The elusive Covid-19

11 Jul, 2020 - 00:07 0 Views
The elusive Covid-19

The Chronicle

Dr Tatenda Simango

“To ask the ‘right’ question is far more important than to receive the answer. The solution of a problem lies in the understanding of the problem; the answer is not outside the problem — it is in the problem,” says Jiddu Krishnamurti in The Flight of the Eagle.

This Wednesday I received a call at 4am about the demise of one of my patients that I had been co-managing with the best specialist doctors in town. The painful part was the fact that we had not been able to figure out what the problem was. We had ordered all the tests and given the best drugs money could afford us, to no avail.

I kept pondering if I had asked the right questions about the patient’s condition and why had we ended up with the worst outcome? If I may extrapolate this to the current Covid-19 pandemic we are fighting tooth and nail without a conviction on the cure.

Sleepless nights have been spent by medical personnel and unwell Covid-19 positive patients alike, battling the disease but still the real solution evades us. Just when we imagine the solution is at our doorstep, the answer is not as resounding in solving the Covid-19 problem.

I was so excited when the Madagascar Covid-organics “cure” was making headlines, but all this has been changed by the 15-day lockdown that was reintroduced in Analamanga (metropolitan area of Madagascar) from July 6 due to the increase of Covid-19 cases.

Covid-organics is a bitter tasting liquid made from Artemisia — an anti-malarial plant that grows on the island that was introduced as a cure and preventative potion against Covid-19.

First world scientists have been having just as much of a challenge to come up with a cure let alone a vaccine. The trial results have shown that hydroxychloroquine and lopinavir/ritonavir (antiretroviral drug) produce little or no reduction in the mortality of hospitalised Covid-19 patients when compared to standard of care. Solidarity trial investigators will interrupt the trials with immediate effect. A few months back, chloroquine and hydroxychloroquine were selling like hot cakes and retail pharmacies were increasing their prices. Our local pharmaceuticals were looking to recommence production of the drugs that had once been banned for their toxic side-effects on our health.

It’s not all bad news though, the World Health Organisation (WHO) welcomes the initial clinical trial results from the UK that show dexamethasone, a corticosteroid, can be lifesaving for patients who are critically ill with Covid-19. For patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth, according to preliminary findings shared with WHO.

What is concerning is how the virus seems to “target” the pillars of hope and livelihood in the communities like the hospitals, medical front liners (such as nurses) and border post controller (South Africa Beitbridge post).

The end of June marked the sixth month since the start of the Covid-19 pandemic. It has stolen the limelight and disrupted services for non-communicable diseases like hypertension and diabetes mellitus, autoimmune disease just to name a few.

What the right question is to the solution is still elusive. Interestingly, I noted a significant reduction in upper respiratory infections (common cold/tonsillitis/pharyngitis/rhinitis) this winter season. This reduction could be attributed to the use of face masks, commercially produced and the home-made masks. This may also prove to be the solution in controlling and ultimately stopping the spread of Covid-19.

One recent study in BMJ Global Health looked at transmission of SARS-CoV-2 in 124 families in which at least one member had Covid-19. The data showed that face masks were “79 percent effective in reducing transmission” if the person with Covid-19 wore them before they developed symptoms.

It was also found that most home fabrics block droplets even as a single layer, a second layer can reach the performance of a surgical mask without significantly compromising breathing. There was no evidence of wearers risk of developing pneumonia or other lung infections.

However, masks can be a source of infection for the person wearing them. A 2017 study involving 16 healthcare professionals showed that self-contamination was common when the volunteers were putting on and removing medical-grade personal protective equipment. The Centre of Disease (CDC) recommend that people do not touch their face covering while wearing a face mask in public and that they wash their hands if they do so accidentally. Medical-grade masks block micro-organisms from reaching the wearer’s nose and mouth.

If a person wears the same mask for a long time, microorganisms may grow on the fabric. The CDC recommends that a person removes the face covering once they return home and washes it before using it again. Moreover, masks should be changed if wet or visibly soiled, either discard the mask or place it in a sealed bag where it can be kept and washed later.

Best materials for homemade face masks: a combination of either cotton and chiffon or cotton and natural silk, both of which appear to effectively filter droplets and aerosols. Combining cotton and chiffon (made from polyester and spandex) was comparable to the N95 mask.

Emphasis has to be put on appropriate fit of mask so as to avoid leakages, but if a mask is worn for more than four hours without removing it, it can cause headaches.

Covid-19 patients who are asymptomatic may still transmit the infection by up to 40 percent if preventative measures are not taken, this is contrary to the statement that had been made by WHO.
Children under the age of two years should not wear cloth face coverings.

The best cure for Covid-19 is prevention. This is a virus with no respect for rules of science and does not abide by them. It behaves like an overzealous class monitor who will write you down for three weeks punishment for “uncovering your mouth”. Winning the Covid-19 pandemic will take a conscious effort from every individual, be your brother’s keeper, wear your mask appropriately.
Till next week stay safe.

Dr Tatenda Simango can be contacted on [email protected] or follow him on [email protected] 9th Avenue Surgery.

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