Expert advice on COVID-19 pandemic: It’s time to think ‘slow’ now

Nobel Laureate Daniel Kahneman coined the phrase, “thinking fast and slow”. Thinking fast is intuitive and effortless while thinking slow is deliberate and calls for effort. After “thinking fast”, taking time out for “thinking slow” can be worthwhile.

The response to the pandemic was driven by panic. Fear of imminent danger led to thinking fast. Governments were like students attempting questions out of their syllabus. In the manner of unprepared students, they resorted to mass copying. Country after country copied Communist China’s draconian measures, the imitators outdoing the trendsetter.

Fast thinking led to contradictions, as they usually do. Initially there were conflicting messages regarding use of face mask by the general public. The WHO also made a U-turn after announcing that asymptomatic persons do not transmit the virus. And then there was backtracking by the WHO after announcing that asymptomatic people need not be tested. None of these statements are right or wrong but need to be considered in the proper context.

Pandemics evolve in stages. What is applicable in one region at one time may not be applicable in another region which may be in a different stage of the pandemic.

Responding to disease outbreaks is a dynamic process like driving a car. Taking off from a stationary position one has to first engage the fuel intensive first gear. Once on the run, fuel is preserved by engaging higher gears. At the end of the drive once again fuel intensive lower gears are used.

Outbreak response also follows a similar sequence. Intensive containment measures should be applied when the outbreak starts to take off, once the outbreak breaks into community transmission, intensive containment measures are not very cost-effective. The strategy at this stage should change gears to control fatalities by ensuring early management of cases leaving the asymptomatic well alone. When the disease is on verge of eradication, containment measures such as testing, tracing and isolation again become important and would include testing of asymptomatic contacts as well.

Strangely it appears that except for the effortless panic driven “fast thinking” responses by most countries, what has been found lacking is deliberate “slow thinking” to consider the stage of the pandemic in a particular region to enable calibration of the response. We are still driving in the fuel intensive first gear.

The sprint is long over. It is time to abandon “fast thinking.” Currently we are running a marathon. It is time for second wind and some “thinking slow.” Having lost the sprint, we should endeavour to win the marathon. To be successful, we should let go of the measures which were appropriate for the sprint and adopt measures appropriate for a marathon.

Being well into community transmission, containment measures such as intensive testing and tracing particularly of asymptomatic cases should be discontinued. It makes no sense to require RT-PCR tests for inter-state travel either.

This will go a long way in allaying the fear and stigma of the disease. Another important step should be proper “risk communication” to the people. The modus operandi of most governments has been to instil fear in people to make them compliant to so called “covid appropriate behaviour.” Without proper risk communication most “covid appropriate behaviour” driven by “fast thinking” has degenerated into rituals with little impact on disease transmission. Superstars preaching and practising these covid appropriate behaviours have contacted the virus themselves!

One example of covid ritualism is the advice not to step out of the house and wearing of masks if going outdoors. The origin of this guideline, as reported in New York Times, dated May 26, 2021, is interesting. The Centre for Disease Control (CDC), US, misinterpreted a scientific paper to conclude that the risk of outdoor transmission is 10%. In response to this misguided guideline, the author of this paper tweeted that the actual risk of outdoor transmission is 0.1%. In fact, in her tweet she recommended to spend more time outdoors to stay healthy mentioning that risk of outdoor transmission is negligible.

This misunderstanding led to restriction of outdoor activities worldwide. Many people who conduct businesses outdoors, such as vendors, street food and terrace restaurant owners could have continued to earn their livelihoods with minimal risk of transmission.

Risk communication should also consider that globally, the risk of dying from infection with the virus is 0.3% while in India it is 0.1%. If someone in our country catches the virus, the probability of surviving is 99.9%.

Living exposes us to much higher risks: daily 1500 Indians die from tuberculosis, 400 young people die every day from road traffic accidents (and 10 times more are maimed for life), and 2000 children die daily from preventable diseases to give a few examples.

The majority of Covid-19 infections are asymptomatic. Interim results released in June 2021, from a joint AIIMS-WHO study, indicates that 60-70% of the population, including children, have encountered the novel virus. Other studies in some parts of the country have revealed IgG antibodies in 80% of the population. Studies worldwide indicate that natural infection give robust and long-lasting immunity. After infection, the virus replicates and circulates in our body for 10-15 days giving enough chance to familiarize our immune system including long-acting memory and T cells. This immune memory logically should work against variants too.

The evidence and logic of not duplicating nature’s efforts of natural immunity can enable population level immunity faster with minimum inputs, by using a “smart vaccination” strategy. If we exclude people with IgG antibodies, we may have to vaccinate only a fraction of our population saving lot of resources and money

Our policy makers need to do some serious and “slow”thinking.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)