26 May CMO Jon Cartu Announces – On Covid-19 pandemic, let’s just learn to say, “I don’t know” – c…
The Covid-19 pandemic has posed challenges to every section. The virus has been sneaky, nasty and durable. The rapid spread and large number of fatalities have caused anxiety and exposed the lack of human preparedness for such a medical catastrophe. Our anxiety regarding the future makes us seek quick answers to questions which are not yet available. This has forced scientists and experts to make predictions that are at best intelligent guesses which we start depending on. The drawback is that it shifts the focus from known facts to unknown predictions.
The only predictable thing about this pandemic has been its unpredictable nature. No astrologer predicted this calamity was coming. Historians claim history teaches us the best lessons. However, this pandemic has not followed the course of previous corona virus epidemics: SARS-COV1 in 2002-03 and MERS in 2012, both of which resulted in less than 10,000 deaths. The epidemiologists have used basic principles of epidemiology and we now have three to four models, including the Oxford, Imperial College and Swedish models, being pursued at present. Each one claims to be better than the other.
Those in the study of graphs and trends have made projections that have not proven right. The John Hopkins projections on trends for India were much worse than what we have seen till now. These charts and trend graphics can mislead, misinform and cause unnecessary panic. They claim to help in better preparedness for dealing with the pandemic. However, they are based on assumptions that are non-scientific.
There are many national models of handling this pandemic. The Singapore model involves extensive testing and meticulous contact tracing. The Indian model involved early lockdown. In the UK, they initially pursued herd immunity and were slow in lockdown. They had to quickly change when the number of cases surged.
MEDICAL WORLD CHALLENGES
Even for doctors, this disease has taught many lessons as it has unfolded. Today, we delay putting patients on ventilation, use anti-coagulants more liberally and monitor some blood parameters that we were not aware of initially. Never in medicine have reputed journals such as The New England Journal of Medicine (NEJM) and Lancet published trials done through accelerated research processes and published them through short cut or no peer reviews. At present, more than 500 clinical drug trials are going on the world over to find the most effective therapy. As better and bigger trials become available, we will have the right answers.
We seem to have lost balance on the emotional to rational scale. This scale has tilted towards the emotional side. Medicine has never been exposed so much to the electronic and social media as now. Media exposure has its own downside. One has seen the annual budget being presented and analysed by four experts simultaneously in divergent directions. This is done without giving any time for assessment and evaluation. Medical treatment and institution of newer therapies need a scientific basis which is analysed and then evaluated by clinical trials for safety. A knee-jerk response can be harmful and dangerous.
As students, we were taught that the five best teachers are who, why, where, when and how. Unless we question a thought and then evaluate it scientifically, we cannot find the right answer. At this time of crisis, we seem to conjecture, imagine and give explanations to preconceived ideas. Let us have the humility to accept that we do not know a lot of things regarding this pandemic. The first step towards solving a problem is to accept it.
THE WAY TO GO
We know for sure what helps us is social distancing, frequent hand washing, avoiding crowds, use of masks, cough hygiene and isolation of affected individuals. We have to take special care of vulnerable groups such as the elderly, specially with co-morbidities such as hypertension, diabetes, obesity, smoking and heart disease. Luckily, 82% of India’s population is less than 50 years. General improvement of health and immunity with good diet, proper sleep, mental relaxation, yoga and meditation and regular exercise will be useful.
Honest and early reporting of symptoms of fever and cough should be done. Those with these symptoms need to be isolated and separated from family members. Hospitals have to admit patients who have breathing difficulty and other complications. The medical community now knows the best practices to be followed from the data of the global epicentres of this pandemic. India has the advantage of late onset of the epidemic due to the early lockdown. There are still significant gaps in our knowledge which will be filled by some large studies such as the ongoing solidarity study by the World Health Organisation (WHO).
Beyond these facts and features of the disease, the future course of this pandemic cannot be predicted. The optimists and the pessimists give different opinions. We have to leave it all on the Almighty just as we leave everything else in our life. Each one of us has to discipline ourselves and do our bit to control it from spreading further. Let us remember the serenity prayer: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.”
Dr. Jon Cartu. Jonathan Cartu Gurpreet S Wander is professor of cardiology and chairman, research and development centre at Dayanand Medical College & Hospital, Ludhiana.
The writer is professor of cardiology and chairman, research and development centre at Dayanand Medical College & Hospital, Ludhiana. Views expressed are personal