Covid-19 will continue to haunt us

We have to continue with all the sanitary measures in place… How long will we go on like this is the query and worry on all lips. The only plausible answer is – when we discover a vaccine

By Dr R Neerunjun Gopee

Shortly after the onset of the COVID-19 emergency, the well-known British medical publication, The Lancet, started a new feature called ‘The Lancet COVID-19 Resource Centre’, which has been updated daily with articles reporting on the latest findings from the multitude of studies going on around the world. I think it would be correct to say that most doctors would be looking up this resource given the global nature in this pandemic, whatever be their field of specialization if they are specialists. This applies to me too, though I am a surgeon and do not deal with infectious disease as a matter of routine.

Nevertheless, I have inevitably been drawn to take an interest in the developments taking place as I was directly involved in the response to the pandemic that preceded the present one, namely AH1N1, as I was serving at that time at the Ministry of Health and Quality of Life. In fact, I have had occasion to mention earlier that this is what led me to view the specialty of Public Health with even greater seriousness.

This was in line with an appreciation of its larger practical dimensions that began when, in 1999, I was interviewed in Harare for the post of WHO representative by the then Regional Director of WHO, Dr Ebrahim Samba who was from Gambia. Like me, he was Fellow of the Royal College of Surgeons of Edinburgh – and not unexpectedly, there was a déclic. The interview turned into his passionate account of how from surgeon he had become Public Health advocate when he had to handle an epidemic of yellow fever, shortly after he arrived back in Gambia in the mid-1960s as Director of the Medical Services there, along with performing his surgical duties.

And hence my curiosity about Covid-19, which is showing up several peculiarities about the various types of diseases that it is spawning, and that no medical practitioner can fail to seek information about, and perhaps discuss one or more aspects which they find intriguing or appealing. And so have I been doing too, with specialist colleagues in internal medicine, public health, etc., and as well with a surgeon colleague who also happens to be specialised in public health. What has been troubling us is the reported non-response to oxygen therapy by several patients put on ventilator, and this is yet to be fully explained.

By now it is generally known by the public at large that there have been so many ‘controversies’ associated with this ongoing episode of Covid-19, ranging from the origin of the virus to the allegedly delayed declaration of the epidemic as a global public health emergency, to the issues about treatment with the anti-malarial drug hydroxychoroquine (HCQ) and the various types of tests that have been devised, to the push for vaccine development besides how best to manage the social and economic impacts of the lockdown that has been advised and imposed as one of the most effective control measures.

As regards HCQ, the latest is the retraction of a paper published in The Lancet on May 22, 2020 by Mandeep Mehra et al: ‘Hydroxychloroquine or chloroquine with or without a macrolide for treatment of Covid-19: a multinational registry analysis’. This came after an earlier ‘Expression of concern’ (EOC) by The Lancet Editors to the effect that ‘important scientific questions have been raised about data reported in the paper by Mandeep Mehra et al’.

The reason for the retraction was that ‘After publication of our Lancet article, several concerns were raised with respect to the veracity of the data and analyses conducted by Surgisphere Corporation and its founder and our co-author, Sapan Desai, in our publication. We launched an independent third-party peer review of Surgisphere…’ and ‘…our reviewers were not able to conduct an independent and private peer review and therefore notified us of their withdrawal from the peer-review process…Based on this development, we can no longer vouch for the veracity of the primary data sources. Due to this unfortunate development, the authors request that the paper be retracted.’ And finally, ‘We all entered this collaboration to contribute in good faith and at a time of great need during the Covid-19 pandemic. We deeply apologise to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused’.

It may be of interest to readers that Prof Mehra, currently at Harvard, in 2009 (he was then at Maryland) came with a team to Mauritius at the invitation of then PM Hon Navin Ramgoolam to advise on medical education, and I led the local technical team at MOHQL.

The paper of Prof Mehra cautioned about the complication of cardiac failure in patients treated with HCQ, a finding reported in other studies after Prof Didier Raoult of Marseilles had strongly recommended the drug based on his own studies of about 1000 patients. This was not widely accepted. But it may be mentioned here that from the outset physicians in India have been using HCP as a preventive drug in personnel who are looking after COVID-19 patients, strictly according to rigorous guidelines issued by the Indian Council of Medical Research. However, the last word has not yet been said about the use of HCQ in COVID-19.

Be that as it may, I had written at the beginning that ‘In course of time, viruses circulate among the population as a normal phenomenon, and produce diseases when the conditions are conducive – like the influenza virus which attacks during the cold weather, and then we talk about the ‘flu season’… This may happen with Covid-9 too, and by then a majority of people would have developed a degree of immunity to it. If a large enough segment of the population, about 75-80%, acquires such immunity, then the rest of the population is also protected, a phenomenon known as herd immunity’. However, in an article on this problem in The Conversation of June 5, 2020 Connor Bamford, Research Fellow, Virology, Queen’s University Belfast writes: ‘The antibody results coming in suggest that only a small proportion of people have been infected by SARS-CoV-2. In the UK, only an estimated 6.8% of people have had the virus; for France, the figure is just 4.4%. This means that we are far away from achieving herd immunity’.

The paper concludes that ‘it’s not clear that SARS-CoV-2 (the virus causing Covid-19) could ever burn itself out. Therefore, our only option remains to suppress Covid-19 as much as possible until we have a safe and effective vaccine available to the masses’.

What this means is that we have to continue with all the sanitary measures in place, though quite naturally wearing masks is starting to tell on people… How long will we go on like this is the query and worry on all lips. The only plausible answer is – when we discover a vaccine. Till then, patience.

* Published in print edition on 9 June 2020