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World Now and After The Corona Pandemic 2020

Living in the times of COVID-19 from the eyes of a doctor who dealt with SARS and H1N1

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When dealing with H1N1 in 2015 (Image Source)

It is 28th March 2020 today. Not even 3 months into New Year. Who would have thought in their wildest imagination that the world would change so drastically! Yes, we had diseases and even one pandemic in 2009. Yes, as a physician I had known about SARS outbreak which originated in china in year 2002. I worked in government medical college as a teaching faculty since 34 years and as professor of medicine since 1996 and retired in 2017 working last 10 years of my service as head of medicine department of one of biggest medical college of India. Yes. We were also prepared for the possibility of SARS spreading to other countries like India. We were trained for the same too. But one fortunate thing about that virus was that though it had very high mortality, its transmission capability was not very high. So it was quickly contained. But I thought at that time that what if in future the same virus may mutate and would be capable of easy transmission? I am sure many physicians and epidemiologist would have thought the same. As we know all viruses mutates, some more then others and then we had swine flu or H1N1 influenza pandemic in 2009 which lasted for 18 months. Though the virus was easily transmissible, mortality was low and many mild cases occurred which did not require treatment and fortunately we had specific antiviral drug Osaltamavir was available. We worked very hard during that time as ours was tertiary care center and also saw many serious cases with fatal outcome too and also we had outbreaks which were severe in 2015 and 2017 but it became endemic and for 9 years I was in core committee managing the cases and was also awarded certificate by government for excellent work.

Well that is a past but the present is horrifying. What originated as an outbreak in Wuhan china as SARS- CoV-2 infection soon spread to many countries and again WHO declared it pandemic. The worst nightmare was coming true. The same SARS- CoV with added 2, but was having very high transmissible properties originated and spread like wildfire. The people were caught unaware. Nobody was prepared for such a disastrous happening. It was thought to be originated from bats or pangolin in wet market of Wuhan where live animals of different species were kept. There were as usual conspiracy theories too. But this is more deadly virus then H1N1 influenza virus. It has a longer incubation period and faster progression causing viral pneumonia and ARDS. Different countries approached it differently as there is no specific treatment and no vaccine at present.

The whole world’s world changed overnight. There were lock downs and social distancing and misery and despair and frustration. No policy was good enough and it spread relentlessly. People were home bound. Beautiful cities and towns looks deserted, roads and parks empty and in India, exodus of people going back to their villages as they were jobless or homeless or having no money or scared not knowing what was happening. So many people all over the world succumbed to the disease. So many medical and paramedical staff also died. Yes we know it is a professional hazard but which other profession has death as professional hazard?

What is the right policy? We know SARS-CoV-2 originated from bats. Their body temperature is not usually high but some studies show that due to human beings disturbing their habitat, they are believed to have been exposed to high stress levels twice a day when they go out for their feed causing their body temperature to raise. So the virus which is harmless to them and present in their body also mutated and could survive in high temperature. There were minor changes in their genomes which made them easily transmissible. So much has already been said regarding the route of transmission and the symptoms of the disease which are not very different from upper respiratory infections which also by the way can be caused by corona or rhino viruses but progression of this disease is different. Fatality is more. It is totally new disease for which human beings have no immunity. Minor mutations keeps on happening .We cannot hope for herd immunity where 2/3 of population will be affected before the transmission slows down. As the exponential spread which is occurring throughout the world is the first time occurrence. Mathematicians can describe it better but suffice is to know that the curve peaks suddenly causing so many infections suddenly and more so in elderly population. There are not enough hospitals to deal with the burden and first time in the history of medicine at least in last 100 years, triage for treatment of survivable patients is being done in certain countries. For example, there would be 4000 patients needing ICU and ventilators when the availability would be 40 ventilators. Who are we to decide who lives or not but the doctors are put in this impossible situation where they have to decide to treat patients who have better chances of survival and that too symptomatic treatment only.

The situation is really bad. We need to test more individuals and if positive for Covid 19, quarantine them. Break the chain of transmission, fast tracking various clinical trials and development of vaccine which unfortunately may still take a year. The summer will probably not make any impact as the virus is believed to survive in hot conditions having adapted to it. I cannot imagine and no one can predict the course of the pandemics and the thought that it can continue like this send shivers down my spine. It may take months or years until either specific treatment is discovered or vaccine is developed. Third option is development of herd immunity at the cost of so many lives. Who will survive and who will succumb? How many more deaths and suffering? People losing their jobs, incomes and homes and of course their dreams!

When will be everything ok? When will be the world as it was before 3 months? Probably never. We don’t know when pandemic will be over. It will become endemic causing same disease off and on. New viruses may arrive. We don’t know if it would be due to change in the environment or global warming or encroachment of humans in the lives of animals or mutation of viruses in other species and then jumping to humans. Travel will probably become less and first thing people will look is the disease prevalence in the place they want to visit. Doctors will be always wearing masks to see patients even in General Outdoors. Masks may become a new fashion accessory for general public too. Work from home or shelter in may become routine. E-learning may become a thing. Schools may evolve to new shape. You will not be able to take any things for granted even as simple as walk in the street with friend or having dinner in a hotel or see a movie or a party or travel in crowded bus or train without worrying about health. Each sneeze will be looked with suspicion. Social distancing will stay. Handshakes, hugging and kissing will no longer be routine for greeting people. People will be always afraid and scared of outbreaks and epidemics of new and fatal diseases. Normal will be new normal and not what we were used to. Mankind with all their advancement and all their resources are fighting the battle against a small virus particle. Irony is that we are not winning at present but it is.

So what can we do? Though it is going to be very difficult situation in coming months, accept the change in routine. This time shall pass too. Hope for a better virus free tomorrow even if it is slightly changed. Learn to appreciate all the good things around us. Learn to help people in need. Learn the value of all human sentiments. Thank God for the family that you have and the friends and relatives who are with you. The diseases will come and go but family is the one thing worth living for!

Professor of Medicine GCS, Ex-HOD Medicine BJMC, Ahmedabad, Gujarat, India

Professor of Medicine GCS, Ex-HOD Medicine BJMC, Ahmedabad, Gujarat, India

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