By Harendra de Silva –
We have been at the feet of Dictators, War mongers, abusive partners or elders but never at the ‘feet’ (Multiple feet like pods protruding out) of an electron microscopic particle ever before. For many of us, income is zero or negative, we have lost our jobs or family, almost many of us are out of our minds, not knowing what to do! Those who planned weddings, Families, children, dwellings, studies ventures or whatever is in the doldrums!
Let’s Look at the infection itself: Corona 19 has certain characteristics that are different from previous Pandemics, More the difficulties we face, the more obvious the surfacing of animal like behaviour of humans!
It has a long incubation period compared to other viruses like SARS-1 or HINI (Swine or bird flu), the patients may be asymptomatic but infective, and they may be infective for a long time compared to seasonal flu. At the same time the infective droplets may remain infective for days not minutes or hours! Unlike common comprehension by the people, It is not the Virus that kills but the body’s uncontrolled immunological over reaction to the virus leading to the cytokine storm that destroys one’s own tissue, akin to previously described Gram negative septicaemia. I and others in 1991 described the same cytokine phenomenon in Haemolytic Uraemic syndrome (HUS) in Shigella diarrhoea.
A new confounding news that the patients may be positive for an indefinite period, although we are not sure whether these are re-infections or latent (hidden) infections which also raises the issues whether the reinfections are mutated viruses or whether the body immune mechanisms get deranged by the virus? It also raises a major concern i.e. if a latent (hidden) infection? whether there would be other manifestations immunologically, neurologically or other systems years later giving shudders to the medical profession. It is already known that it would leave long term scars in the lungs and heart! SSPE (subacute sclerosing pan encephalitis) in measles causes invariably fatal brain degeneration years later, Kuru (described in P. New Guinea) is another slow virus, or even common Herpes after chicken pox comes out decades later although not fatal. Only time (even decades later) will tell.
Everyone is dreaming of a Vaccine! Is it a reality? We in Sri Lanka it would just be a daydream, at least in the near future! Trump & Co. will Never make it available even for UK or EU, (unless it is dud!) Meanwhile, EU will never give developing countries or even to the UK! Our hope will be China, India or S. Korea who will have to cover their own population first. By the time we get the vaccine (in years) the virus would have mutated and the vaccine would not effective at that time. But once the process and infrastructure (factories etc) is developed it would be easier to develop for the mutant viruses. Yet another confounding issue from scientists is: that a vaccine is not a dream but a nightmare! They are finding difficulties. After Corona 1 (SARS) almost 20 years ago they worked on a vaccine, but it has not seen the light of the day yet! After decades of search for a vaccine for HIV, have we found any? Almost 10 years of hard work on dengue, the vaccine failed. Even the seasonal influenza vaccine has to be given yearly due to continued mutations. Corona virus has already mutated several times in a few months. What if it goes through another animal such as Civet cats, snakes, bats or Pangolins and changes the genetic sequence complicating immunity? Now the most disturbing latest scientific news are: reports of ‘reinfection’. It may be that the virus has gone into ‘hiding’ (latent) in the body and not been detectable on routine testing and subsequently resurfacing to infect others and then being detectable again! Or whether mutations that occur fast in the humans is re-infecting patients and if so, what happened to the immunity he/she should have developed?
As a result of the obscurity and elusiveness of the virus, one cannot superimpose strategies used in previous infections; but some principles may be applicable. It will be a matter of ‘playing by ear’. Many other countries do the same by trial and error since strategies adopted by some countries, although good at the time have resulted in tragic secondary waves of infection.
Latest (22/Aril) from the from the Chief CDC Atlanta Robert Redfield the foremost authority of the subject who says “There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Referring to politicians who want to open the economy he says “they don’t understand what I mean” He goes on to say “We’re going to have the flu epidemic and the coronavirus epidemic at the same time”. More inauspicious news (21/4) from head of the World Food Programme (WFP), David Beasley, “the world is at risk of suffering widespread famines ‘of biblical proportions’ within just a few months”.
Unlike Corona 2, we know that many animals including dogs, tigers etc mark their territory by urinating around their territory! Human behaviour is no different! Humans are known to consciously or unconsciously consider their own space (Territory) and its effects (Threats) on social relations. We do see universally certain instances where administrators and medical personnel jealously guard their territories and domains! It may be due to personal insecurity and/or unsure of the subject or personal agendas. It would be interesting to study this day to day phenomenon escalating during a calamity. Everybody feels important and talks from information they have gathered from other Pandemics. They give competing information and ultimately realize that they have put their foot in! Unfortunately, human behaviour is such, that they still don’t accept blunders! Misinformation, initially by even the WHO or the US leadership not to wear masks, not to test aggressively, isolation strategies etc. was a result of poor advise due to the elusive nature of the virus. We hopefully are learning slowly, but Trump still refuses to wear a mask!
The media response has largely been positive with health education and fund raising. But inherent conflicts of interests and racism has surfaced in some media anchors (presenters); or are they echoing the views of puppeteers? In the media world, demand for advertising is of prime importance: and depends on ratings of the channel and anchor which depends on tracking of viewers and comments! Even if there are negative comments the increased hits may increase ratings! We can see this with certain channels in Sri Lanka. HBO’s John Oliver exposed false information being peddled by Fox News (that targets conservative group) about the coronavirus, and the impacts those falsehoods are having on President Donald Trump and his decision-making. “They only pretend to believe these things on television for money.” (or own interests)
In the climate of ‘Insecurity’ humans become irrational and start hoarding food. While reading a medical article from 1964 By Prof RS Illingworth and J Lister (J Pediatr 1964 Dec;65:839-48) long ago; they mention an experiment with mice: two similar groups of young mice that were taken and the first group was given slightly inadequate amounts of food. They found that this group saved by hiding (hoarding) some amount of food, while the second group that was given an abundance of food did not save anything and ate all. In th second phase of the experiment, they switched the two groups. i.e. the first group was now given more than necessary but they still hoarded some food and the second group that was given less than necessary did not save food. It shows that if you are in an insecure environment from a young age you tend to hoard, which is also applicable to saving money. No one has done any research to look at hoarding patterns in the rich (may have been poor when young) and poor, but I believe that hoarding is a result of an insecure future.
It is interesting to see the behaviour of politicians of whatever creed who may be in a dilemma of grabbing or holding on to power? In South Korea they even succeeded to piggyback the Pandemic to a successful win! Although he messed it up right royally from the beginning with his Amygdala, (reptilian brain) Dopamine mediated responses, Trump’s statements, behaviour, body language and the palming the blame is also an obvious plan for the next election. It is important to understand that arrogant and fateful decisions may amount to mass genocide of one’s own people? Only history would be able to decipher these complex political games as to whether they are innocent or guilty? Populist leaders often of a showman type; have certain characteristics that has been enhanced during Covid 19. They show ethnic hatred e.g. ‘Wuhan’ or ‘Chinese’ Virus; talk of threat to territory by coining conspiracy theories of lab generated Bio Warfare! Often resulting in counter theories; insults to others including races and gender (E.g. “That ‘Woman’” i.e. governor); Aggressive nasty comments to reporters contradictorily calling them ‘nasty’! Language and body language is full of virility, sexism, masculinity & pontifications! We have not seen similar behaviour in leaders of Australia, New Zealand or most European countries?
The price USA is paying today is due to their Arrogant behaviour (led by the leaders) towards the ‘Chinese’ disease as if their skin, power, science, medical facilities and money could ward of the disease! There was possible misinformation that immunomodulation by the BCG vaccine could prevent Corona: without considering evidence. In addition, since the disease had spread less to Africa, it was assumed that it hardly affects blacks? This type of belief on the background of illiteracy and perceived notion of freedom in the West led to, disobeying advise of social distancing (as opposed to China), led to the highest morbidity and mortality in the ‘BAME’ (black, Asian and minority ethnic) community in UK and US. A few days ago, 10 doctors had died in the UK and ALL were BAME and 9 of them born outside the UK! The argument of them having had the BCG comes in negatively: but the other variables such as living conditions, co-morbidities, age and possible discrimination in management has to be considered!
In natural calamities, such as this: different personalities react differently. Exploiters jump in to action to make money, some legally and others not. Those who genuinely help by providing food to the poor or donations to funds; and in the midst, there are political exploiters who take political advantage. In the aftermath of the Tsunami, I came across a politician who stopped vehicles taking donations to victims and put his rubber stamp as if it came from him! He is still surviving in the political sphere. Even in the present crisis food some donations were by politicians sometimes with party logos! This is political exploitation. There are others who do not care and mind their own business.
Exploiters, try every trick of the trade in an insecure society to make a quick buck! We have seen rotten vegetables and fruits being delivered by unscrupulous vendors. Some are sending goods that were not ordered; e.g. when Astra is ordered, exorbitantly priced Lurpak is sent, wheat flour instead of rice flour etc etc. The prices too are exploitative. A tin of mackerel (misnamed as ‘Salmon’ in Sri Lanka) was controlled at 100 Rs. But the wholesale market in Pettah was selling at 235/= by claiming that the retail price was lifted? Lentils (Dhal) has also gone underground. At the same time home deliveries have saved the day for many of us and I don’t know whether to complain or not; but exploitation is exploitation, whoever does it! Limited liability Companies have blatantly stopped paying rents and expects the landlord (whose sole income may be the rent) to bear the brunt while they are not willing to compromise or pay from their personal assets!
In the UK, some Corona Test kits were ‘dud’ putting the society and countries which may amount to widescale carnage! In Sri Lanka, Masks that were 15 Rs. Suddenly went up to even 150/= now with an influx of masks it is anything between 50-100/=. At the Sydney airport masks were 25 $! Sanitizers doubled in price partly due to increase in price of alcohol by wholesale dealers!! I don’t understand why the mostly state-owned sugar cane industry, that has its main income from absolute alcohol does not release in a legal way to make more sanitizer solution a lifesaving commodity at a controlled price? Or are they wanting to make more money from the brew that destabilizes the society? Of course, exploiters can get permits to make brews rather than sanitizers! It is well known that the alcohol industry is controlled by powerful persons in Sri Lanka and all over the world!! It was interesting to see an order to open liquor shops suddenly got stalled after a large public protest. At least the government bowed down to public pressure rather than pressure from the political alcohol industry!
We have also seen huge number of medical, traditional or spiritual personalities who have come out with hoax cures and theories for Corona! This may be due to conscious misleading to make money or due to illiterate unscientific beliefs in supernatural powers of Cunjee, Smoke pots or tradition foods, prayers, chanting of stanzas or God ‘Natha’, etc. It may be for popularity and power but knowingly misleading persons would be detrimental in preventing spread and morbidity. I suppose some harmless practices may relieve stress and mental status! Advocacy of cures short of statistical/medical evaluation especially by doctors may amount to malpractice? In the US, a licensed physician in San Diego, was charged with mail fraud on for his role in selling “Covid-19 treatment packs”. In one of a few other incidents, German state of North Rhine-Westphalia failed to put in place a citizen verification procedure and allowed fraudsters to steal millions of euros in a phishing operation raising funds.
Telemedicine has been advocated for decades in situations where access to medical care is scarce but with standard protocols and procedures. With social distancing and travel difficulty it may become a necessity for minor ailments with patient anxiety? It may be a way doctors could advertise themselves, or exploit patients; although in most instances it may be a genuine effort to help a patient and to keep the patient’s confidence. However, there would not be any physical examination although picture on WhatsApp may be sent; but a possibility of missing physical signs is an issue. Nevertheless, There is no legislation or regulations in the SLMC to guide such a practice! The Indian Medical Council came out with a new regulation and protocols in telemedicine. In Sri Lanka the Procedure in formulating a regulation is only through parliament and a locked down SLMC and Parliament does not permit such regulations but should not be an excuse. This leaves open a huge gap that could lead to exploitation of patients and potential legal action against doctors.
The dimensions of this cryptic annoyance keep on changing and cannot be predicted. However, human behaviour is predictable and only adjusts to circumstances. In a few days this article may be obsolete!
*Vidyajothi, Harendra de Silva -Emeritus Professor of Paediatrics.