Our Waterloo is awaiting at the next bend – especially when the enemy is invisible and elusive
By Dr R Neerunjun Gopee
Six months into the pandemic caused by Covid-19, it is perhaps time to make a pause and survey the scene with some detachment. From this angle, there’s the good, the bad and the ugly. Nature revived, pollution levels plunged and blue skies were seen again in many cities, and people the world over have realised that there’s no alternative to going green and create a sustainable environment if we want to survive as a species. However, worldwide the number of cases is increasing and so too the number of deaths, and there’s no knowing when the trend will be buckled for good.
The sheer volume of tests needing to be done is posing a logistical nightmare in some countries, but there is no other alternative to try and perform as many as are required if a country is to be made safe. Photo – media-eng.dhakatribune.com
Meanwhile, Covid-19 has become a scapegoat for many a repressive policy decision and has shaken both national and global politics, causing rifts and antagonisms even as scientists and doctors are trying to find common cause by sharing information about various aspects of the virus, the disease syndromes it is giving rise to, the various approaches to diagnosis, prevention and treatment. A very tall order indeed – but as doctors we are used to navigate such situations and combine knowledge with experience so as to produce the best outcomes possible for our patients, fully aware that our Waterloo is awaiting at the next bend – especially when the enemy is as invisible and elusive as Covid-19.
It is worth noting that since the virus was first detected in Wuhan there have been almost 24,000 publications related to it, many of them at pre-print stage. That is, not peer-reviewed but containing findings significant enough to be brought to the attention of the scientific community and to clinicians, pending further studies of a more rigorous nature to confirm or modify the preliminary conclusions arrived at.
A good place to survey the situation is to start from the beginning, namely the origin of the virus: it appears that the scientific community is coming round to a consensus that it originated from bats and not from a laboratory by design or default, an escapee virus. The question that therefore arises is: will the obvious solution of not consuming those poor bats and other potentially infective animals be applied? Who will venture a guess?
As regards diagnosis, the disease is coming in so many forms that are baffling doctors and researchers attempting to find explanations of the ‘how’ that can lead to more effective treatments. Practically everybody will now have some basic understanding of the various tests being undertaken, and are by and large willingly submitting to them especially where the disease is spreading rapidly. Understandably, the sheer volume of tests needing to be done is posing a logistical nightmare in some countries, but there is no other alternative to try and perform as many as are required if a country is to be made safe.
That the disease is not a mere influenza or influenza-like has been shown by the fact that it is affecting all age groups and even children – for example, a few days ago I read that in Texas they are treating 100 children under one year of age who have been infected. Earlier, about 350 children had developed what was termed a ‘Kawasaki-like’ syndrome (Kawasaki disease is an autoimmune inflammation of small arteries), which presented with a severe inflammation of the heart muscle along with red skin patches on the thighs.
Besides, the virus particles have been found not only in the lungs but in several other organs as well, for example the kidneys and the nervous system including the brain. Early on, a curious phenomenon was seen, what has come to be labelled as ‘happy hypoxia’. Hypoxia is a reduction in the level of saturation of oxygen in the blood, which is usually 96-98%. Below 94% is considered dangerous and may cause loss of consciousness. But here were patients presenting with levels of 60-70% who were walking into hospital smiling and apparently well, except that their lung scans showed the advanced changes seen in Covid-19 cases.
While clinicians are still trying to find an explanation for this bizarre presentation, a pre-emptive measure has been to use pulse oxymeters to keep a tab on the oxygen levels. This is a small device, made affordable, that can be clipped on the thumb; it assesses the oxygen saturation levels electronically.
When it comes to treatment, this has to cover the whole gamut of cases from the asymptomatic ones to those with the more severe complications, many of whom cannot alas be saved. What has been apparent from the start is that possession of a strong immune system is a great advantage, and so a variety of ‘immuno-boosters, coming from the field of complementary medicine, such as the Ayurvedic and Unani systems,have found a place alongside the allopathic therapies which are based on scientific principles. Several drugs used for other conditions have been ‘repurposed’ and used for Covid-19, and these include the antiviral Remdesivir, dexamethasone, hydoxychoroquine (HCQ).
While the evidence for the first two was strong enough, the use of HCQ has been mired in controversy that started with the publication of a paper by Prof Didier Raoult recommending its use together with an antibiotic. Both that paper and one published in the Lancet – which has been retracted since – have been severely criticized. However, in India, HCQ has been used for prevention in hospital personnel who are in close and constant contact with Covid-19 cases, following the strict guidelines of the Indian Council of Medical Research based on indigenous studies. But it must also be underlined that malaria is endemic in India and so practitioners have wide experience with HCQ which is used as an antimalarial drug. That’s not the end of the story, though: now randomized controlled trials – the gold standard of evaluating treatments – are being undertaken in Seattle, Washington, so that HCQ may yet prove its worth.
This brief overview is to remind that there is still a long way to go before we can claim control over Covid-19, and as prevention is always the best treatment – it is still our best bet. Therefore, let us do our part as responsible citizens by self-protecting and protecting others through preventive measures advised.
* Published in print edition on 21 July 2020