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LETTER TO THE EDITOR
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 161-163

COVID-19 Impact − A Physician’s Perspective


1 PRIST University, India
2 Starcare Hospital, Muscat, Oman

Date of Submission25-Jun-2020
Date of Acceptance26-Jun-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Preeja Prabhakar
PRIST University
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_62_20

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How to cite this article:
Prabhakar P, Punnaveetil S. COVID-19 Impact − A Physician’s Perspective. Int J Nutr Pharmacol Neurol Dis 2020;10:161-3

How to cite this URL:
Prabhakar P, Punnaveetil S. COVID-19 Impact − A Physician’s Perspective. Int J Nutr Pharmacol Neurol Dis [serial online] 2020 [cited 2020 Sep 28];10:161-3. Available from: http://www.ijnpnd.com/text.asp?2020/10/3/161/292690



It has been more than 6 months since the first case of the novel corona virus (COVID-19) presented to a health care facility in Wuhan, China. Meanwhile, the whole world has gone through a paradigm shift on account of this pandemic. With the evolution of this disease from a possibly innocuous viral pneumonia to its rise as a pandemic of epic proportions, COVID-19 has the whole world’s healthcare structure and economy in tatters, leaving mankind at a loss to understand as to what just hit them. As the world lies in shambles, healthcare workers including doctors, nurses, pharmacists and other auxiliary staff have stepped up to the task and are at the forefront of this battle between the deadly virus and mankind. Till now, we have made significant progress in understanding about the virus and in developing treatment protocols and evolving evidence-based therapeutic strategies. However, the healthcare systems across the globe is currently wilting under the weight of the COVID-19 and non-COVID related illnesses and it may collapse soon unless until the remedial measures are undertaken.


   Challenges for the Medical Practitioners Top


Being a physician at any time comes with its own reasonable share of challenges, be it clinical, academic or psychological and this COVID-19 pandemic has given new meaning to what it means to be a frontline healthcare worker (HCW). As HCWs put on a PPE (personal protection equipment) in this combat, they adorn multiple roles involving advanced decision making (such as triage, resource-allocation, notifying concerned authorities), risk prediction (such as morbidity and mortality), epidemiological assessment, contact tracing, isolation, quarantine measures etc. Each patient seen by the frontline HCW must be treated as a potential COVID-19 patient. Hence adequate care needs to be exercised at every stage starting from detailed history taking to culminating in the diagnoses. The use of PPE, N95 masks, visors or hazmat suits have been helpful, however even the best donned clinician or HCW runs the risk of contracting the virus and infecting their kith and kin. Social distancing is the norm, be it with patients or one’s own loved ones.

In all honesty, none of the nations of the world are “Pandemic Ready”. Hence, HCWs should be up to date with the appropriate, time tested guidelines, standard of care and evidence-based-medicine which evolves over the time. ENT (Ear, nose, throat), dental examinations and other procedures (eg: nebulization, anesthesia, endoscopies etc.) via aerosol generation tend to increase the risk of this infection. Even before the pandemic, the healthcare sector in many countries was already cash strapped and affected by staff shortage, lack of social support, delayed and uncertain remuneration with absent risk-protection benefits. HCWs including doctors form a substantial chunk of the mortality due to this COVID 19, possibly due to exposure to multiple patients with high viral load, improper PPE and increased physical and mental stress due to the increased work load and work hours. A study by Ing et al. concluded that the death rate among physicians due to this pandemic are the physicians working in Emergency (ER) or general practitioners (GP) (40%) followed by internal medicine (6%) and dentists (5%).[1] These numbers are quite disheartening and unless there is a real political will to develop healthcare system and a wide spread international cooperation, these numbers are prone to rise.


   Patient Care During COVID-19 Pandemic Top


From a patient’s point of view, there a lot of physical and psychological issues at play here, which the HCW is privy to. The patient at time of diagnoses is mostly bewildered because he/she is not sure how the next 2 weeks may unfold. Newly diagnosed patients once quarantined are isolated from the world which stresses them and leads to psychological disturbances such as anxiety, panic attacks, acute cardiac events, suicidal tendencies etc. Most of the time, an admitted patient’s only contact with the outside world is the HCW and it is extremely important that we present ourselves positively and offer a ray of give hope to these patients. During this unprecedented and exceptional time, the physicians’ role transcends in to one of a teacher too. The whole community depends on the governments and health care workers to give out the rational instructions regarding preventive measures and the current progress for better understanding of this infection. This is especially important now due to the horde of potentially harmful misinformation conveyed via rumors and social media. Dejected patients and persons who have come in contact with COVID-19 patients might follow social media propaganda and unsolicited advices, try to obtain and consume harmful drugs and chemicals which might worsen the state of their health and lead to disastrous consequences.

There has also been a spike in the acute exacerbations of many chronic illnesses. Clinical out-patient department (OPD) is flooded with patients with pre-existing diseases experiencing a flare due to this highly stressful circumstances which include diseases like bronchial asthma, peptic ulcer disease, fibromyalgia, irritable bowel syndrome, clinical depression etc. Indeed the world has witnessed a spike in suicidal deaths following the onset of this pandemic. As the physician is also responsible for the healthcare needs of the community as a whole and not just for patients with COVID-19, it is imperative to allocate resources and time for other patients too, otherwise, a large number of patients can have a bad outcome from non-COVID illnesses resulting in delayed care and deaths.[2]


   What’s Next? Top


Even though there is a lot of information on COVID 19, vaccines are still awaited and prevention is the most lucrative option for now. Simple preventive measures of social distancing, stay and work from home, hand washing and face masks have resulted in committed nations achieving admirable results and getting back to near normalcy.

Many drugs including hydroxychloroquine, remdesivir etc. have been tried and tested in admitted patients with COVID 19.[3] It’s a well-known fact that the so-called ‘Cytokine Storm’ is a major contributor to the morbidity and mortality of advanced COVID-19 infection,[4] The cytokine storm occurs when the patient’s immune system unleashes a very strong immune attack in response to the virus, potentially self-harming by its exaggerated response that lead to a hyper inflammatory milieu damaging blood vessels, triggering blood clot formation, ARDS and multi-organ system failure. Corticosteroids have been extensively used for immune system afflictions like auto-immune diseases, inflammatory bowel diseases, cancers etc. The RECOVERY (Randomised Evaluation of COvid-19 ThERapY) trial assessed the efficacy of 6 mg of Dexamathesone daily for 10 days on patients on intensive treatment (including oxygen supplementation and ventilator support) and has shown promising results. However, there was no discernible benefit in the outcome of patients not on respiratory support. Hence, its rational and judicious use is highly recommended as it may backfire on people with milder symptoms, since suppressing their immune system then could worsen COVID-19 prognosis.[5]

A vaccine has been considered as a game changer and an easy solution to this pandemic. However, discovering and producing a novel viral vaccine is not an easy task in a short span of time due to efficacy and safety concerns. Since the onset of this pandemic, researchers have been working hard round the clock globally for a viable vaccine and many are purported to be in the pipeline to bring back normalcy to the world. However, in spite of the researchers’ Herculean efforts, we cannot expect a ‘miracle one-time cure it all’ vaccine due to the genetic variations of viruses and it is unlikely to give a life-long protection similar to the SARS and MERS-CoV infections.[6]

Due to the contagious nature of the COVID-19 infection and its incubation period of an average of 12 days and the lack of “immunity-passport”, it is important to adopt social distancing practices along with adequate hygiene and personal protection and take responsibility for oneself and society.[7] We also wait for the herd immunity to kick in as the population gets exposed to the virus on its natural timeline. It also warrants the flawless international cooperation in the prevention, public health aid and prophylaxis. Lastly, the importance of preserving the ecosystem, wherein a breach in to its homeostasis has led to zoonotic outbreaks in the past too.


   Conclusion Top


After 6 months on the battlefield of COVID-19, we did make progress, albeit slowly. However, it has to be said that the situation has taken an immense toll on the healthcare fraternity, yet restored a sense of pride, passion and unity amongst us. As it is a new infection and these are unprecedented, uncertain times, healthcare fraternity, researchers, and community leaders and policymakers have to come together now for our survival and better future. False pride and jingoism has taken a back seat and people have realized how important it is to set apart petty differences and come together as a community. Even though the present scenario is bleak and uncertain, as physicians and HCWs, it is our responsibility and privilege to put our best foot forward, be resilient and plan for a better tomorrow. This, too shall pass!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ing EB, Xu QA, Salimi A, Torun N. Physician deaths from corona virus (COVID-19) disease medRxiv 2020. 04.05.20054494; doi:https://doi.org/10.1101/2020.04.05.20054494  Back to cited text no. 1
    
2.
Henri H, Wickramasinghe R, Mendes P. Prevention and control of non-communicable diseases in the COVID-19 response. The Lancet 2020;395:1678-80  Back to cited text no. 2
    
3.
Editorials- Nature Coronavirus drugs trials need scale and collaboration. Nature 2020;581:120 doi: 10.1038/d41586-020-01391-9  Back to cited text no. 3
    
4.
Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The Cytokine storm in COVID-19: an overview of the involvement of the chemokine/chemokine-receptor Cytokine & Growth Factor Reviews. 2020; 53:25–32.  Back to cited text no. 4
    
5.
RECOVERY trial: Oxford University News Release 16 June 2020, 13:00 (UK Time) Low-cost dexamethasone reduces death by up to one third in hospitalized patients with severe respiratory complications of COVID-19.  Back to cited text no. 5
    
6.
Tay MZ, Poh CM, Rénia L. et al... The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 2020;20:363–374. https://doi.org/10.1038/s41577-020-0311-8  Back to cited text no. 6
    
7.
“Immunity passports” in the context of COVID-19” https://www.who.int/publications/i/item/immunity-passports-in-the-context-of-covid-19  Back to cited text no. 7
    




 

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