Understanding COVID-19 from a Socio-medical Aspect - REDENDRON - Fear of Missing Out

Understanding COVID-19 from a Socio-medical Aspect

INTRODUCTION

We all can get over the COVID-19 pandemic with proper planning and execution. I strongly believe in it; because there is no individual who can’t, no society that can’t and no nation which can’t. My belief is not only based on the aforementioned shloka but also the socio-medical science which supports the fact (vide infra). The situation is just a bit more arduous this time and we need a proper ‘Yojana’(planning), and we will all be done.

That which deprives (vyasyati) a person of his happiness is termed vyasana (vices or calamities).”– Kautilya (Arthashastra).

We cannot turn our faces from this strenuous truth that this ‘Global Pandemic’ is also a ‘Global Calamity’ as we are unhappy because we aren’t obvious that as soon as we step out of our houses the first person we meet would not give us SARS-CoV2 infection which has a sharp potential of destroying us and our family. We feel insecure, but for how long? There are ways in which we can curtail all these insecurities as well as the catastrophe itself but we need to know about them but from authentic sources.

Calamities can be dealt with at three levels of a functional society,

  1. At an individual level.
  2. At a community level.
  3. At the Government Level.

When we talk about any particular element of the human society, suppose say a Civil Society we generally refer to the Community level operation, but that is never specific. As creation has a cyclical nature, it always puts its constituents within an ecosystem wherein one factor always influences the operations of another factor. So, Community level operations to combat a disaster is dependent upon every individual of the society and the decisions made and implemented by the government. It can never be a one-man show and requires proper coordination between these three systems. Hence, there is always a room for the game of blaming each other which will but create only more chaos, difficulties and panic which tends to prolong the disaster or the impact impressed by it. Hence, it becomes the chief concern for people to recognize their roles and their duties in tackling the catastrophe in the aforementioned three degrees of mitigation and act accordingly.

I would like to take this opportunity to acquaint the readers about our duties against the battle of COVID-19 (Coronavirus Disease – 2019). I am writing this article after going through several guidelines and advisories issued by the MOHFW (Ministry of Health and Family Welfare – Government of India) and WHO along with my physiological and pathological awareness of viral diseases as a medical student.

We are going to consider the general introduction to COVID-19, its mode of transmission, pathogenesis, host’s immune response, diagnosis and therapeutics in brief (Well, I know everybody knows a lot already, but if I don’t entail them, this article would lose the objective, so I’ll present my rendition of these things) and then we will proceed to talk about the roles we have to play to combat COVID-19 pandemic (It won’t be any kind of suggestions because there are already enough guidelines from the concerned institutions) and lastly we will also dissect the various misunderstandings about COVID-19 that are prevalent across the society (principally in Sikkim). So, take a deep breath and let’s begin.

General introduction to COVID-19: What is COVID-19, SARS-CoV2? Is it a type of Influenza Virus?

COVID-19 is a pathological term, it means a disease that is caused by the virus SARS-CoV2. SARS-CoV2 is a strain of a virus which belongs to the family Coronaviridae and genus Betacoronavirus. It shares its family and genus with the SARS (2003) causing SARS-CoV and MERS-CoV. It is not taxonomically related to the Influenza Viruses as the latter falls under the family Orthomyxoviridae and not Coronaviridae. And also the Rhinoviruses that cause the common cold are not sub-taxa of Coronaviruses, so the rumours are wrong, but they are of the same class.

SARS-CoV2 spreads through the pharyngeal droplets (aerosol) and direct/indirect physical contact and attack our respiratory system. One peculiarity of the SARS-CoV2 is that along with the upper respiratory tract it also infects the lower respiratory tract causing subsequent fibrosis of the lungs. There is a lot of misinformation regarding whether COVID-19 is airborne, there cannot be a precise answer to this question. SARS-CoV2 is ‘Aerosol borne’, aerosols are the small droplets (micro particles of some liquid) suspended in air and these droplets can be present in the air for a variable time. Now, the air is the mixture of a whole lot of things than just aerosol, so calling it airborne is incorrect. So, till today, i.e 25-05-2020, there are no specks of evidence of the COVID-19 being airborne.

Infection and Host’s immune response: Viruses are acellular, no one’s sure whether they are living or non-living. They do not produce toxins, don’t have any defence shields, and they do not have the minimum nutritional requirements. Their only objective is to multiply, for which, they require a host. These properties make them very weak parasites and more vulnerable to the defence mechanisms of the host. But they aren’t easily ripped off, because they hide inside the host cell within their genomes. So now, the host to attack the virus has to attack his own cell as that is the new virus. This takes time when the virus attacks the host for the first time (primary encounter) but the secondary and further responses are immensely amplified. Well, describing the body immune response in detail would make this article very long so I will not write about it, but I would like to mention that our body until and unless immune-compromised is fully capable of dealing with viral infections. This can be supported by the fact that most of the patients suffering from COVID-19 have been reportedly recovered and those who lost the battle had other associated diseases and age-related immuno-inefficiency.

Diagnosis and Treatment: As I mentioned earlier that the SARS-CoV2 has reportedly shown more infections in the lower airway than other recent coronavirus infections and the result was the subsequent fibrosis for the lung tissue. So people may freak out when they aren’t able to hold their breath for more than the period that is spreading in the various social media rumours, but that is not a state to panic, because holding your breath for a relatively shorter time accounts for various other physiological and pathological factors and not just COVID-19. Also, diagnosis based on increased body temperature and abnormal chest x-rays is wrong. So if you have doubts or a recent travel history you have to go to the designated laboratories and hospitals where your tests will be done either based on PCR activity of the viral genome or the specific antibody produced by your plasma cells when presented with the viral antigen. For the treatment, to date, there are no antivirals that are reported to be fully effective against the new virus. Drugs like HCQ have shown to help fight off the infection but its basis is still under study. Plasma therapy could be an option but comes with its own complications. Recently, the USFDA has approved a drug Remdesvir which tends to inhibit the viral replication but very little information is available regarding it. To be factual, there is no vaccine even for the common cold, so respiratory viruses are difficult to deal with. This leaves us with only one option, i.e Social Distancing and Hygiene.

Now let’s move on to the heart, soul and the main purpose of this writing, i.e, to spread awareness regarding:

Our Roles to Combat the Pandemic.

We will consider our roles at the three basic levels that I have mentioned before.

  1. The Government: “The King is the aggregate of the people.” Says Chanakya. In Democracy the Government is comparable to the king. The Government must take efficient measures to protect the public keeping in mind it keeps itself regular. The Indian government has been very prompt in adopting measures but that doesn’t mean the government has been 100% efficient, some inadequacies need to be addressed because our situation is gradually worsening. We are a thick and hefty population having around 60% of people living in poverty and during such epidemics, they are the ones who are hit the hardest. So, our government has to stride with it more than any other country. The problems are grave, and those problems come along with the important roles the government has to play during such a crucial time.

Some of those roles which I think the government has to play being given priority are,

  1. To keep the public aware, conscious and educated.

How can there be public tranquillity when the mind is revolting inside? Hence, it is very critical of the government to keep the public informed about every news regarding the number of cases, sophisticated zones, the scope for the vaccine research, prophylactic measures, authorized testing centres, the treatment that will be provided in every either/or scenario, obstacles the public will have to confront during the combat period, services available, services closed, etc. If all these aspects are not taken into consideration, then there will be rampant mayhem which may aggravate the condition. A famous example would be the Anandvihar incident involving thousands of daily wage labourers amassed at a bus stand, shattering all the guidelines set.

The WHO has recently issued a Risk Communication and Community Engagement (RCCE) activities guidelines which point out the various sections of the society with whom the communication cannot be established easily, such groups must be contacted in a distinctive way as per the guidelines. While the guidelines may be specifically meant for us, but we must know which groups are those. I provide the link of the issued guideline below.

  1. To reduce the tension build up in the health sectors.

In fact, this is what the entire Lockdown concept is about. COVID-19 isn’t the only illness in the world. While taking utmost care of COVID-19 patients, other patients cannot be left behind. This is not possible when the entire Health Sector is busy addressing one illness. The other ways to help the health sectors are, increase fundings, recruit more doctors, nurses, paramedics and hospital staff; enhance life tools using new technologies and build supplementary easy setup hospitals.

  1. Provide the public with essential goods.

This is the time when everybody compromises at certain levels, but the essential goods must be ensured for the public regularly. There is no rationality in being a green area where the people are starving, unclean and health compromised. Govt must ensure uninterrupted supply of food, water, electricity, etc. to keep the public conformed to the scenario. Also, when the situation is handleable, the government must promote small businesses like shops, taxis, daily wager jobs, etc. This will partially reduce the stress on the economy.

  1. To not politicize the issue.

At a point, we all must recognize the fact that the government is a political party or an alliance in power who has to fight the other elections. What would be terrible than politicizing issues like an epidemic? No one should ever do it and the government must work with all the political parties to work out the mishappening. This also helps, spreading awareness in the public as politicians have a lot of influence over society.

  1. The Community: “Alone, we can do so little; together, we can do so much” – Helen Keller. I read this phrase in 10th grade, and this is so valid. There is no point of a concerned skinny nerd shouting from inside his house, “stay home, stay safe” while being socially bullied by his neighbours. If it is combat, then everyone must be together, bound in a certain uniformity. A community has a very crucial role to play.
  2. To check upon one another.

Every contravention of the rules that comes to our notice must be reported. Otherwise, that may later create an illness cascade which would turn into a turmoil. But also when your neighbour runs out of vegetable supply then lending him a dozen of potato would be far better than watching him toil to go to the market. The communities can share useful and authentic information among each other through chat groups. By hosting their rentees and not letting them go away miserable.

  1. To be social by not being social.

This may sound utterly contradictory, but it makes sense. By not socializing out in public we may actually be socializing in the best way because we’re taking care of our community by staying indoors.

  1. To keep one another healthy and secure.

Depression cases are heightening in this rapidly urbanizing society, and the main cause is that someone in some corner of our society feels insecure. Let us not judge or comment or alienate our community members at such times of hardship. Everybody is going through a lot, let us understand that and spread positivity all around. Let us help the needy with the needful we can do. Let us be a responsible and yet strong community altogether.

  1. An Individual: “I am my brother’s keeper, I am my sister’s keeper that makes this country work”-Barack Obama. Everything initiates from an individual who just realized his duties. Every dismissal of crowds starts from an individual staying home. Every healthy community sprouts from an individual who doesn’t litter around. The spread of COVID-19 is like a Domino Game if one dice falls so do all the other dices. This cascade can be stopped only if the successive individual stays home and creates some gap in the public. An individual is the fundamental unit of the Civil Society because he/she can be in all the three roles, The Government, The Community and The Individual who’s responsible. If we just start pointing out the roles of an individual, even an epic would be a lesser story. I will mention only one role for every individual.

DISCIPLINE

Every doctrine and all codes collapse into this ten-lettered-word. Discipline means- Take care of yourself and others. Discipline means- Don’t spit in public, don’t litter in public. Discipline means- Wash your hands properly. Discipline means- Don’t spread fake information, rumours and panic. Discipline means a healthy community. Discipline means an able ruler.

To summarize, Discipline means – We’ve won.

DISCIPLINE MEANS EVERYTHING.

Confusions and Misunderstandings regarding COVID-19

Well, even though there is a lot of information available in the Social Media, they are not compiled enough to aid the ease with which the people can access them and hence, there remains a lot of confusions, as well as doubts in the people’s mind and they, need to be addressed. We don’t have the exact data regarding what all of those doubts are but still here are some common doubts which we feel coincide with almost everyone.

Q.) Can I get COVID-19 from pets?

Ans: The direct answer is No. But to understand why? we can break this question into two basic ones.

  1. Can my pet be infected from SARS-CoV2 and transmit it to me?

Ans: There are few cases which show certain animals being infected by the SARS-CoV2. Recently in a New York zoo, there was a report claiming that a Tiger was tested positive for COVID-19. But the CDC (USA) says that the chances are minimal because your pet needs to be exposed to get infected.

  1. Can my pet transmit COVID-19 without getting infected if it has vulnerable exposure?

Ans: This may be possible, but remember the phrase – “if it has vulnerable exposure”. I don’t know whether the Govt. has issued anything regarding this, but I do suggest you to take care of yourself and your pet while handling them, prevention is always better than cure.

Q.) Can COVID-19 spread through Drinking water?

Ans: A direct answer based upon the facts and studies is, No. While the presence of the COVID-19 virus in untreated drinking-water is possible, it has not been detected in drinking-water supplies. Furthermore, other coronaviruses have not been detected in surface or groundwater sources and thus the risk of coronaviruses to water supplies is low. –WHO (WASH and Waste Management, Vide Infra.)

Q.) Can a person have COVID-19 but not show any symptoms?

Ans: The direct answer is, Yes. There are many cases now, to just prove the fact. So, always take safety measures while and after meeting anyone from outside.

Q.) I take too many precautions regarding COVID-19, is it OCD?

Ans: For that, we need to dissect the term OCD. Obsessive-Compulsive Disorder means a certain thought or a feeling is obsessing you and making you compulsive to perform certain actions again and again that may satisfy your obsession. So if you’re following the precautions as per the Guidelines issued by the WHO or MOHFW, you don’t have OCD. And if someone bothers you with this stuff anymore, then just educate that person, successful or not, you will be doing your part.

Q.) Will gargling with warm water added with salt or Betadine, prevent COVID-19?

Ans: For now the answer is, No. The study on COVID-19 is still going on, and the survival of COVID-19 and different salt concentrations, temperature, pH, etc. are not confirmed. If you suspect getting COVID-19, you have very high chances of your lower airways being infected, so doctors are the only ones who can treat you.

Q.) Will anti-retroviral, flu vaccine, HCQ or a simple cold medication treat COVID-19?

Ans: Surprisingly the combination of there medications have shown positive results, but there are no rigid pieces of evidence regarding the mechanism of their work, the study is still going on. There is no direct answer to this. Vaccines generally work by the principle of antigen-antibody interaction which is different for different viruses (Vide supra.) so other antivirals do not work in this case. And regarding the work of HCQ, the MOHFW has issued a separate set of Guidelines which I will attach below.

Q) Does Arogya Setu app detect COVID-19 in an individual?

Ans: Direct answer is no. The only way to detect COVID-19 is through laboratory tests. Arogya Setu App is built uniquely, It uses your mobile number, location (through the GPS) and the Bluetooth. It is well synchronized with the COVID-19 infections database maintained by the government and keeps information regarding the locations of the infected patients. The Bluetooth is used for detection of the patients’ device and the transfer of information presents the result i.e the vulnerability of a person. Again, the accuracy of this system and the privacy issues are questioned by various politicians and the experts, but my recommendation would be to download it and keep it on, because we should not blindly but cautiously trust the Government who is keeping us safe.

Like these, there are various questions inside our minds and to address most of them the Government has issued several guidelines in the websites of various organisations like MOHFW, WHO, CDC, ICMR, etc. Sometimes we just need to give about an hour to study those guidelines, so that we have enough knowledge to take mandatory precautions.

Last but not the list, CoVID-19 has entered Sikkim, but there is no need to worry. No one is just “Dying” because of it. There are a lot of cases where optimism has proved to be tremendously efficient in treating several illnesses. I do recommend you to read the book, “The Power of Your Subconscious Mind” by Joseph Murphy, it is amazing and teaches us how to remain positive during different circumstances. I’ll end this writing with a quote extracted from this book and leave upon our readers to contemplate it.

“EVERY THOUGHT IS A CAUSE AND EVERY CONDITION IS AN EFFECT.”

Let us all be positive, realistic, aware, safe and healthy.

References:
Water, sanitation, hygiene, and waste management for the COVID-19 virus
Interim guidance23 April 2020
COVID-19-RCCE-Guidance-Update-200422
The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak
Article (PDF Available) in Journal of Autoimmunity 109:102433 · February 2020

Additional References: Textbooks of Physiology and Microbiology (For Medical Students).

*The information regarding COVID-19 change regularly, if any irrelevance found in the article, kindly report it to the writer or the team.

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