By Aloka Liyanage –

Dr. Aloka Liyanage

‘Even if the open windows of science at first make us shiver after the cosy indoor warmth of traditional humanising myths, in the end, the fresh air brings vigour, and the great spaces have a splendour of their own’ ~ Bertrand Russel (1872-1970)

A renowned story of our time

In December last year, a group of doctors in Wuhan City Hospital of Hubei began to unravel a series of rather unusual cases with severe respiratory symptoms due to a flue like viral infection for the very first time. Within weeks the number of cases soared to an unprecedented scale that the authorities of Hubei had no choice but to lock-down the city with over 10 million people in an attempt to contain the virus. By 11^th of March 2020, WHO declared the viral-outbreak a pandemic, being a global public health concern due to its exponential spread across the continents. 

In the middle of the pandemic, the entire world has been struck by fear and uncertainty to a scale that has never seen in the entire human history. Interestingly, it is not the very first time that humanity witnessed such catastrophe. From Antonine plague (165 AD) to the recent Swine flu in 2009, humankind has perseveringly been beaten by epidemics, pandemics and great famines yet, bounced back to thrive and propagate on earth over and over proving their remarkable resilience and ability to endure.

Infodemic!

To everyone’s surprise, scientists and physicians who are dearest to all kinds of ailments, infections and infirmities seem to have been shaken more than the general public wittingly or unwittingly of the imminent doomsday. An abundance of theories is emerging on bizarre solutions and treatments to the most unknown disease ever; COVID-19. It would be prudent to take a  risk in dismantling the native intellectual cocoon (within which we found our comfort ) to catch a glimpse of these pseudoscientific theories muddling our society in the viral outbreak which is claimed to have no faith in geographical, societal or cultural boundaries.

I’m no expert on disease outbreak in the epidemiological perspectives but a clinician who deals individual bodily ailments on everyday basis and an advocate of rational thinking. There won’t be a time more critical than ever in fulfilling our social and moral responsibility towards people in empowering them with knowledge and attitudes in this decisive hour of humanity as the tentacles of myths are entwining the society at a greater pace than that of the virus claiming its lives and territories.

Scaremongering

At the beginning of the viral outbreak in Wuhan, it was assumed that the virus could be a misadventure of calculated state violence (conspiracy theory) particularly in the west. This deepened the anxiety among the people who were already being struck with fear and trepidation by the disease. Disgracefully, superpowers started denouncing each other in the usual manner to wash their hands off and to conceal their hypocrisy. Owing to the robust and expedient research on the Genomics of the virus the conspiracy theory was readily condemned. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was overwhelmingly concluded to have originated in wildlife ^1-2.

In the other side of the world, the liability of getting infected by the virus seem to have been shifted to the infected (individuals) than the contagion (reverse conspiracy theory). In the presence of this new enemy (COVID -19 convicts) the legitimacy to nab the control of everyday lives of people by those governing regimes has been arbitrated. A recent article by a scholar in Colombo illustrated this phenomenon quite meticulously ³. The infected individuals are being hunted down and banished like never seen before. This process of transforming the infected, a delinquent could accrue the difficulty in contact tracing in the short term and also perpetuate disease resurgence in the long run if the attempt of developing a successful vaccination is failed by any chance. 

There is also an acrimonious discourse on the safe disposal of cadavers in the current context. Whilst many countries with a staggering number of death rates following the clear WHO guidelines ⁴ on safe disposal while maintaining the dignity and religious expectations of the deceased and bereaved, contentious ideologies  spread the fear by theorising the risk of spread of virus by burial of corpses beyond much rationality. Coronavirus is one of the fastidious most viruses outside living cells and there are enough and more virulent varieties in a decomposing human body that could pose greater environmental risks than that of the virus if the said theory is credible. 

Chloroquine and neo-imperialism

Then came the hype created by Trump’s misleading announcement on the effectiveness of antimalarials (Chloroquine and Hydroxychloroquine). He stated that this could be the ‘game-changer’ in the treatment of coronavirus in one of his recent press briefings. This sparked a tantrum amongst the desperate, which led to widespread hoarding of chloroquine stocks and at least one death in the US and several cases of toxicity in other parts of the world ⁵. The speculation of Antimalarials came from the observation of its anti-viral properties on studies conducted on SARS virus (strain HCoV-OC43) in animal models ^6-7. However, to date, there is no high-quality clinical evidence to prove its therapeutic efficacy or benefits on humans.  Despite Trump’s baseless claims, the American FDA (Food and Drug Administration) openly denounced its routine therapeutic use but later on granted the permission in emergency use under specific circumstances ⁸.

American face mask

Wearing face masks in public was common sight amongst certain regions even before the current pandemic (particularly in spells of seasonal flu). The effectiveness of face masks in community level in minimising the spread of respiratory infections, however, is still a debate⁹. This has been creating anxiety and distress among people who do not wear the masks in that particular environment due to the feeling of vulnerability to get exposed to contagion.  Ironically, all of us happened to be behind a mask right now. Despite WHO clear guidelines ¹⁰, many countries advised their citizens on wearing face masks in public. A recent publication in the US ¹¹ once again drag the attention of proponents of public use of face masks amidst the crisis of limited availability of PPE (Personnel Protective Equipment) in the clinical settings. Trump the unpredictable, declared his decision of abstinence from wearing face mask behind his prestigious resolute desk in oval office against the public health advice, while Trump supporters showed up wearing red masks with a printed slogan MAGA (Make the America Great Again). The mayhem created by the mandatory face mask in public left people in developing world at despair, yearning to improvise their own mask and there by putting themselves at greater risks of catching the virus⁹.

Cuppa or cow excreta

Drinking tea has been known to have many health benefits for no doubt been a practice for centuries. At present drinking tea by and large is rather a social ritual than a health habit. Chemical composition of tea has also been extensively analysed, and the health benefits of tea can readily be explained in the scientific context by the effects of these components in bio-chemical pathways in the internal milieu. However, the inspiration you gather (in the social context) sharing a cup of tea with a friend or family (of course while maintaining the social distance) is by no mean comparable to the so-called health benefits. Now we have been advised to drink tea quite voluminously as a remedy for the virus, citing a small print on the presence of trace amounts of Theophylline in tea (the concentration of theophylline in brewed tea is about 1mg/L¹²). The therapeutic dose of Theophylline in an adult (with chronic asthma) is in the range of 250-500mg every 12hours (British National Formulary) and even a child could now calculate the volume of tea one has to gobble down to have that therapeutic effect (as they claim)! It is also worth having to look at the side effect profile of theophylline before being inclined to guzzle gallons and gallons of tea like some people in the neighbouring countries did that with cow excreta recently as a remedy.    

Fumigation, the way to serenity

In the aviation industry, comprehensive disinfection and sanitisation of passenger cabins have been a practice to prevent the spread of airborne diseases amongst passengers. However, the broad-spectrum disinfectant products currently in use in fumigation have not been tested on novel coronavirus and hence its efficacy on this new virus has not been proven to date. Although, novel coronavirus being an enveloped virus, these chemicals are thought to have the same effect as for Influenza A and H₁N₁ (A surrogate virus for lipophilic viruses) ¹³. When it comes to the household settings, simple handwashing with soap and water could have more or less the same effect (split open the viral envelope and thereby deactivate) as that of high-end disinfectants. The significance of these simple measures seems to have not been adequately emphasised and propagated, but advice on herbal fumigation been glorified beyond someone’s expertise and astuteness. It is indeed beyond the author’s expertise to examine the medicinal value of herbal therapeutics; however, irrational use of any medications could also have adverse effects not only on people with chronic illnesses but also on those who are utterly healthy¹⁴.     

Scientific method vs folklore

Philosophers already have explored and addressed general methodological problems, such as the nature of scientific explanation and the justification of induction (method of reasoning). The scientific method, therefore, is critical to the development of scientific theories, which explain empirical (experiential) laws in a scientifically rational manner. A researcher develops a hypothesis, tests it through various means, and thereby modifies the hypothesis based on the outcome of the tests and experiments. When it comes to medical intervention, any test or treatment must be subjected to vigorous testing before any human application is being instigated. Having said that, it would also be imprudent to seek highest levels of evidence (i.e. inference from systematic reviews or meta-analysis of randomised clinical trials) before any intervention is being implemented in a crisis. However, it’s our duty to make sure that the decisions on all recommendations, treatments or interventions to be drawn from consensus of a panel of experts and not from individual anecdotes or narratives (Here, I would not get into the unresolved argument of the science being an ultimate truth that explains everything on earth and answers all the questions on ethical and moral principles). 

Conclusion

Human physicality is unique in its composition, the way it responds (there are subtle idiosyncrasies) to an insult (i.e. infection) and how it reacts to an intervention irrespective of someone’s religion, beliefs or skin colour. So do the virus, as proving its universality right in front of our eyes. There could, hence, be only one but not many solutions to the crisis as it unfolds its grim reality. Anyone with a slightest understanding of the dynamics of this predicament would agree that the ultimate solution to the crisis is nothing but a vaccine which obviously is going to be a scientific discovery.

I shall endeavour still further to prosecute this inquiry, an inquiry I trust not merely speculative, but of sufficient moment to inspire the pleasing hope of it becoming essentially beneficial to mankind (Edward Jenner 1749-1823)

Dr Aloka Liyanage MD FRCS  is a general surgeon currently working in the department of surgery of Southport and Ormskirk NHS Trust in the United Kingdom. He pursued his doctorate in general surgery from the University of Colombo, Sri Lanka and was awarded the fellowship of Royal College of Surgeons of England in 2018.

References

1. Zhou P, Yang X-L et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; published online Feb 3. DOI:10.1038/ s41586-020-2012-7.
2. Andersen KG, Rambaut A et.al. The proximal origin of SARS-CoV-2. Feb 16, 2020; http://virological. org/t/the-proximal-origin-of-sars-cov-2/398 (accessed Feb 17, 2020).
3. http://www.dailymirror.lk/opinion/COVID-19-and-Bio-Politics-The-Emergence-of-Tyranny/172-186308
4. https://apps.who.int/iris/bitstream/handle/10665/331538/WHO-COVID-19-lPC_DBMgmt-2020.1-eng.pdf
5. https://www.theguardian.com/science/2020/mar/25/can-chloroquine-really-help-treat-coronavirus-patients
6. Keyaerts E, Li S, Vijgen L, et al. Antiviral Activity of Chloroquine against Human Coronavirus OC43 Infection in Newborn Mice. doi: 10.1128/AAC.01509-08
7. Vincent M J, Bergeron E, Benjannet S, et.al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69. doi: 10.1186/1743-422X-2-69
8. https://www.fda.gov/media/136784/download
9. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30134-X/fulltext
10. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
11. https://www.sciencedaily.com/releases/2020/04/200403132345.htm
12. http://archive.food.gov.uk/maff/archive/food/infsheet/1997/no103/table2a.htm
13. www.callingtonhaven.com%2Fcoronavirus-aircraft-disinfectant.
14. Persichini R, Allou N, Allyn J, et.al. Near-fatal lung injury with rapid onset bronchiectasis caused by traditional fumigation therapy on the French Island of Mayotte. Ann.ATS. 2017;6:14.