Explaining the Infection
By Naseem Salahuddin
Karachi, Pakistan
Swarms of SARS-CoV-2 virus wrack the globe, striking mortal fear of Covid-19 into the hearts of humankind. Images of disease and death flashing across our screens are heartrending, and while despair argues with hope, or denial with intelligent acceptance, decision-makers are faced with an agonizing choice: death of the people or of the economy.
Alas, we have already crossed the Rubicon, and the government here has given precedence to financial advantage for the masses over ill health. Regrettably, neither is the economy visibly escalating, nor are appeals for disease control being accepted by the multitudes. Reminders, pleas and intimidation for the implementation of physical distancing, handwashing and wearing masks are falling on deaf ears.
Poverty, illiteracy and dense populations are a recipe for non-observance of these basic precautions. Rehri wallahs, thela wallahs and laborers are unlikely to change ingrained habits; what is unfortunate but not surprising is that large segments of our population remain unconvinced that the virus is real and life-threatening. Rather than indulge in blame games and recrimination, experts along with health professionals ought to address the reasonable concerns of society and plan strategies to mitigate them.
I place before our reader facts presently known in the scientific world, and how they pertain to our population. SARS-CoV-2 virus is a distant cousin of the SARS-1 virus that caused a serious outbreak of pneumonia in China in 2002-2003 and spread to several European countries, but physical distancing and masking contained further transmission.
Similarly, MERS, first diagnosed in Saudi Arabia in 2012, spread to countries in the Middle East and still smolders, albeit in negligible numbers. Although far fewer people were infected, the number of deaths was disproportionately high. By contrast, SARS-CoV-2 is playing havoc with lives; more people are affected because it spreads almost entirely through the upper respiratory tract, namely the nose and throat. A cough or sneeze sprays virus-laden droplets into the air; tête-à têtes or hearty laughter among friends — once thought to be the elixir of life — are now feared and shunned. Being in close proximity to a person hosting the virus and long exposure in closed spaces increase the chances of inhaling the virus. When the inhaled viral load is high and host immunity depressed, the lungs are vulnerable. Fever, cough and shortness of breath indicate inflammation of the lung tissues, resulting in poor oxygen exchange. Irreversible complications may follow, resulting in permanent damage to other vital organs.
Covid RT-PCR done through nasopharyngeal swabbing, though not a perfect test, remains the only dependable investigation to date. A positive test clearly means the virus genetic material (RNA) is present, while a negative result may not be truly negative, depending upon several factors, and may have to be repeated if there remains clinical suspicion of Covid-19. The much-hyped antibody test is only helpful in surveying if people in certain communities have experienced the infection and then recovered; it does not confirm the presence of active infection and is not a reliable test for diagnosis.
The behavior of the virus over the past several months has been puzzling and even inexplicable to virologists. The virus is novel, its course is unpredictable, and therefore we are frequently lost for answers. What is categorically understood is that it can reside silently in the body; it can behave insidiously, or assault violently. It can attack adults and, very occasionally, children; however, people with chronic illnesses or those with compromised immunity fare poorly. Laboratory tests and their interpretation are often misunderstood by the inexperienced, resulting in misinterpretation and waste of time and precious resources. Drugs prescribed injudiciously further complicate the healing process. Many as yet unproven drugs presently under trial might kill the virus in laboratory experiments but not necessarily inside the human body. Several drugs, earlier thought to prevent or treat Covid-19 have been discredited, while some are presently under trial across the world.
Only a safe and effective vaccine will give respite from the pandemic. Currently, several vaccine candidates are under trial, of which some may prove to be safe and effective, while others may fail the standards. In any case, one should not expect a good vaccine before late 2021. Bulletins from professional sources are delivered periodically as more scientific information unfolds about the behavior of the elusive virus and its control.
Anxiety regarding Covid-19 is not entirely over the escalating number of positive cases. Fortunately, four out of five affected people recover completely, while statistically, one patient out of five will feel air hunger from low oxygen levels in the blood. These are the patients who should go to a hospital for evaluation and triaging to determine who needs only observation and supportive care, and who qualifies for urgent care.
As numbers swell, waiting areas and emergency rooms overflow with sick patients and anxious families; laboratory facilities are strained; beds in special Covid-19 units fill up rapidly; cost of care spirals; caregivers are stressed, even quarantined; and the workforce dwindles. Often, anxious families making unreasonable demands turn violent, and security is unable to control the crowd effectively. It is not unusual to witness scenes of grief turning into pandemonium as a dead body is trundled out of the ward.
So how can health professionals help? In a highly populated country where illiteracy reigns, creative ways of spreading knowledge, rather than information, via radio, television and social media are the best modalities. What we often witness on such programs is sensationalism of virus statistics, insensitively accented by shrill voices and background clamor. What is needed are information-rich programs in which specialists are given ample opportunity to inform the audience without having to compete with the moderators who are often impatient and unprepared in terms of relevant questions. Professional media ‘clinics’ would earn the gratitude of millions of viewers whose fears stem from ignorance and the uncertainty of coronavirus outcomes.
SARS-CoV-2 is here to stay, and the least we can do is to help our fellow beings in distress.
(The writer is a specialist in infectious diseases. Dawn)
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