COVID-19 could be master of metamorphosis

Dr Ather Pasha

Novel Coronavirus (COVID-19/SARS COV-2) is a major global public health emergency crippling the world with uncertainties and panic among people. Where best of health care providing countries are failing to contain the disease, India, on the other hand, has emerged well in containing the disease. The main reason could be early lockdown and the involvement of the best of healthcare staff.

Coronavirus infects both humans and animals, identified as frequent case of common cold. Besides MERS major health problem in Arabian peninsula and SARS in China. SARS-COV2 is most recently identified human coronavirus causing global pandemic.

In early December, cluster of cases identified as Pneumonia of unknown origin were reported from Wuhan, China, linked with live animal market and started rapidly spreading the whole world with wide spectrum of severity due to different strains. Since then virus has mutated at least into 30 different strains with varying virulence.

COVID-19 causes an acute influenza like illness with fever, cough and shortness of breath. Additional common reported symptoms include fatigue, myalgias, sore-throat, nausea, vomiting diarrhoea, headache, loss of smell, altered sense of taste.

Some of the patients without these above-mentioned initial symptoms presented with complications like heart attacks, strokes and gastroenteritis.  Absence of fever was also reported in patients. Risk factors for severe diseases include 65 years of age, diabetes, obesity, chronic lung, heart, kidney and liver diseases etc.

Virus spreads from person to person through droplets in air or on deposits on surfaces. Speech, cough or sneeze produces droplets (large particles) which settle down slowly due to gravity. Where as normal breathing or talking produces aerosols (small particles) which are in micron range & does not settle, get carried away with air current and diffuse and remains viable and infectious from three hours in air to three days on plastic and stainless steel.

Once you acquire the illness it takes 2 to 14 days to manifest the illness. In many individuals the illness goes unnoticed. Current studies are showing that 80% of patients are asymptomatic which is an alarming figure, giving it a name CONTAGION. Virus can be seen in urine and faeces in later part of illness or during recovery, but faeco-oral route of transmission has not been documented.

Besides lockdown and social distancing of 2m, current mantra to contain the illness is testing, tracing and isolating (quarantine). We should not forget 15 lakh air travellers who came to India in 2 months with poor surveillance. Initially they caused major spread of the virus, probably due to lack of understanding of gravity of situation by the authorities.

Hyderabad, with numerous hot spots in Telangana, faces major challenges. Because of the lockdown most of the regular OPDs in private clinics and hospitals are closed in fear of spread of illness from healthcare provider. Many of the patients are hesitant to report mild to moderate illness to the helpline. They trust local pharmacist for OTC (Over the Counter) drugs without prescription leading the government to take strict action against purchases.

Lockdown, no doubt, has been beneficial in controlling the spread of virus and arresting the flood of critical patients pouring in hospitals for which our healthcare system is not ready to handle. On the other hand lockdown is delaying herd immunity which invariably has to come. It seems no one in health governance wants to take chances for survival of the fittest when a lot of it is at stakes for vaccine development which can save many lives; so till then it is the survival of laziest.

Isolation, Quarantine or Social distancing will increase the risk of mental disorders like depression, irritability, anxiety, aggressive behaviour and suicide in severe cases besides severely hampering our Ganga-Jamuni tahzeeb. One such example where cluster of cases are identified on the basis of religion leading to blame and multiple conspiracy theories making pandemic communal when cluster of cases required sympathy during illness, same clusters are now utilised as cure for saving human lives .

Where are other non-COVID diseases have gone  like TB, malaria, typhoid, heart diseases etc? Have they been reduced, ignored or neglected?

Poverty and panic in labours has lead to migration on footsteps adding to existing disease burden. Lack of PPE among healthcare staff is also a concern which is suppressed.  More than virus famine has struck the poor people who constitute majority of our population.

Numerous uncertainties remain in our understanding of the spread of COVID-19 and its management. Contribution of transmission from asymptomatic to pre-symptomatic people to the community and the extent to which families and aerosols contribute to transmission are unclear. Trials are in progress to assess the effects of various medications. Studies are underway to develop effective vaccines. It is unknown whether the infection confers partial or complete long lasting immunity.

In the end, I deeply mourn the death of patients and healthcare professionals who have lost their lives in the struggle against COVID-19, especially Dr Li Wenliang, Chinese whistleblower doctor.

Dr Ather Akhtar pasha, MD Internal Medicine, Professor & HOD, PMRIMS.

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