With more than 3million cases worldwide and about a quarter of a million deaths and still counting, we face a dire situation with many lessons to be learnt. With recent developments, it appears we were myopic to think of Covid-19 as just a respiratory disease.
We know from the practice of Medicine that the first doctor interacting with a patient can initiate a cascade of thought processes and events that would determine how soon a patient gets a definite diagnosis and treatment; the nature of such diagnosis and treatment as well as what the cost would be to the patient financially and otherwise.
A wrong initial assessment can be costly, our handling of COVID-19 demands a thorough investigation on what went wrong ab initio, why were basic facts and principles ignored in pursuit of more complex analysis and treatment protocols?
Can we attribute this to ‘panic’ or would it be enough to say that often with new diseases it takes a lot of effort to clearly understand how they present and how they can be managed, or that findings can vary across the age groups, from one continent to another and differences can exist across the many sociocultural determinants of diseases?
Interventions for Covid-19 have been largely ignored, some coming from laypersons with little medical knowledge and others from renowned physicians. These ‘people’ have shared various forms of therapies; diets, warm massages, physical therapies, etc. while we paid little attention to many of these, billions have been spent on ICU beds, ventilators bought at exorbitant prices, economies are at the verge of collapse, families have been destabilized after losing loved ones and the death count is growing. It appears that we have not done anything uniquely different from the developed world but so far nature has been kind to us in Africa.
Now to a little about the science, It would appear that Covid-19 presents with significant vascular/haematological problems that deserve more attention. We have well-documented evidence for higher mortality for Covid-19 in older persons with background medical conditions such as Diabetes and Hypertension. That being the case, can thrombosis, coagulopathy, and their relationship with atherosclerosis in populations of hypertensives, diabetics, obese individuals, elderly bedridden seniors in nursing homes, individuals in prisons, the hospital inpatients (where ambulation is restricted) explain the higher mortality from Covid19 in these patients? There is also documented evidence for a Kawasaki like syndrome in children in the UK. Again, this suggests that physical inactivity, staying for a prolonged period at home, lying in bed for hours, or sitting for many hours taking online classes can worsen the outcome of coronavirus infection even in children and young adults.
I would not risk dwelling too much on the science because this writeup is not for the medically inclined only, it is not a scientific paper, it is not to seek self-aggrandizement but rather it is to call our political leaders to action, encourage our own “home-based” scientists to take the bull by the horns, so we can all stop seeking copycat solutions from the western world.
This is a global pandemic that has been taunted to have emerged from China and Covid-19 has wreaked huge havoc in communities in Europe and America. Wuhan is back in business, the European nations are gradually getting ready to reopen their economies, Ghana had taken a bold step of lifting lockdowns and Nigeria is about to do same, we should work with data and scientific evidence, we should shy away from attributing every fatal outcome to Covid-19. We had several causes of death before Covid-19 and those can not disappear suddenly, Covid-19 may likely be around for a long time to come. There is an urgent need to do away with stigma, press reporting should be sensitive to this.
Let us stand by our government and health authorities to fight this virus. This pandemic should not slow down globally to become an African epidemic. If we act swiftly and smartly, trials of vaccines would not be done in Africa because it would not be necessary. African scientists must work together to develop sustainable solutions to diseases that ravage us and not just Covid-19. These other diseases take more lives than Covid-19 and so should remain in focus for funding and research. The NCDC should consider placing equal priority on other infectious diseases killing our people.
As a people prone to myths and cultural interpretation of events, it is important to embrace Covid-19 as a viral disease of our time and accommodate it as such. In developing a treatment for Covid-19 at this time, we should give considerations to the following:
Conditions that predispose to blood stasis or coagulopathy such as the haemoglobinopathies may provide an interesting comparison to Covid-19.
From what anecdotal reports suggest, every suspected or confirmed Covid-19 patient may benefit from empirical treatment with antimalarial drugs. We should consider the use of anti-inflammatory drugs, careful use of intravenous fluid, intravenous medications, and exchange blood transfusion in the management of Covid19 patients.
We should consider the use of prophylactic anticoagulants such as Aspirin; which is cheap and readily available in all persons at risk of adverse outcome, factors to be considered include being Male, age 35 years and above, obesity, physical inactivity, evidence or predictors of atherosclerosis; hypertension, diabetes, substance use, previous stroke and in those with underlying medical conditions where the use of anticoagulant is not contraindicated.
The mental health of Covid-19 patients should not be neglected.
We should consider physical therapy by qualified physiotherapists in patients with Covid-19.
The various techniques employed by Physiotherapists can help improve blood flow. Use of supplemental oxygen when necessary. However, mechanical ventilation should be actively discouraged except as a measure of last resort. Increased testing should be encouraged in emergency and outpatient settings, a positive test for Covid-19 will henceforth alter treatment and prognosis for too many patients, such that provider-initiated-testing may become necessary for all medically ill persons seen at our clinics and emergency departments.
The government should approve the use of rapid test kits, which can give results within minutes and can be conveniently done by the attending physician using blood or plasma-like we have for malaria. Even low specificity tests for coronaviruses can be considered for approval as we await better ones.
Finally, our political leaders and leaders of industries must be made to see reasons to more rapidly lift lockdowns, allow businesses run under the new reality of this pandemic, let our children go back to school, those that can work productively from home can continue to do so but should make plans for regular physical exercises, adjust workspaces to allow for physical distancing and continue the practice of hand and respiratory hygiene.
There is an urgent need to re-strategize for economic growth and to adopt innovative methods for running businesses and governments.
We should actively position ourselves for economic inclusion and diversification on a global scale. Our government should empower the medical establishment to work at full capacity, please make personal protective equipment available for all doctors and health workers. Until when a vaccine is available, the use of a face mask by everyone in public places would likely continue.
Please, let us get the information out there, let us encourage our scientists to look inwards for solutions while also actively collaborating with colleagues abroad, we can not afford to wait for the western world on this, they have been hard hit by the virus. It is time to take responsibility for ourselves and in doing this positively impact our world.
Dr. Adigun Agboola J.
Writes from Ibadan, Nigeria.