COVID 19: THE NEW CHALLENGE OF HEALTH CARE GLOBALLY 3

The covid-19 pandemic has created an unprecedented disruption in the global health and development community. Organisations fighting infectious diseases, supporting health care workers, delivering social services and protecting livelihoods have moved to the very centre of the world’s attention. But they find their work complicated by challenges of identification/diagnosis, access, safety, supply chain logistics and financial stress like never before. 

Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) a novel coronavirus identified in Wuhan China in December 2019. A novel virus meaning it’s never been seen before. It was declared a pandemic by the World Health Organisation (WHO) on 11th of March 2020. More than 2 million people have been infected in 210 countries resulting in more than 150,000 deaths and numbers are still rising at an alarming rate. Most people infected with the COVID-19 virus will experience mild to moderate symptoms and recover without special treatment. Common symptoms include fever, cough and shortness of breath. Those at risk include older people and persons with underlying illness like cardiovascular diseases, cancer, et al. The virus primarily spreads through droplets of saliva or discharge from the nose when an infected person coughs or sneezes and can also survive for some hours on surfaces. 

We can’t fight fire blindfolded. In a pandemic that’s affected about 210 countries, identifying who is infected, who has been exposed and who is immune is crucial. Testing for SARS-COV-2 is central to our ability to control the crisis, unfortunately our tests are not up to the task nor are they affordable to all those in need and its accuracy is still in question. The tests themselves are a limited resource, the mainstay, Polymerase Chain Reaction is limited, slow and expensive. In the beginning of the pandemic the majority of samples were sent to the Centre for Disease Control for testing which slowed progress immensely. Rapid test-kits have been developed but they’re not enough and increasing levels of inaccuracy are major drawbacks. False negative and false positive results presents serious problem as some persons who erroneously test negative for the virus continue to infect people and they’re likely to ignore symptoms when they arise. Developing countries with sparse laboratories and inaptitude to produce their own test-kits rely on donations from international organisations thereby limiting their testing capabilities. Developed nations are not spared from this shortfall just as countries are being urged to test as many as possible in the face of limited resources. Contact tracing have also become challenging due to lack of cooperation, unreliable information and fear amongst the population. 

A diminishing and ageing workforce. Protecting our front-line in a war against a highly transmissible virus is vital to our fight for victory. Health workers are at risk on two fronts, one in the hospital and the other in their communities, according to WHO 1 in 10 health 

care workers become infected. This poses a major threat to an already overburdened health care system, the math is simple; less doctors more casualties. The reason behind this is the scarcity of personal protective equipment (PPE) desperately needed by these workers, delayed recognition of COVID-19 symptoms and lack of experience dealing with respiratory pathogens. 

Ventilators are no Panacea for the critically ill. Lungs are the main battleground in COVID-19 infections. About 20% come down with the severe form of the disease requiring ventilators to have a chance at survival. Ventilators take over breathing giving the lungs time to recover unfortunately the lungs don’t always heal no matter how much help is offered. Once a COVID-19 patient ends up on a ventilator survival chances reduces significantly and many go on to die. With demand for ventilators at an all-time high manufacturers are unable to meet up, now every country is racing to take up remaining stores. Another dilemma facing health care workers is the decision on who gets to use the limited ICU spaces and ventilators, say a 65 year old otherwise healthy retired civil servant vs a 30 year old father and husband with a life threatening underlying health condition. 

We are in unchartered territory. Despite the worsening trend of COVID-19 no drugs have been validated to have consistent and significant efficacy in clinical treatment. Little to nothing is known about SARS-COV-2 and while there’s a large and growing body of research on drugs, breakthroughs are still few and far between. The shelves are open and the pressure is building but there’s need to be systematic. Clinical trials the scientific gold standard for studying drugs are essential to understanding what works and what doesn’t. So many experimental therapies are being tested either formally or informally. Majority of COVID-19 patients recover without any form of treatment hence, it’s difficult to know if they are actually effective. Hydroxychloroquine, remdesivir, ropinavir are some of the popular ones, these drugs have never before been used for coronavirus and though they show some promise their efficacy is still under study. According to WHO a vaccine is still months away but some are already on clinical trials. A successful vaccine could stop the virus dead in its tracks but only if the virus doesn’t mutate its way around the shot and little is still known about SARS-COV-2 mutation. 

COVID-19 is arguably the greatest challenge since WWII and although this write up does not come close to covering the magnitude, the short-term implications of this global challenge are evident everywhere, but the long-term consequences of the pandemic-how it will reshape the health institutions, development and priorities- are still difficult to imagine. 

Ibe Divine