Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2020  |  Volume : 13  |  Issue : 6  |  Page : 578--579

Commentary on nCovid 19


Vishnu Sharma Moleyar 
 Department of Respiratory Medicine, AJ Institute of Medical Sciences, Mangalore, Karnataka, India

Correspondence Address:
Vishnu Sharma Moleyar
Department of Respiratory Medicine, AJ Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka
India




How to cite this article:
Moleyar VS. Commentary on nCovid 19.Med J DY Patil Vidyapeeth 2020;13:578-579


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Moleyar VS. Commentary on nCovid 19. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Nov 25 ];13:578-579
Available from: https://www.mjdrdypv.org/text.asp?2020/13/6/578/300152


Full Text



When we encounter a public health problem, proper handling of the situation is very important. When it is a new one like nCovid19 pandemic, handling the situation may be very difficult. We feel implementation of proper strategies at the appropriate time can lead to a better outcome in controlling the pandemic.

A strong political will with astute leader should choose the generals and the army wisely to lead the war against the pandemic situation. The scientific advisory team should comprise experts in the field of epidemiology, preventive health, respiratory physicians, general physicians, pediatricians, and virologists who are interested to serve and should be dedicated for the work. A team comprising people without any understanding or knowledge of the situation will lead to disaster.

When a problem is new, how to tackle it? We should remember few general principles and basics till we understand the actual problem, its magnitude, and dimensions which may take some time. Just like Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), nCovid 19 is also a coronavirus infection.[1] Hence, initially, the same general principles which were used for controlling SARS and MERS, namely isolation of cases, quarantine of contacts and travelers, and restrictions on travel, were initiated by most of the countries. However, this failed miserably to control the spread. It only delayed the community transmission.

It is important for the leadership to be very clear about the desired outcome while implementing the drastic measures and to recognize whether the outcome is fulfilled or not. In case if it is not fulfilled, one should be quick to change the mode of action and should implement alternative measures. Initial measures such as lockdown, isolation, and quarantine failed to contain the spread of the pandemic. This was probably due to the fact that the virus was more easily transmissible by droplets than it was thought to be. This should have been recognized within 2 weeks after the lockdown. Moreover, the disease had spread to many continents around the globe before these measures were taken.[2]

Definitely, the initial measures were successful in delaying the spread and peaking of the cases in our country. We should also remember that these restrictions were withdrawn only after the management guidelines to reduce morbidity and mortality became more clear.[3],[4] This is probably the major reason why the mortality in our country is comparatively less. This we feel is the major achievement of initial measures such as lockdown, isolation, and quarantine.

Community transmission of the disease should have been recognized much early and preparedness to tackle the same should have been implemented more vigorously with the help of experts. Too much time and resources were wasted in isolation of cases, quarantine of contacts, and treating asymptomatic/mildly symptomatic cases without achieving the desired result of containing the spread of the disease. Current home quarantine guidelines should have been implemented at least within a fortnight of lockdown. These resources could have been re-allocated for upgrading the facilities for treating symptomatic cases. Futility of strict containment measures should have been recognized early and only the vulnerable population should have been advised containment measures.

Social media should have played a proactive role to allay the fears in the mind of public. More focus should have been given to educate the public regarding the basics of social distancing, wearing of mask, avoiding gatherings, and hand hygiene. Stigma and fear for the disease should not have been created. At least now, efforts should be undertaken to rectify these mistakes.

At times the basics of infectious disease were forgotten. In an infectious disease due to virus, if the infected person does not have any symptom, then there is no disease.[5] Hence, if a person is asymptomatic, there is no need for testing. Even if tested positive, there is no need for treatment in asymptomatic persons as host immune responses will clear the organism. What is required in such cases is just to monitor for development of any symptoms. Unnecessary treatment of asymptomatic will result in drug adverse reactions and increase the health-care cost and burden.

I overheard an old lady expressing her views to her neighbor during the lockdown period – “If corona is so fatal as the media is portraying, then people should have fallen down on the road just like ripe mangos falling from trees, but we are not seeing any.” I felt this lady is wiser than many top scientists in the world. All we need is the ability to assess a situation in a practical manner, use our previous experience. We should find out what were the measures taken and the outcome in similar situations previously and try to apply these to the current situation in a logical manner.

All those who are exposed to an infectious agent do not develop a disease. In case of respiratory viral disease, maybe around 50% might develop symptoms after exposure. Others may never show any symptoms. In those who remain asymptomatic, host immune response will clear the organism and they will not develop the disease.[6] Our observation of previous viral diseases indicates that over a period of time, the infectivity of a virus increases, but virulence of the virus reduces. A strong host immune response will bring down the virulence of the virus.[7] Hence, it is logical to allow the low-risk group to resume normal activities and protect the vulnerable from exposure.

We should modify the risk factors for developing the disease. Since host immune response is crucial, we should focus on general measures to boost the immunity of the population. Balanced nutrition, regular physical exercise, adequate sleep, measures to reduce physical as well as mental stress will boost the immunity.[8]

We agree that other diseases are forgotten and whole system has come to a grinding halt. Now, it is time to relax the norms/restrictions/protocols and make sure that all needy patients are attended in time.

We firmly believe that if there is a problem, we should identify the same and come out with solutions. It is overtime for all our health-care organizations to come together to put a joint effort and join hands with the government in this time of crisis.

References

1Weiss SR. Forty years with coronaviruses. J Exp Med 2020;217: 5: e20200537.https://doi.org/10.1084/jem.20200537.
2WHO Statement. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)”. World Health Organisation; 31 January, 2020.
3Villar J, Ferrando C, Martínez D, Ambrós A, Muñoz T, Soler JA, et al. Dexamethasone treatment for the acute respiratory distress syndrome: A multicentre, randomised controlled trial. Lancet Respir Med 2020;8:267-76.
4Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol 2020;75:2950-73.
5Cho I, Blaser MJ. The human microbiome at the interface of health and disease. Nat Rev Genet 2012;13:260-70.
6Cadwell K. The virome in host health and disease. Immunity 2015;42:805-13.
7Hooper LV, Littman DR, Macpherson AJ. Interaction between the microbiota and the immune system. Science 2012;336:1268-73.
8Davis DM. Presenting the marvels of immunity. Nat Rev Immunol 2014;14:351-3.