Preparing for the next pandemic? Take lessons from cricket
Fast pitches can make even average bowlers look deadly. Similarly, SARS-CoV-2 was deadly on Western pitches where an ageing and obese population with unhealthy lifestyles was easy prey
A lot goes into the preparation for war. Most of it is behind the scenes and unexciting. An old dictum, "the more you sweat in peace, the less you bleed in war," sums it up.
Napoleon, one of the greatest military strategists in history, was defeated by the Duke of Wellington at Waterloo, bringing an end to the Napoleonic era in Europe. According to the Duke, who was a graduate of Eton College, a keen cricketer and Commander in Chief of the British and Allied Armies at Waterloo, "The battle of Waterloo was won on the playing fields of Eton."
Like the Duke of Wellington, the world can borrow strategies from the game of cricket to prepare for the war against the next pandemic. Failure teaches us more than success. The strategic blunders committed during the current pandemic can provide lessons for planning for the next disaster.
A new pace bowler often rips through the batting order, with the batsmen ducking and taking their eyes off the ball. The novel coronavirus too created havoc globally and the world ducked. In the chaos and anarchy, unprecedented measures were hurriedly adopted, fracturing society and destroying the economy. The captains driving this team took their eyes off the ball.
In their haste and arrogance, they ignored the few feeble voices of umpires who raised concerns that such measures were not quite cricket, unconstitutional and violative of human rights. While China, which never played cricket, locked down a single district and town, other countries went for nationwide lockdowns at short notice.
The captains in this pandemic failed to read the pitches in different countries. Bowlers, however furious and fast, do not have the same impact on all pitches. On English pitches they may be deadly while turning out to be benign on slower Indian pitches.
The virus too encountered different pitches at different places. Fast pitches can make even average bowlers appear deadly. Similarly, the novel coronavirus was deadly on Western pitches while much less so in African and Asian continents. Captains in different countries could have customized country-specific strategies. They instead went for “one-size-fits-all” steps that backfired.
The novel virus ran through the aged population of the West, particularly the vulnerable in nursing homes. A large proportion of deaths occurred among people in their eighties with co-morbidities. Lack of plans to protect this vulnerable group caused severe disease and deaths, overwhelmed the health services and added to global panic. Death rates from these pitches provided inputs for mathematical models predicting a global catastrophe.
In addition to higher age, the population in Western countries have three times higher rates of obesity compared to the East. Obesity is a risk factor for severe diseases and death.
The virus had less impact on the leaner and younger populations in African and Asian countries. This difference is stark on the on the “Worldometer.” Few outliers give further insights. Japan has one of the oldest populations. Paradoxically, it has a far lower death rate. The reason may be much leaner population compared to the West – the proportion of people in Japan who are overweight is 25% compared to European and American population where it is around 60%.
The other paradox is Brazil. It is a fast-growing economy, with a comparatively younger population. Still, it is experiencing high severity and deaths from the pandemic. Almost 60% of Brazilians however are overweight. Obesity is turning out to be a bigger risk factor than age.
Policy makers in most countries, however, appeared like fumbling cricket captains, making hasty decisions on being forced to play on unfamiliar and unpredictable pitches. No attempt was made to make an assessment of local conditions, demographics and population profiles.
The Achilles heel in countries like India are the lack of good fielders, poor field placements and absence of scoreboards, i.e. a proper disease surveillance system for most endemic diseases. Meagre available resources and infrastructure are concentrated in urban areas. The second wave in India revealed these fault lines. Rather than the lethality of the virus (in India the infection fatality rate from Covid-19 is 0.1% compared to global figure of 0.3%), these limitations caused a large number of preventable deaths.
How do we prepare for future pandemics? The present pandemic indicates that lifestyle factors such as obesity are as important to reduce severity and deaths from acute communicable diseases as they are for chronic diseases. This pandemic is a wake-up call not only for the Western countries but also for fast growing economies in Asia and Africa where unhealthy life styles are catching up fast.
These factors damage the pitch and could again spell disaster in case of future emerging pathogens and pandemics. Development of vaccines takes time and do not afford full proof protection as is becoming evident. Even with helmets and body guards, cricketers do and can get injured due to lack of practice and damaged pitches.
In countries like India, long term planning should address the rural urban disparities in public health infrastructure. The state needs to invest more in public health. It also needs a good disease surveillance and monitoring system.
The Covid-19 template of monitoring and surveillance can be extended to our endemic communicable diseases such as dengue, scrub typhus, typhoid, Japanese Encephalitis, malaria and others. Private insurance and corporate model of health care, increasingly being adopted, involves an ever-increasing number of stakeholders with their own vested interests. A gentleman’s game like cricket fell from grace due to high stakes and match-fixing. We need to insulate the noble profession of medicine from increasing conflicts of interest and a similar fate.
And finally, Americans need to play a little cricket too besides baseball. There are no pitches in baseball, which perhaps explains the limited perspectives of American thought leaders in this pandemic.
(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)