Too Deep For Tears

We are a grief-stricken island as we mourn the many who are becoming orphans or widowed, and the number of young people who still had much to live for and to give to the country. There is little to console us at this stage…

By Dr R Neerunjun Gopee

The health situation caused by the Covid-19 pandemic in the country is so dire that the only way in which we can hope to rein in its relentless march is a ‘Whole of Government, Whole of Country’ approach. This means that the main focus of both government and the people – who are rapidly turning into hapless victims – should be about how best (for government) to control the spread of the disease based on the most reliable evidence available as regards prevention and treatment, and for the people how most effectively to protect themselves from getting infected by following sound and reliable advice.

We are not the only country facing the multiple challenges and difficulties that Covid-19 is throwing up non-stop. However, what can make the difference in outcome is the management approach at each level, with system-wide coordination and collaboration both vertically and horizontally. Two days ago, this is what appeared in an online newspaper in the UK:

‘Ministers in England have “lost the message” over Covid-19, scientific advisers and leading experts have warned – on the same day the devolved nations strengthened their own strategies against the virus.

‘While Northern Ireland reinforced its working-from-home guidance and the Scottish government admitted the country was in a “precarious” position, scientists in England warned that Downing Street needed to take Covid “more seriously” as the country heads into winter.

‘Experts believe messaging has slipped around basic measures such as mask-wearing and avoiding crowded, unventilated spaces – policies that are being actively pushed by England’s closest neighbours.’

Have we too reached a stage where we have ‘lost the message’? We must hope not, otherwise things are going to get worse. As is happening in several other countries such as Germany where the number of new infections is now running into 400 per 100,000 people (nearly 67,000 in 24 hours on Wednesday).

As a result, according to online sources and witness accounts on the German TV channel DW, intensive care units (ICUs) in the country are packed to the brim with over 90% of the Covid-19 cases in ICUs being unvaccinated people. Patients are being forced to move around to where ICU beds are available. But at least they have that possibility and obviously infinitely vaster and more sophisticated resources than we have.

How serious the level of infection is in Germany can be gauged when compared to that in the hardest hit state in the US, Michigan, where the comparable figure is 82/100,000. It has been pointed out that the vaccination rate in Germany stands at 68% fully vaccinated people, which is comparably low compared to European standards. And Germany may go into a fifth lockdown.

This resurgence in Europe has led the US Centers for Disease Control to add Germany and Denmark to its ‘Do not travel’ list. Protests against pandemic restrictions have erupted in Austria — where authorities had to use water cannons against protesters – and, for that matter, in two French overseas territories as well.

Inevitably, we are falling into the pattern that has characterized the pandemic as it swept across countries, which have seen surges and serial lockdowns succeeded by intervals of relatively freer movements before there were new restrictions and also their serial partial lifting, followed by re-imposition of more stringent ones afresh.

As regards vaccination levels they vary depending on the willingness of people to accept being jabbed or not, sometimes because of a clear-cut official protocol widely disseminated is absent. Then there is a panic rush to vaccination outlets when the surge is occurring, by then it is rather too late already for the body to mount a response in time. Of course, vaccines do not give full protection, and that is a fact that has been emphasized repeatedly by all competent authorities, so that they have necessarily to be supplemented by the most reliable and basic sanitary measures, of which mask wearing is the most effective in preventing transmission – that is, in catching the virus oneself and in spreading it to others, especially the mostly asymptomatic Delta variant.

Throughout the pandemic, the sanitary protocol has remained the only one of the control strategies available (sanitary measures, vaccination, treatment) that has been consistent and constant. Data on vaccines and treatment options have been undergoing constant scrutiny and review in light of new findings coming in based on ongoing studies which are reported regularly in the medical press.

With some manageable logistical hiccups, the vaccine rollout locally – including booster doses despite initial reluctance – has been extending the coverage. Foreseeably, some division of views about vaccination are likely to persist, which is all the more reason for everybody – especially those who are reluctant – to be even more rigorous about adhering to the sanitary protocol.

As regards treatment, the lack of adequate and accurate information has sent a number of people either testing positive or having responsibility for family or relatives similarly affected to rush to get medicines without proper medical advice. The difficult conditions in the hospitals have received ample publicity in the media, and the truth cannot be hidden.

However, the most crying lacuna is the paucity of personal attention and care, especially of a general nature such as hygiene, feeding, providing moral support and comfort, because of a lack of sufficient nursing personnel, themselves exhausted and overwhelmed.

Under even normal civilian circumstances, such as having to handle patients in crowded outpatient clinics or in the Accident & Emergency Department, medical care is a stressful and daunting task. And now that we are literally at war, the risk of burnout and of staff themselves falling to the disease is a permanent sword of Damocles on their heads which doesn’t help either them or the patients.

Ways will have to be found about how to ensure general care of admitted patients so as to release qualified nursing staff from these chores and free them to do the continuous monitoring of, in particular, oxygen levels of patients which is key to managing these patients. Roping in interns in the various hospitals to do such monitoring — which will hone their skills and add to their training – is an option to be considered. One suggestion has been to allow relatives in to provide general care. With a bit of organisation this should be possible in selected cases and help to reduce the pressure on nurses. Such carers, however, must not come in the way of the nursing or medical procedures

Further, as is well known by now, most critical is the timing of treatment based on the oxygen level (other than administration of oxygen) which comprises administration of steroids and anticoagulants. This is in addition to all other supportive treatments administered.

An experienced senior physician colleague has successfully treated several patients at home following this line of thinking, and that is why the ‘Whole of Country’ approach is vitally needed – so that all the available local experience is put into the service of patients. It is still possible to save lives by proceeding logically and according to evidence and experience.

We are a grief-stricken island as we mourn the many who are becoming orphans or widowed, and the number of young people who still had much to live for and to give to the country. There is little to console us at this stage, save to seek refuge in words written long ago about the expression of our human emotions, such as those of the English poet William Wordsworth. Though they were meant for happier circumstances, modified slightly (the third line), they still resonate:

Thanks to the human heart by which we live,
Thanks to its tenderness, its joys, and fears,
To me the Covid cyclone that is blowing can give
Thoughts that do often lie too deep for tears.

* Published in print edition on 26 November 2021