Chronicles of Covid
The once-in-a-lifetime pandemic brought unprecedented affliction to the human race, tested their affinity for finding solutions and, now, presents a forewarning for returning to a balanced normal
It was on January 30, 2020, when the World Health Organisation (WHO) gave the first warning – Public Health Emergency of International Concern (PHEIC) about an impending crisis which largely got ignored by almost all the world leaders. Covid-19 was declared a pandemic in March 2020 and soon after, Donald Trump withdrew all financial assistance to WHO after accusing it of not penalizing China for the pandemic, the country he thought, was responsible. There was a widespread impression that there was some delay in declaring the pandemic which might have accelerated the spread of the infection.
It started in Wuhan province of China but information from that country about the disease became sparse as millions of cases kept being reported from other countries. Soon, the entire world started to witness a catastrophe, it was not prepared for. It quickly spread across the continents and no community was spared. To date, the official figure indicates that there are more than 500 million confirmed cases but a study suggests that over 3 billion people may have contracted the disease which amounts to about 44 per cent of the world population. It is estimated that more than 3 million people have died but the real count may be a lot higher.
The cause of the pandemic was a viral infection, about which there was very little prior knowledge. There was no consensus among different countries about how to deal with the pandemic and unsurprisingly, the directives coming even from the WHO kept on changing. Initially, the magnitude of this crisis was perhaps underestimated and some of the economically advanced countries failed to implement the most basic of public health measures, even after WHO declared this a pandemic. Subsequently, however, stringent measures had to be taken- public gatherings were banned, academic institutions closed, travel restrictions imposed, working from home became the standard practice and a "new norm" was established.
India, like many countries, was not prepared to face the pandemic. Initially, there was not enough testing facility, hospitals were not equipped with the required infrastructure and there was a degree of panic among the healthcare workers. There was reluctance to self-isolate or wearing masks etc and the Government had to enforce a countrywide lockdown and impose containment zones. Unfortunately, there was a tendency to stigmatize the disease sufferers and their family members within the community. Conflicting information or misinformation, in some instances, did not help. At the height of the pandemic, there was an acute shortage of hospital beds and ventilators and in some parts of the country; there was a limited supply of oxygen. Disturbing scenes were televised of affected people dying on the streets. Since there was not enough clinical evidence of how best to treat these patients, uncontrolled use of various drugs without proper clinical trial became a common practice. Inadvertent publicity about the efficacy of some of these drugs even led to hoarding and black-marketing, which were found to be of no use in further research. One example was Hydroxychloroquine, which was used to treat Covid patients but later discontinued after a trial found out that this was not effective and in some instances was responsible for sudden cardiac death. Interestingly, Donald Trump threatened the Indian Government for not supplying an adequate number of that drug when it was believed that this could be a cure for Covid!
Thousands of scientific papers got published as more and more proper evidence was gathered. Clinical trials were encouraged and useful information was obtained. Older age and co-morbidities like diabetes or high blood pressure increased the risks of infection and were associated with poor outcomes but uncertainties remained as it was noticed that many young and healthy individuals also contracted the infection and died. Most patients presented with cough, fever and respiratory distress but as time progressed it became apparent that the virus affected almost all parts of the human body. Inflammation, thrombosis of blood vessels and immune suppression were evident and accordingly, treatment was targeted against those components. Use of corticosteroids, anti-inflammatory, IL 6 antagonists, anticoagulants and monoclonal antibodies came into use where appropriate and they helped in reducing morbidity and mortality. These medications were used in addition to other supportive measures which were already in practice including ventilatory support, where needed. Some large scale clinical trials like RECOVERY and SOLIDARITY PLUS are still in progress globally to ascertain the efficacy of certain drugs in the treatment of Covid 19. Drugs like Ivermectin, Lopinavir, Ritonavir, Interferon, Convalescent Plasma, Azithromycin and Remdesivir were found to be of no benefit.
The impact of Covid on children needs special mention. At the outset, few children were affected by the infection but there was a severe disruption in their education, as the schools were closed and this was associated with reduced movement and physical exercise. Confinement at home increased anxiety, mood swing and depression. A long period of uncertainty has led to psychological distress. Considerable delay in deciding to offer vaccination to these young adults may have resulted in an unnecessary delay in their return to school.
The development of vaccines, however, has been the game-changer in containing the pandemic. Different types of vaccines have been developed and mass vaccination has started in December 2020. India has been one of the largest vaccine manufacturing countries and has been able to fully vaccinate nearly 90 crore of her population. Vaccination has certainly protected a substantial number of people from getting infected but more importantly even in breakthrough infection, it has reduced the severity of the illness, improved survival and reduced transmission by reducing viral shedding. Aggressive publicity for vaccination and making it a travel prerequisite, have helped in containing the pandemic. With the scientific advances, it was possible to develop various types of vaccines within a year which was also an unprecedented achievement.
Have we seen the end of the pandemic? It is still too soon to answer the question. Many are coming to the hospital with a sequel of Covid infection. Post-Covid or Long Covid is the name given to those who are suffering from a wide spectrum of symptoms that is continuing after 10-12 weeks of the infection and is lasting for months. The common symptoms are loss of taste or smell, shortness of breath, chest pain, extreme fatigue, impaired cognition, anxiety, and depression but there are many more. No effective treatment for this has yet been developed and there is still an element of uncertainty about the persistence or long term effects of this condition.
What lessons have we learnt from this pandemic? The world has witnessed many major catastrophes mainly brought about by disease, warfare and famine. Somehow, the human population has managed to survive through the events. Eminent scientist, the late Stephen Hawking has repeatedly warned that some low probability, high impact disaster can suddenly strike leading to the extinction of the human race and of various probabilities, he mentioned the attack from some genetically modified viruses. The recent outbreak of Covid-19, with its spread at an alarming speed throughout the world in a short time created panic everywhere. The sheer number of people affected made a profoundly negative impact on health, the economy and our social behaviour. We have got a rude reminder of how helpless we can be at the onslaught of a pandemic which can affect the entire world in a way that has not been seen in our lifetime. As we return to a normal way of life, we have got to learn quickly that our attitude and behaviour as responsible citizens have got to change. We need to avoid excesses of any kind, stop abusing natural resources, respect our environment, bring humility to our life and prepare a sustainable planet which can support our future generation to thrive.
The writer is the Managing Director, Peerless Hospital, Kolkata. Views expressed are personal