A year on, COVID-19 is still an unsolved mystery

The first case of novel Coronavirus SARSCoV2 was reported on November 17 2019 in Chinas Wuhan city and in March the WHO declared the respiratory disease a pandemic that has left many across the world with poor mental health disturbed sexual health and impending poverty All this has become a matter of concern for health experts midday recaps the impact of the coronavirus disease COVID19 a year laterOne year later the pandemic has impacted every walk of life globally And COVID19 has posed the biggest challenge to the medical fraternity as no specific treatment to target the virus has evolved yet Dr Ketan Vagholkar professor of surgery at D Y Patil Medical College said Gradually unknown aftereffects of COVID19 are coming to light posing yet another bigger challenge to medical professionals Research scientists are still struggling to develop a fully effective and safe vaccineImpact on mental healthPointing to the pandemics impact on the economies and jobs worldwide Dr Vagholkar said Many selfemployed businesses have shut down There have been pay cuts in many firms and the world is witnessing a staggering increase in unemployment This has added to the mental stress of the global population which is already living in fear of contracting the deadly virus The incidents of depression has increased especially among the younger working population and social relationships within families have also crumbledAlso ReadCOVID19 Mumbais cases count rises but casualties see a fallHe added that the adverse mental health has led to an increase in the incidence of suicideDr Subhash Hira professor of Global Health at the University of Washington said First years score of pandemic performance given by scientists 2310 Long way to go The COVID19 pandemic is the most disorganised one because all stakeholders were caught unawares despite having prior inkling of what was coming Multiplicity of untested diverse interventions have reduced trust of the general public and healthcare systems credibility to such an extent that not many seems to be sure of what to do next This burnout fatigue and reduced earnings exhibit themselves in several ways such as emotional exhaustion reduced sense of personal accomplishment or meaning in life mental exhaustion decreased interactions with others isolation depersonalization symptoms disconnected from real causes and physical exhaustionDr Hira continued Left unchecked pandemic fatigue can lead to two consequences poor performance and poor health People show poor judgement make errors and less than desirable interactions with family and friends Personally they may suffer physical ailments such as headaches and gastrointestinal problems and exhibit psychosocial traits such as apathy detachment depression and irritability They may also be impacted by a lack of willingness to observe the COVID19 prevention guidelines disturbed sleep loss of selfworth loss of hope and changes in their worldview and spiritualityDr Ketan Vagholkar professor D Y Patil Medical collegeA challenge to allDr Wiqar Shaikh senior allergy and asthma specialist said The pandemic has thrown an open challenge to the preamble of the countries around the world including the richest and the most advance nations which have now realised that they were ill prepared for such a disease both on the medical front and economy frontHe added With no medication or vaccine in sight it appears that we are going to face difficult and uncertain times especially with wave after wave of the virus returning to various countries including IndiaAlso ReadCOVID19 Wary of second wave in Mumbai BMC steps up testingDr Shaikh listed several areas of concern that has evolved during the outbreakHow information evolvedInitially the disease was not taken seriously but as the number of deaths increased governments worldwide sprang into action and lockdowns were imposed in an attempt to control and curb the spread of the virusWhat is interesting is that COVID19 which was first thought to be only affecting the lungs is a year later acknowledged to cause adverse impact on multiple organs such as the heart brain liver kidneys blood vessels hearing and muscles and is also known to have psychiatric manifestationsDrugsAnother major problem with COVID19 today is the absence of effective medicines Initially drugs such as HCQ remdesivir tocilizumab favipiravir and plasma therapy were extensively being used in the treatment of the disease However the WHO in October declared both HCQ and remdesivir as ineffective Similarly studies to date have failed to convincingly prove that the other drugs have any effective role in curing patientsVaccinesA large number of pharmaceutical companies across the world including in India are involved in a race to develop a vaccine and several candidates are in various phases of clinical trials Any vaccine needs to be both efficacious in preventing the disease and safe without any side effects In the history of medicine no vaccine has been developed and marketed before five to 10 years of research So a question mark hangs on the launch of a safe and effective vaccine for COVID19The public needs to be cautioned not to delay appropriate treatment which is related to a significant increase in complications and mortality in patients The same caution and warning have been also echoed by the US Centres for Disease Control and PreventionHerd immunityFinally in the absence of a cure the only solution is herd immunity This is a 100yearold immunology concept proved in various epidemics and pandemics Despite scepticism regarding herd immunity the world does not seem to have alternative answers to COVID19 as of todayFlashback of Nov 17 2019The SARS CoV2 surfaced on November 17 2019 when the virus was first reported in a 55yearold individual from Wuhan in the Hubei province of China It was not clear then how or from where this virus originated One theory was that the virus was transmitted from fish to human beings in the sea food market of Wuhan Another theory stated that it transmitted to humans through bats and then there was one about a leakage from an experimental laboratory in Wuhan However till date the origin of the virus remain unsolvedIn early December 2019 Dr Li Wenliang an ophthalmologist at the Wuhan Central Hospital warned his fellow doctors about the outbreak of an illness causing severe acute respiratory syndrome SARS with pneumonia now known as COVID19 Dr Li died of COVID19 on February 7 2020 Dr Zhang Jixian a pulmonologist at the Hubei Provincial Hospital had also reported Dr Lis findings at the end of December 2019 The warnings of both doctors went unheeded by the Chinese authorities the WHO and indeed the rest of the world The first confirmed case in India was reported in Kerala on January 30 2020 in an individual who had returned from Wuhan By then China had reported 7736 cases and the disease had begun to spread to other countries Although deaths were reported from China earlier the first death outside China was reported from the Philippines on February 2 2020 What is shocking is that despite all this information the WHO declared COVID19 a pandemic as late as March 11 2020A look at timeline of events since the outbreakDr Hira lists the sequence of important happenings since the outbreak in ChinaNovember 17 2019 According to an unpublished report from the Chinese government the first case of COVID19 was traced back to 17 November 2019 55year old person had developed pneumonia He used to deliver bats and wild animals to Huanan Seafood Wholesale Market which was believed to be the epicentre of the outbreak as the cases of the virus started to appear from this same area at that time Four men and five women were reported to be infected with pneumonia in November but none of them were labelled as patient zero by Wuhan Health CommissionerDecember 2019 No information was officially shared by the Chinese government with the health agencies around the world China continued to sequence the coronavirus in Wuhan Virus Research Laboratory and released it to the world around January 19 2020 However several of its neighbouring countries that had confidential access to information about this epidemic namely Taiwan Cambodia Thailand South Korea Japan etc shut down their flights to and from China Those countries escaped the wrath of pandemic early onJanuary 2020 The World Health Organisation in Geneva was ascertaining information of the epidemic for a full month and declared the novel coronavirus outbreak a Public Health Emergency of International Concern January 30 2020 On the same day the first case of COVID19 was reported in India from Keralas Thrissur district after a student of Wuhan University in China tested positive on coming home on a vacation A classic example of public health disaster was seen when an ICMR scientist blindly followed WHO advice against use of face masks It took ICMR three to four months to correct the basic principle of respiratory infectious disease to block droplet transmission By February 4 Kerala declared coronavirus a state calamity after a third case emergedFebruary 2020 On February 11 the WHO coined an official name for the disease COVID19 an acronym that stands for coronavirus disease2019 Iran emerged as a second focus point and explosive growth in cases started in Italy from initial five cases to more than 150 within a few days By end of February 800 people were infected in Italy and neighbouring countries like France Germany England and Switzerland also started reporting casesMarch 2020 The WHO declared COVID19 a pandemic on March 11 As the world struggled to contain the spread of SARSCoV2 several governments started to shut down their country entirely some locked down selective cities and districts or milder restrictions were placed on the movement of people and their congregation with schools colleges offices malls and most other business establishments were shut In India Kerala was the first state to ban all public gatherings and suspend classes in all schools and colleges and exams Prime Minister Narendra Modi announced a oneday Janata Curfew on March 22 and urged millions of people to stay home and practice physical distancing so that the chain of the virus is broken The curfew turned out to be the precursor for moderately stringent and largest lockdown in the world for over 80 daysApril 2020 By march 29 2020 India had recorded 1000 COVID19 cases and the numbers quickly grew to 10000 by midApril due to rapid increase in testing facilities Death toll reached 100 by midApril Dr Hira who has been working actively since the pandemic began shared his experience The early clinical picture of COVID19 during Phase 1 imported cases from abroad in JanuaryMarch 2020 comprised of fever cough headache fatigue and muscle pains difficulty in breathing with hypoxia loose motions etc A low percent 23 per cent of patients progressed to vascular clots and autoinflammatory syndrome mediated through interleukins such as IL6 IL23 etcMay 2020 The US became the country with topmost number of COVID19 cases Cases iin India doubled from 50000 to 1 lakh within 11 days Towards the beginning of the 21st century that saw huge pandemics of HIVAIDS tuberculosis Malaria dengue NIPAH ebola swine flu SARS MERS zika among others the world leaders started to pay attention to the health sector The 21st century was hailed as the Century of Pandemics for several biologic reasons Then lightening struck the world with COVID19 that rapidly became a pandemicJune 2020 Cases doubled in India from 2 lakh to 4 lakh within 18 days and the country ranked fourth among those with highest number of cases followed by the US Brazil and Russia The entire world started to report cases to WHO Soon thereafter the pandemic in India moved to Phase II local human transmission during AprilJune 2020 since local contacts were identifiable as source cases and additional clinical features such as loss of taste and smell as an early feature was document as also ground glass opacities in lungs on CT scan cardiomyopathies kidney shut downs and vessel and brain clots causing multiple paralyses were documentedJuly 2020 India became the third country with most cases and cases rose to 16 lakh The intensely debated Phase III community transmission occurred in high containment zones starting JuneJuly 2020 The clinical features attributed to COVID19 have added the following symptoms to those described above namely dermatologic swellings on tips of fingerstoes neural deafness transient blindness with retinal clots etc mostly attributed to hyper coagulation of blood in circulation due to autoinflammatory syndrome attributed to cytokine storm released from COVID19infected human cells onorafter 12 to 15 days of onset of early symptoms described aboveAugust 2020 India recorded 35 lakh cases and ranked second Likely sexual transmission of SARSCoV2 was suggested by two European studies after novel coronavirus was detected in semen Treatment of hyper coagulation and cytokine storm gradually emerged when CRP tends to gallop up that is the time to start dexamethsone and blood thinners Clopidogrel heparin or aspirin to prevent the occurrence of blood clots in vessels or brain cardiomyopathies acute heart failure acute kidney shutdown etc Alternative drugs like tocilizumab monoclonal antibody cocktail and remdesivir emerged for experimental use said Dr HiraSeptember 2020 Indias cases doubled to 64 lakh and maintained second highest spot after the US COVID19 death rate reached 53million population and health workforce death rate was reported at 122million WHO convened meetings discussed unknown areas of natural immunity after COVID19 infection its quality its durability etc as also the unknown correlation between the natural immunity and the vaccineinduced immunity However Dr Hira said that among so many unknowns about COVID19 so far there were some precedence in science whereby once vaccine efficacy is established the world does not wait for findings about immunity and neutralising antibodies A classical case was cited of Hepatitis B vaccine that was introduced for human use in 1986 after twenty years of vaccine research wherein immunity markers remained unresolved till then It took another 20 years after use of Hepatitis B vaccine that its neutralising antibodies and immunity questions became evident to the scientific worldOctober 2020 India started recording fewer cases which reached 83 lakh With the onset of winters round the corner common cold and influenzas are likely to add on to the disease burden in India in addition to the ongoing COVID19 cases The following are differences seen in patients with different diseases COVID19 starts with lowgrade fever and gradually adds on more illnesses common cold begins with sore throat and gradually adds on watery eyes sneezing and running nose Influenza starts with cough and abruptly add highfever headache sore throat and running nose body pains etc General practitioners should be able to use this paradigm to try and separate out the cases of COVID19 from oncoming cases of common flu and influenzas With passing time physicianscientists will be able to compile full progression and management of COVID19 in newer medical textbooks and as monographs said Dr Hira The Solidarity clinical trial of four medicines namely Remdesivir HCQ Lopinavirritonavir and Interferon coordinated by WHOGeneva and implemented between AprilJuly 2020 at 405 hospitals with varied characterisation in 30 countries and involved 11262 patients did not endorse benefits of these repurposed meds on two countsNovember 17 2020 India has witnessed a fresh wave of infections taking the count to 89 lakh due to winter and high air pollution that has increased the transmission of SARSCoV2 in northern India and major cities As the COVID19 pandemic moves in to the end of first year of its tirade several analogies have been used by medical scientists to compare it with the past pandemics Most commonly referred to is the Spanish flu of 19181920 that killed over 50 million people and that included a disproportionate large number of Indians who had died However the better analogy of past pandemic that is comparable to COVID19 is influenza pandemic of 19561958 also known as the Asian flu that was a global pandemic of influenza A said Dr Hira Three vaccines mainly containing synthetic mRNA have shown unspecified immunity in 9094 of volunteers in interim analysis of Phase3 trials Durability of this immunity remains undisclosed by the sponsorsNov 17Day in 2019 the first COVID19 case emerged in ChinaKeep scrolling to read more newsCatch up on all the latest Mumbai news crime news current affairs and a complete guide from food to things to do and events across Mumbai Also download the new midday Android and iOS apps to get latest updates MidDay is now on Telegram Click here to join our channel middayinfomedialtd and stay updated with the latest news