Every corner of the world has been hit hard with the Covid-19 disease, which resulted in a lot of apprehension along with social anarchy, financial turmoil and political instability. During last 6 months, trillions of dollars have been evaporated from world treasury. At present, neither an effective vaccine nor an effective medicine is available to fight the Covid-19 disease. The only weapon now to fight the disease is to adopt policies, which could prevent further spreading of the SARS Cov-2 infection. Such as lock down, social distancing, restriction of movement and maintaining of personal hygiene. These efforts will help to control the infection rate in most countries of the world. Despite, taking all these measures in account, both Covid-19 infection rates and death rates are spiking day by day globally. There is no answer to epidemiologist that how long the infection will continue worldwide and when this virus will be extinct from the face of the earth. The Influenza Pandemics from 1918 Spanish flu to 2009 swine flu, all most 120 years have passed. We have observed that most of the pandemics continued for around 1-3 years and 3-4 recurring waves of infections had occurred afterwards where most of them were more deadlier than the initial one.
Besides talking all the measures of preventing infection, we have to work hard in order to gain the confidence of the public at large is indeed a difficult job. Psychosocial, medical and political willingness is needed to handle this situation until an effective vaccine and as well as an effective medicine is found. Here I would like to highlight some of the medical aspects of this issue. Three polices may be applied to gain confidence of the community at large.
First, we have to adopt a policy that can make the people confident. Feeling of safety of an Individual’s health through widespread publicity is needed to create awareness of the various aspect of Covid-19 disease, which should be given utmost importance. Provide people with adequate support for diagnosis alongside SARS Cov-2 virus testing and Covid and non Covid treatment facilities.
The second solution is that we can use mass scale SARS Cov-2 virus RT-PCR testing for suspected, infected and for the non-infected apprehended people. No country in the world can bear the huge expenses for SARS Cov-2 virus tests alone. So therefore, the Government needs to allow all private hospitals and diagnostic labs throughout the country with higher standards of PCR facility and manpower to perform the test. People will go for testing as per their own desire or being referred by a registered physician and paying diagnostic fees themselves. Patient’s data must be preserved in a database of the respective hospital or diagnostic from where it shall be then sent to the government approved “Corona cell” daily or every other alternate day for epidemiological and legal purposes. Tests should be cheaper as well as reliable. In order to do that the Government may ease taxes and reduce the import duty for machine and materials that will be required for conducting the test. This will ensure that people will not run around, as a mad man to do the test.The Government largely will be able to know the picture of infective population of the country when private data will be lumped with the government data. This will greatly reduce the anxiety in the community when it is pinpointed towards the infected people. Private health sectors will then inform about the SARS Cov-2 RT-PCR positive patient to the family members, THA, TNO office, local Chairman Office and police station so that appropriate measure could be taken to prevent the spread of Covid-19 infection from an infected person. The authorities shall maintain a record of all Covid-related positive cases, death and recovered cases
The third policy is to estimate the SARS Cov-2 seroprevalence by carrying out mass antibody tests on both symptomatically infected and asymptomatic people. Mere antibody tests will show their immunological status of the past SARS Cov-2 infection irrespective to symptoms. This policy will make people to understand about their body’s capability to fight the SARS Cov-2 virus infection and give an estimate of the asymptomatic infection in the community Public confidence will then rise when they will come to know that they are immune to the SARS Cov-2 infection. As a result people from all walks of life will be greatly benefitted, where there will be doctors, nurses, other hospital caregiver, Government and private employees, garment workers and worker of big industries. They will be stimulated to join their workplace without any anxiety or fear and cheerfully will perform their duties when they will know that they are immune to SARS Cov-2 infection. It will not only build the confidence of the public but it will greatly help to rebuild the economy.
As we know that within 1-3 weeks of symptoms, two SARS Cov-2 antibodies, IgM and IgG appear in the blood of which IgM appears earlier. Although, antibody tests are available in many countries worldwide and hopefully, will be available in our country or be introduced soon. Medical experts of developed countries are trying to find out the perfect antibody tests. Recently the Swiss Pharmaceutical giant Roche found that if someone had been infected, antibody tests gave the correct positive results in 100% of the time. If someone had not caught coronavirus then it showed the correct negative results more than 99.8% of the time. But some other have found less correct rate of detection than Roche figure. The perfect test could detect most of the positive cases perfectly as positive where negative cases should show up negative. False positive test will be dangerous to the individual as well as the entire community because of feeling of false assurance of protection from the infection. If the test appears to be less perfect at this stage, re checking the antibody should be done in another lab with same the type of kit may help to identify the real status of positive/negative cases. Confirmed positive cases will be a great asset for the community as a whole as the infection source of the country will be greatly reduced and they can donate plasma. In addition, it will, help to make an epidemiological data, open the doors of hospitals in order to get other nonCovid treatment (Hospitals declines to admit for the fear of spread of SARS-Cov-2 infection among their patients) and will allow near normal atmosphere to prevail in the community.
Several questions may be asked regarding the antibody test: 1) What is the optimal level of protection? 2) Will the positive patients be able to resist the different SARS-Cov-2 strains? 3) How long will the immunity last? We will get all these answers in coming days as the search for development of perfectly accurate new kits is on the way. However, very soon we will have to make a choice that is which kit (Roche or other) to order for import or to develop home grown perfect antibody detection kits in order to have a good start. Once these tests are available, it should be done in a mass scale both in the private and public sectors (as mentioned earlier) and shall be opened for all citizens. As long as an effective vaccine is not found, we have to rely upon our own immunity and adopt interim policies to prevent the spread of SARS-Cov-2 infection as well as gain public confidence.
Prof Dr Mahbub H Khan
PhD Liver Med (Sydney Uni) D Gastro (Vienna)
Member: International studies of liver