid-19: disease surveillance, case finding, contact tracing, and mass communication campaigns to inform affected populations,” said Tedros.

Dr Mike Ryan, executive director of WHO’s Health Emergencies Programme is concerned countries are not prioritising this, “avoiding the uncomfortable realty that we need to get back to public health surveillance.”

He stressed that “we need to go back to where we should have been months ago — finding cases, tracking cases, testing cases, isolating people who are tested positive, doing quarantine for contacts.”

Echoing this, Dr Maria Van Kerkhove, an infectious diseases epidemiologist and technical lead for the WHO’s Covid-19 action plan added that passive responses to the virus simply aren’t enough to curb transmission.

“Countries have demonstrated that if you aggressively look for people with the virus, isolate them and care for those with severely affected, identify all of their contacts and quarantine their contacts – that works and can stop transmission.”

She said that although it’s been five months, and it seems like a long time, “we are at the early stages of understanding this disease.” However, she’s confident that Covid-19 can be curtailed, saying “this is the first pandemic in history that we can control by following these measures: find, isolate, test, treat, and quarantine.”

Lifting of lockdown

Some countries that have managed to suppress transmission, such as China, Hong Kong, South Korea, Singapore, Japan, New Zealand and Australia, are starting to open up their economies, and are slowly lifting public health constraints.

But in Japan and Singapore, there’s been a resurgence in cases, notably amongst migrant populations living in crowded conditions. “Targeted strategies can contain cluster outbreaks, but managing widespread community transmission is hard. Once you reach intense community transmission it’s difficult to do systematic and comprehensive surveillance”, explained Ryan. South Africa’s mass screening and testing strategy is intended to avoid widespread community transmission.

Hong Kong and South Korea have largely succeeded in preventing a second outbreak by conducting widespread testing, sharing data with the public on the location of infections and following up with infected people and their contacts.

“We’ve seen in countries that have contained this virus without the need for massive lockdown have done it through principled, human rights driven, but aggressive public health surveillance,” said Ryan.

Surveillance, testing and social distancing

He cautioned that “the numbers will jump back unless there’s continuous surveillance, cluster testing, and social distancing.”

This is part of South Africa’s strategy. Professor Salim Abdool Karim, chair of the Covid-19 ministerial committee, has previously told South Africans in a public briefing that the next stage of the response will involve ongoing national surveillance where small samples of people are tested at schools, densely populated hotspots and large companies.

Kerkhove warned that citizens must prepare themselves for periodic lockdowns.

“What we’re learning is these measures have to be lifted in a slow and controlled way because it’s possible for the virus to take off again. We have to be ready for a push-and-pull situation, where lockdown measures are lifted, then re-implemented, as we try to suppress this virus across the globe.”

It’s clear that there will be no return to normal for a long while. According to Ryan, social distancing measures will be in place for months, with mass gatherings prohibited.

“We have to accept that it’s going to be much more difficult to make gatherings like concerts, sports matches and conferences perfectly safe. I believe there is a path out, but it will involve the partial opening of schools and workplaces, with special considerations for people working in highly dense environments.”

He further said in time sport matches may be allowed to resume, but without live spectators.

His message is unequivocal: there will be a significant change to our lifestyles until we have an effective vaccine.

Vaccine ‘not enough on its own’

There are currently 115 Covid-19 vaccine candidates in the pipeline, in varying stages of development. But it’s expected that a vaccine may only be ready for use within 18 months at the earliest – by late 2021.

But a vaccine cannot be viewed as the only preventive measure. As Tedros said, “although a vaccine was crucial for ending smallpox, it was not enough on its own.” The vaccine was first developed by Edward Jenner in 1796, but it took another 184 years for smallpox to be eradicated.

WHO officials stressed that global solidarity and action is required, with Ryan saying that “community education, knowledge and empowerment is vital. If we pull this together with a vaccine in the future, that’s the core of it.” – Health-e News