COVID’s Catch 22

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COVID’s Catch 22

Sunday, 30 May 2021 | MUSBA HASHMI

COVID’s Catch 22

It’s been more than a year-and-a-half into the pandemic, yet experts worldwide are struggling to completely understand the nature of the Coronavirus. This has led to Catch-22 leaving lakhs clueless about what to do next. MUSBA HASHMI brings you a report

Remember, last year, experts and even the World Health Organisation suggested that everyone need not wear a mask, but only those looking after COVID patients. Not only this, people even anticipated that the Coronavirus would die in summers because of the high temperatures, not to mention the perception that the elderly and people with comorbidities are at a higher risk of getting infected. There is more. A certain type of UV rays were believed to inactivate the virus. However, all these notions got nullified sooner than later.

“Few new reliable scientific studies say that temperature, humidity or UV rays do not play a significant role in Coronavirus spread. That means whether it’s hot or cold outside, the transmission of COVID-19 from one person to the other depends almost entirely on human behaviour. Weather influences the environment in which the Coronavirus must survive before infecting a new host. But it also influences human behaviour, which moves the virus from one host to another,” Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth, tells you.

Whenever a pandemic breaks out, the origin country knows more about the virus than  any other country and for all the right reasons. “When COVID broke, initially it was believed to transmit through droplets; hence, the mask was only mandatory for COVID caregivers. For the rest, a six-foot distance and hand hygiene was enough. But gradually, with time, it was found that the virus is air borne and can sustain in the air for about four hours. Hence, masks were made mandatory for everyone,” Dr AP Singh, Senior Consultant Physician, Yashoda Super Specialty Hospital, Ghaziabad, tells you.

That said, about two years into the pandemic, experts worldwide are struggling to completely understand the virus’ nature completely. So much so, that there are clashes of opinions even when it comes to treating the disease. Be it the use of common drugs like Remidesivir and Fabipiravir or steroids, dark clouds of confusion  have engulfed everybody’s mind resulting in a Catch-22 situation, and many people worldwide remain clueless of what to do next.

“Many are asking why experts haven’t been able to find a treatment or cure for the virus. The simple answer: there’s too much they don’t know. Two years feels like a long time, but it’s no time at all when it comes to medical research. COVID-19 is a novel virus, which means that very few have natural immunity to it and experts couldn’t research on it prior to the outbreak in December 2019,” Ali says.

While the reasons for the usage of unproven drugs are complicated, for once, it is difficult in a pandemic to treat a patient with only minimal care. “This pressure to ‘do something’ might nudge physicians towards creating guidelines for unproven drugs that are either considered innocuous, or may have shown promise in animal studies or theoretical models, based on biological pathways. Another reason is that constantly reviewing the rapidly changing evidence in a pandemic is an intensive exercise, which many doctors are finding it difficult correlating with individual patients and their conditions. Making quick changes to treatment protocols to reflect evidence may be challenging for everyone, given that they have to coordinate with people across institutions, States and local administrations,” Ali explains.

Singh adds and tells you that both Remidesivir and Fabipiravir drugs are repurposed for COVID. These are the drugs that helped fight several infections earlier, but for COVID, the efficacy was less and that we are yet to find anti-viral drugs for COVID. “These drugs are for emergency use only; they are not fit for long-term use,” he says.

This is not all. The use of steroids are under the scanner too. Steroids are a life saving medicine and have been used historically for a long time in conditions of acute stress and where the patient’s life is in danger. And they should, in the same way be used in COVID as well when the cytokine shower is starting, and is in imminently danger of becoming a cytokine storm that is when the steroids should be started.

“They should not be started too early, especially never during the viremic phase, because they suppress your antibodies, your immune response and will allow the virus to replicate in an unlimited form,” Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals, opines.

Singh agrees with Bajaj and says that steroids have been used in the treatment of several diseases for years and so is being done in COVID. However, it should only be started in the second phase of the disease where a patient experiences cough, chest pain and his oxygen levels start to fall.

“There are cases of Black Fungus in various hospitals which are being attributed to extensive use of steroids. However, in our hospital we haven’t seen a single case of this fungal infection. Like I said, steroids aren’t a new treatment. Then there are some, who call it a hospital acquired infection. The reason being the use of industrial oxygen and lack of hygiene practices. But, again there are no facts to support it. Hospitals are doing everything they could. It is too early to predict whether Black Fungus is a post-COVID complication or a hospital acquired opportunist fungal infection,” Singh opines.

The other side of the story is many people are avoiding hospital visits due to the fear of catching infection. Bajaj has a take on that.

“Hospital visits being avoided by patients is the right thing to do actually, patient should not be visiting hospitals unnecessary. What we see in India and especially North India is that people even for the smallest of ailments like common cold will go and visit the highest super specialty hospital. So it’s a good thing that now due to COVID patients are avoiding hospital visits most of the conditions, more than 90 per cent, can be solved easily at home, especially in these times with the availability of teleconsultation. And even if you don’t trust teleconsultations you can visit your neighbourhood clinic or the doctor who you want to see, I think most of them have their own standalone clinics. So you can go and visit them, only in very unavoidable cases should you go and visit the hospital directly,” Bajaj suggests.

Singh has a different take on the matter. He doesn’t find this as a feasible option. Many people with serious diseases, too, are avoiding their visits to the hospital. They keep on tolerating the symptoms; this leads to the advancement of the disease.

“Take proper precautions and visit the hospital if you are undergoing treatment for cancer of tuberculosis. Avoiding it can pose serious threat to your health. Remember, mortality rate of COVID is only 2 per cent, while for cancer, it is much higher. So, if it’s the fear of catching infection that is holding you back from going to the hospital, don’t forget there are other diseases that are equally or, for that matter, even more deadly. But, this doesn’t mean that you start taking the virus lightly,” Singh advises.

Doctors believe blaming experts and scientists worldwide for not finding a cure for the disease is not the right thing. It takes years to come up with a proper treatment for diseases.

“COVID is a new disease which none of us understand right now. So there is a lot of conflicting claims coming in. It was said that ventilators will be the only cure, then it was said maybe ventilators are not necessary, maybe you need to have high flow nasal cannulas. Then it was said that smokers will be most affected because their lungs are already weak and they will die. Later, it was changed to that smokers may be the only people who will survive this. So this is something that is coming back and forth. But it is, I think, exactly like how science functions. Science works on getting evidence. And we are unearthing a lot of evidences which will take some time to understand. Most of the diseases that came in usually took hundreds of years for us to understand and find an effective cure. We’ve seen this only for one year. So I think within the next one or two years, we will have a much better understanding and we will develop a sure shot cure for it as well. Historically, viruses have been difficult to cure. HIV we have not been able to cure even now, even after 40 years of its emergence. So it may take some time, but we will definitely find drugs to control it,” Bajaj asserts.

Ali adds that researchers are moving as quickly as they can to find a complete cure for this virus and as part of this scientists have spent the past two years developing vaccines and treatments to slow the pandemic and lessen the disease’s damage. “Healthcare professionals are working tirelessly to fight this disease, but they can’t do it alone. The people will still have to help flatten the curve by following all the precautions and guidelines,” Ali says.

Singh concludes by saying that the need of the hour is to to be patient. The focus of every doctor right now is to save lives. Research can wait. Having said that, there are people who are studying the virus, but they need time as well. Once, the situation is under control, we will be conducting research to get more insights about the virus.

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