The panic is in the air! We used to say “spring is in the air” around this time of the year. We all get very excited when spring is in the air, don’t we? But this year, it’s a completely different story. Most of us are overwhelmed by this crisis caused by COVID-19. The World Health Organization finally declared this outbreak a pandemic on March 11, 2020 after much hesitation and dragging delay. The agony of not knowing what’s going to happen next and the pain of thinking of the inevitable cause even more anxiety in all of us. As for the physicians, nurses and other healthcare workers, it is still business as usual yet at a neck-breaking speed and amid much chaos. The transition from regular speed of healthcare to the current speed with new changes happening every minute is not so pleasant for most of us. Yet we move on because we always think of the suffering and the relief of the healing. We generally put our lives on the line and in harm’s way when it comes to saving someone’s life and specially when it matters the most. This is one such example.
Here in the US, we are impatiently waiting for more RT-PCR test kits to arrive, so that we could test someone with fever, respiratory symptoms like dry cough, respiratory distress with or without travel and contact history and rule out COVID-19 on definitive terms. I feel that the US government and CDC have not fulfilled that requirement in a timely manner. Who knows what will happen tomorrow? We need to continue to discuss with physician leaders and nursing directors (task forces) and come up with a solid working plan as to what we need to do when more test kits are available. Where exactly are we going to take the swabs (Nasopharyngeal, oropharyngeal), sputum collection and bronchoalveolar lavages for the tests? Should we set up surge tents for testing which are known to be risky if not carried out properly? Should we have drive-through testing like some already perform around the world? If so,do all patients have private transportation in this country which is arguably the largest economy in the world? (We all know that’s not the case) If not, how do we do the testing and send them back home if stable? Do we have enough ICU beds for the most serious patients who require artificial ventilation? So many questions that define a fine line between life and death for some of them who already suffer from the infection and for some of the us who are more vulnerable than others. Some are immunocompromised due to underlying medical problems. Furthermore, we also know that the death rate escalates with age after 60 years (3.6% at 60 years, 8% at 70 years and 15% above 80 years of age). These are significant case-fatality numbers compared with other world pandemics.
Hopefully, we’ll find a vaccine and an effective medication for this in a few months’ time with over 80 clinical trials being currently conducted world-over. What if the virus mutates in the meantime? What if the virus ramp up its vigor and virulence in the southern hemisphere in the coming months which will be their autumn and winter? Are we ready for the virus to return to the Northern hemisphere next September? Will it ever happen in a seasonal pattern like influenza? So many questions, yet no one knows the right answers to any of those questions. We could only speculate at this time. The seroprevalence is usually tested by serological tests based on whether we developed antibodies to the virus. When are we going to be ready for such testing? I know some are raising to develop such tests already. How long will such patients, who survived the infection, be immune to another COVID-19 infection? Will it be like Dengue which causes immune-augmentation of your own antibodies causing more harm and complications? The antiviral medications experimented against COVID-19 (such as Remdesivir) show a lot of potential. Do we have enough quantities of the medicine? Are they going to be effective in very sick patients? Will the virus develop resistance to them? Can we come up with chemoprophylaxis with one such antiviral medication to prevent the infection (PrEP and PEP)?
This pandemic has already caused an enormous paranoia in the minds of the speculators triggering a 23% stock market free fall last week. I know for a fact that we are more tenacious than this and we will bounce back in style in the near future. I do not think we need to do any soul searching at this juncture, but we do need to be strong and robust as a nation and as a global community. In order to make a real difference, let’s raise our voices against consumption of innocent animals like dogs, cats, civets etc who need to be loved not consumed. Those are typically domesticated animals and pet animals for most of us. Let’s be open against consumption of exotic animals and fish that we need in the universe for our own survival. Let’s minimize meat consumption and instead, encourage plant-based food consumption. Let’s continue to be thorough with hand and facial hygiene and respiratory etiquettes. Let’s be dependent less and less on China. Let’s all learn a lesson from this crisis going forward!
Dr Deepthi Jayasekara,
Consultant Infectious Diseases, Foothill ID Group, Claremont
Chair Infection Control, Emanate and San Dimas Hospitals, CA
Clinical Professor, Western and Touro University Medical Schools
