The world has recently gone through the only true pandemic in the recent history. The world also witnessed a truly global effort in trying to control COVID-19.

When we analyse the data, the disease trajectory seems have entered the containment phase in a large majority of the affected geographical locations and others are soon to follow this course.

The Pareto principle (also known as the 80/20 rule, the law of the vital few, or the principle of factor sparsity) states that, for many events, roughly 80 per cent of the effects come from 20 per cent of the causes.

Today when we look at the COVID 19 situation, 5 per cent of the countries are contributing to more than 80 per cent of the reported cases and only 8 countries (4 per cent) are contributing to 85 per cent of the mortality. An interesting fact to note here is that all these countries are the ones which contribute more than 8 per cent of their GDP on healthcare. Leading the list is no other than USA which spends more than 17 per cent of its GDP on healthcare.

However this much of a spending did not stop them from getting badly hurt. This primarily resulted from the failure of the leaderships across the globe to look at the available data rather than the hypothetical projections put forward by the so called experts in the fields.

Hundreds of thousands of people have lost their lives and millions more will lose lives in the economic turmoil that seems to be unfolding because of our handling of the situation.

None of the calculations or estimates have worked in these difficult times. The Pandemic and the way it has been handled has created havoc in the world. Only the wisest and proactive leadership can build a damage control response, unfortunately the world lacks in this area. We have witnessed a commodity price collapse, supply demand chain disruption and an unprecedented collapse in global trade.

And then we see the hardliners who are calling out loud for total lockdowns across the globe. Yet once again they fail to recognise and accept the basic fundamental biological principles as outlined below:

1.          The previous WHO figures and projections for disease severity/fatality are around 30 per cent overestimated than the ground realities. A fatality rate of 0.1 to 0.2 per cent once infected is way better than the projected models. The age correlation also varies with the most vulnerable population being elderly with multiple comorbid illnesses. Normal healthy young and adults have only 0.02 per cent risk of having any serious disease.

2.          Rather than having an emergency situation across the board that has stretched the healthcare systems globally , the strategy to protect the elderly will ensure that the hospitals will stay uncrowded and as such the healthcare system will not collapse.A large proportion of people (around 50 per cent) of PCR positive do not have any symptoms and as such the healthy young and adults do not need any significant medical care even if they did acquire the disease.

3.          The crowding of hospitals whereby every positive patient getting compulsory mass quarantine has put considerable burden on the health care system to the point of its collapse. This mistake of treating and putting patients in quarantine in most hospitals has been a double edge sword.

It depleted the resources and crammed both the sick and non-stick patients together creating havoc. The Italian experience of mixing the patients together was a fatal mistake. If there were dedicated facilities to house the sick from day one then the number of people dying and the frontline staff becoming affected at the start of the pandemic could have been prevented.

4.          The panic of COVID 19 disrupted the working of a vast majority of the hospitals. The institutes rushed to take care of the projected number of “Potential COVID” and forgetting the routine medical care and electives. Cardiology patients got delayed and died. Pulmonary patients failed to either receive the critical care or were simply Triaged off as Non COVID (not to be touched) resulting in increased morbidity and mortality. Acute strokes missed the only chances for emergent treatment and subsequently would face lifelong debilities. Cancer patients have been badly hit. Same is the story with Elective surgeries thus sky rocketing the morbidities.

5.          Lack of proper training and education among the healthcare workers resulted in a panic state whereby the serious patients presenting in the ERs were refused consultations until the COVID testing has been available. This resulted in delayed treatments. Myocardial infarctions and strokes missed the golden hours and countless other diseases complicated during this waiting period.

6.          The population that needed something to be done ie the elderly group also got neglected in the heat of the affairs. No concrete efforts to isolate this group materialized resulting in them being treated with everyone else. Cross infections and a neglect on their co-morbids practically put them at a greater disadvantage.

7.          In the effort to curtail the disease and measures to flatten the curve resulted in lockdowns across the globe with few exceptions in the western hemisphere . Decision makers in the panic phase failed to anticipate that total isolation policies prevents the population getting the Herd immunity. To establish a widespread immunity across a society these infected asymptomatic /mild symptomatics are the key vehicles. By transmitting the virus to others in the low-risk group who then generate antibodies, they block the network of pathways toward the most vulnerable people, ultimately ending the threat.  If we extend this isolation polices across the board we directly prevent that mass immunity to develop. Countries like Sweden have recognized this point early on and have been successful in walking off with minimal damage.

8.          The appropriation of huge funds to the pandemic on the speculated models are liable to bleed the already thin healthcare budget for the serious illnesses once this frenzy gets over. Countries across the globe will find themselves in a difficult corner with no resources left to combat the day to day co-morbid illnesses.

9.          The lock down also wrecked the fragile economies of third world countries. Factories were closed. Small businesses were forcefully shut down. All this happened because of the utter failure of the administration to have a holistic picture in front of them. The projected figures took over the saner decisions. The countries who did not impose the lockdowns i.e. Sweden have successfully pulled out the difficult situation without devastating their economies.

Critical appraisal of the current ongoing policy needs to be carried out and a more focused strategy based on the lessons learned from across the globe needs to be implemented. The vulnerable group needs to be protected. Self-isolation of mildly ill needs to be stressed. All other larger group of population should be allowed to continue the routine lives with recommended precautions to avoid the impending financial collapse of the individuals as well as the institutes.

 –Writer is a consultant Pulmonologist and heads the Critical care department at Evercare hospital, Lahore. He has diverse international experience in treating critically ill patients. He can be reached at kaachy1@gmail.com.

Dr. Kamran Qureshi is a Health Economist and a Health Policy Expert and works as an Independent Healthcare Consultant. He holds a medical degree from King Edward Medical University, Post Graduate Diploma in Clinical Research from University of Surrey and an MSc in Health Economics and Policy Making from the London School of Economics. He has a diverse experience in Clinical Research, Pharmaceutical Development, Hospital Management and Clinical Work. His views are personal and cannot be ascribed to any organisation. He can be reached at kizhar@gmail.com.