COVID-19

Coronavirus (COVID-19), the world is shaken, life stands still – what we know, what is next, what to celebrate?

Coronavirus (COVID-19) entered the world like a ferocious wild storm and caused world wide devastating impact in rapid successions before the world could realise and get ready to protect itself from it. This is a taster for the world to reimagine its own power.

Disease impact variation

The disease is spreading with different speed and intensity in different parts of the world. As a result the medical communities in the west had very little time to act in advance and official bodies issued various advice and instructions about treatment, prevention and protection strategies (BMJ, P14, 4 April ‘20) that caused some early confusion, however, the disease trend is changing on a daily basis and overall clinical effectiveness are being observed gradually.

Case incidents and Mortality Statistics variation

The global case incidence statistics are hugely different in different parts of the world and Central Europe and the USA alone with China have recorded the vast majority of all cases in the world (ECDC data 15 April). The total identified cases in the world, about 2 million including 126,000 deaths, out of which over 1.6 million cases and over 115,000  deaths are in Central Europe and USA alone (ECDC data 15 April’20).  In south east Asia India, the spread of the disease appears to be surprisingly very limited, with only 11,438 cases and 377 deaths as of 15 April 2020 (ECDC), in a country of 1.3 billion population where even the implementation of preventative measures and its compliance had been very challenging.

The case statistics data used here are only limited because the numbers are rapidly changing on a daily basis so the number quoted here will have changed by the time this article is published.

Although very limited number of virus testing and contact tracing have been reported in India so far, if such low infection rate is proved to be genuine, then this demographic discrepancy remains an unknown medical mystery either related to genetic or biological or environmental or life style factors that demands scientific analysis and clarification..

World wide case incidence and Disease severity

The current case statistics show the most serious impact in terms of both severity and mortality was almost entirely in Central Europe, USA and china, whereas the rest of the world including Africa, middle east and the south Asian community have suffered very little (ECDC data), except few odd variations.

For example, if the spread of the disease in India were similar to the west, it would have been a catastrophic disaster for a country of 1.3 billion people. A possible protecting factor in developing countries could be that people are vaccinated in childhood for various viral diseases that are rare in the west or Europe, and that childhood vaccination might be working for covid-19 as well. Time will tell.

What the people want to know?

What is puzzling is why this virus causes so little symptoms in most people who recover easily, but it’s thought to be deadly to some with higher comorbidity who die rapidly, but there is no evidence that it is the virus that causes the death and not the existing disease itself. Also there are cases of 101 year old with obvious comorbidity has survived when 12 and 13 year old healthy have died, meaning the current concept on prognosis assessment should be reviewed.

Questions also occur why there is high mortality in some geographical locations with relatively fairer skin compared to the rest of the world? The combined mortality in Central Europe and USA alone including china represent more than 90% of total mortality in the world to date (ECDC 15 April). In comparison, the disease impact is much less aggressive in Africa, middle east and south east Asia which together represent almost two third of the world populations. One might think it could be due to a genetic or demographic or environmental or life style or childhood vaccination factor, that is yet to be known.

What Preventative Measures

There was wide spread anxiety, confusion and concerns about correct protective methods against the virus. The standard medical concept is wherever there is a risk of infection, use appropriate gloves, mask, gown, disinfectants and isolate. But that was not the consensus advice given by the world authorities. And no wonder people were confused whether to wear face masks or not? It seems the advisory authorities had anticipated the risk of bottlenecking of sudden surge of huge demands of resources and political pressure on responsible bodies. An appropriate look back analysis of the lessons learnt might offer better understanding about the appropriate protective methods policy for future.

Definitive protective measure

This is a virus and invisible and common thoughts will be that it will spread everywhere including the surrounding open air space and can easily enter the body through the nose, mouth, eyes, ears including any breach of skin with blood or mucus contact and not just hand touch alone. And the reality shows hand washing had limited impact and as a result complete isolation had to be adopted as a definitive measure, and that seems to be working gradually.

How many people affected and at risk

There could be huge number already exposed to the virus but remain asymptotic live carriers in the world. This requires worldwide virus test scheme, not only to identify the virus but also to follow up the long term impact on human body and future consequences. There is no evidence so far to show that the treated patients may not acquire the disease again. We also do not know the fate of untreated asymptomatic carriers and whether detecting virus antibody will offer any benefit.

Is there a specific treatment for Covid-19

In some places the Covid-19 patients are being treated with medical drugs that are not universally recognised or recommended for clinical use. Medical community is required to come together to agree to an evidence based standard of medical care that is safe and truly effective. However, there are some promising work going on with scientific research and drug trials at many centres around the world and soon we will hopefully establish an effective prevention and drug treatment for Covid-19 patients.

What is outcome and next

What we learnt so far is that this virus disease is largely self limiting, and therefore most people do not require any specific treatment nor hospitalisation, except a minority and high risk groups of patients who may require hospital care for supportive management. However, disease can be fatal to anyone.

Human Impact and Hopes

This is a scary and stressful situation not knowing what will happen next. And being locked up at home in isolation took its toll causing many out of job, lost earnings, lost livelihood, and many spending days, weeks in uncertainty with high level of anxiety causing an additional negative impact on their health on a daily basis. This is a situation without any one’s fault, and people need moral support, and encouragement to feel happy with anything like music, songs, dance, clapping and whatever that will elevate the mood, lift up the energy and spirit and bring the peace to the mind. This will also boost the moral of all front line staff and medical community to continue with their efficient care to save lives and save themselves. We will see happy and healthy days ahead. Together we will beat the Covid-19.

 

Author: Dr Sish Chakrabarty, Consultant Cardiologist, London, Clinical Examiner Medical Education Faculty, King’s College London University Hospital Medical School

Schakrabarty@doctors.org.uk

*The data in the article above is correct as of 15th April 2020

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