|Ahead of print publication
Panic of pandemic proportions: Medicine to makeshift miracles
Department of Emergency Medicine, Dr. DY Patil Medical College, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||01-Feb-2021|
|Date of Decision||01-Mar-2021|
|Date of Acceptance||01-Mar-2021|
Department of Emergency Medicine, Dr. DY Patil Medical College, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
The COVID-19 pandemic has been a startling challenge for modern medicine and its practitioners. We were caught unaware and off-guard. As clinicians, it is expected from us to make level headed decisions in times of crisis and most of us usually do. However, our trainings had never really addressed a biological calamity of this scale. It was an apocalyptic manifestation of biblical proportions.
The health-care systems were pushed to the brink of breakdown. With the eyes of the world upon the scientific community, we were at the cynosure of this quandary. We were expected to deliver-and deliver we did. But then we panicked.
A race began to find the “cure.” The resulting impetuosity led to prompt abandonment of the scientific method and a series of unproven therapeutic interventions being touted as miracles. The first domino to fall was the repurposing of hydroxychloroquine (HCQ) as both a therapeutic and prophylactic agent against COVID-19. Perhaps no singular agent has been as synonymous with scandal as HCQ has been. There was huge international push for its usage and even became an issue of Indo-US tensions. The Lancet published an article discrediting HCQ and correlating it with higher incidence of cardiac adverse events. Deeper investigation of the data, provided by a company by the name of Surgisphere, led to a highly controversial retraction within 2 weeks.
The latest official advisory by the Ministry of Health, Government of India still recommends HCQ prophylaxis for health-care workers. Surgisphere stands to face charges of medical malpractice in the matter. Data regarding utility of HCQ as an effective modality against COVID-19 stands inconclusive.
Another glaring example of lackadaisical science has been the rampant use of convalescent plasma in critical cases of COVID-19. The Indian Council of Medical Research (ICMR), which has been the government's chief scientific advisor during the pandemic, published a paper (PLACID trial) in the BMJ which categorically concluded that plasma therapy “did not translate into a reduction in 28-day mortality or progression to severe disease.” A therapy which stands widely invalidated, still finds a place in the official government treatment guidelines. The ICMR has claimed the PLACID trial as a victory yet they have failed to amend the therapeutic guidelines appropriately, leading to ongoing rampant and erroneous use of plasma therapy.
Interleukin 6 inhibitors-Tocilizumab and Itolizumab-gained tremendous momentum for their therapeutic utility in cases of COVID-induced cytokine storm. The Drugs Controller General of India (DCGI) even gave emergency authorization to their usage in cases of COVID-19. They were eagerly embraced by the physicians with open arms and rampant administration began. Usage reached a magnitude where Tocilizumab became an entity being black marketed. Just like the other miracle “elixirs,” its efficacy is still questionable yet usage still passionate.
The public health advisors of various nations proposed nationwide lockdowns. Similar lockdown was imposed in India which was supported by methodical statistical analysis. Despite its controversial nature, the nationwide lockdown also found support in the scientific community. The duration of the lockdown should have been utilized to bolster the health-care infrastructures for the ongoing public health challenge. However, the men in suits decided sit on their hands and expected that the lockdown would be enough to break the chain of transmission. The rest, as they say, is history.
As the natural cycle of the epidemic has progressed, we have reached a point where the healthcare systems have had the breathing space to stabilize themselves. Now, the focus of the entire industry seems to be on the next miracle- the vaccine. The new found phenomena of '“emergency authorization” has found its way into this process too with DCGI providing the same to both CovishieldTM and CovaxinTM. World's largest vaccination drive has been initiated under much incredulity from the scientific community and the ethics of the way in which the human trials were conducted have also been questioned.
Perhaps that is where the entire debate should be concentrated upon-ethics. The profession that we are in is demarcated not just by legal boundaries but also by the intangibles of professional rules of conduct. This pandemic has exposed systemic inadequacies in our institutions on most fronts. Whether it is the way we conduct research, authorize treatments, design therapeutic guidelines or follow through with their execution- a constant tone of entropy is apparent. This should also be a bellow to medical educators in understanding that teaching goes beyond clinical skills. Good physicians should be omnisceptic, in that they should inherently demand evidence. Critical reasoning cannot be taught, but must be encouraged. Professional ethics need to be on the forefront of the discourse and novel methodologies to impart the requisite knowledge need to be explored.
Principles of disaster management command that post mitigation comes the phase of preparation. The cracks in the apparatus are fresh and highly prominent. It is an opportunity to fill the gaps before the next storm hits.
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