Living through the second wave | Pakistan Today

Living through the second wave

Among the imminent miseries worldwide, the mortalities and morbidities caused by the combination of covid-19 and Diabetes Mellitus are considered to be the most tragic. The pandemic has created a pandemonium and is a byword for misery. Since the beginning of the 21st century, the viruses of Nidovirales order have affected the humanity three memorable times: SARS-CoV in 2002, MERS-CoV in 2012 and SARS-CoV-2 in 2019-2020. Coronaviruses are large, enveloped and positive-stranded RNA viruses. The SARS-CoV-2 consists of an envelope which is made of spikes, membrane and envelope glycoproteins. Inside the envelope, there is the Nucleocapsid that is formed from multiple copies of the N proteins. The Nucleocapsids are perennially attached with te RNA of the virus. The Spike protein is implicated in binding to the ACE2 receptors that are located on the cell surfaces of the respiratory tract of human body. The pinioning of viral envelope and cell membrane of human cell is followed by the release of the viral genome into the target cell.

The clinical symptoms of covid-19 are fever, dry cough, malaise, diarrhea, dyspnea and pneumonia. Lab findings include lymphopenia and bilateral ground glass opacity or consolidation that is observed in Chest CT-scans. Covid-19 can be confirmed by real time RT-PCR and IgM plus IgG antibody tests.

The pharmacists and biotechnologists must track down a veracious antiviral that should eradicate the disease once and for all. Furthermore, the inhabitants of the globe should come forward to voice their apprehensions regarding any possibility of biological warfare in the New Cold War era that has already exhibited and manifested itself since the beginning of the 21st century

As a doctor in the pandemic, I made  some observations regarding diabetes mellitus and unintentional childhood injuries at home. Diabetes Mellitus refers to a group of common metabolic disorders sowing as hyperglycemia. The factors contributing are reduced insulin secretion, decreased glucose utilization and increased glucose production. Type 1 DM is a subtype of diabetes mellitus (DM) due to an autoimmune beta-cell destructive process mediated by T-lymphocytes. It can transpire at any age but it frequently manifests itself before 30. It is estimated that between five and ten percent of those developing DM after the age of 30 years have Type 1 Diabetes Mellitus (DM). Another subtype of Diabetes Mellitus is called Maturity–Onset Diabetes of the Young (MODY) that is characterized by autosomal dominant inheritance, early onset of hyperglycemia (usually under 25) and impairment in nsulin secretion. MODY is divided into MODY 1, 2, 3, 4, 5, 6 and so on. Other subtypes of DM are Gestational Diabetes and Type 2 Diabetes Mellitus. Type 2 Diabetes Mellitus is characterized by Impaired Insulin Secretion, Insulin Resistance, Excessive Hepatic Glucose Production and Abnormal Fat metabolism.

The acute complications of DM are Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State (HHS). The micro-vascular complications of DM are Retinopathy, Neuropathy and Nephropathy. The macrovascular complications are Coronary Heart Disease, Peripheral Arterial Disease and Cerebrovascular Disease. Other complications include Diabetic Foots and Ulcers. In the light of all the aforementioned complications of DM, simultaneous COVID-19 disease can lead to dreadful effects. This group of patients needs our sympathy.

Another hallmark of interest is the unintentional injuries of children at home, especially under the age of five. These injuries mostly occur due to burns, drowning, poisoning and fall and are responsible for the mortality of round about seven percent among 875,000 deaths of children each year. According to a report of Centers for Disease Control and Prevention (2001), In the USA, more children between the ages of one and four die annually from unintentional injuries than from all childhood diseases combined. Furthermore, For every childhood death caused by injury, there are approximately 18 hospitalizations, 233 emergency department visits, many more visits to medical facilities, and a much larger number of home-treated injuries. The factors associated with unintentional injuries at home are physical, biological and social environments. During the coronavirus pandemic, there is a dire need to minimize such types of injuries for reducing hospital admissions and stays, which are high-water marks for contamination of COVID-19 in third world countries.

To beat the extremities of agoraphobia and of the purgatory-like scenes around the world, the philanthropists and community of scientists must come forward to ferret out a pragmatic screenplay of active and passive immunity against SARS-CoV-2. Research should be carried out to discover a meaningful vaccine and synthetic immunoglobulins. Though, Pfizer and BioNTech in November 2020 released the details of a vaccine that could prevent more than 90 percent of people from getting covid-19, still much more efforts are required from brains and brawn of humanity. Antivirals like Favipiravir and Remdesivir are already approved for elimination of this menace in some countries but the pharmacists and biotechnologists must track down a veracious antiviral that should eradicate the disease once and for all. Furthermore, the inhabitants of the globe should come forward to voice their apprehensions regarding any possibility of biological warfare in the New Cold War era that has already exhibited and manifested itself since the beginning of the 21st century.

In order to give hope to diabetic patients who also suffer from covid-19, the whole health community should devise plans to find selective TGF-β inhibitors. Studies should also be carried out on inhibition of Inflammatory Signalling Pathways such as Nuclear Factor kB (NF-kB) pathway. Similarly, gene therapy by viral vector or by non-viral transduction and stem cells curing techniques should be explored worldwide for the best results. VEGF-A inhibition therapy in retinopathic cases should be provided at nearby primary health care centres by a covid-19-free healthcare professional if possible. Incretin analogues may also be supplied to deserving patients. The depression and anxiety of these patients need to be reduced and for this purpose, psychiatrists and psychologists are advised to play their lead role.

Though Duloxetine is the drug of choice for curtailment of neuropathic pain, the clinicians and policy makers should ponder over the scenario as an organic whole that also includes factors like poverty, environment and trust capital. Vitamin B-12 (Cobalmin) should be proffered free of cost to diabetic patients. Antibiotics that can act against MRSA should be included in the essential drugs list of hospitals during the pandemic.

Policies should be shaped to bring into existence a safe environment within abodes for children during the pandemic and an awareness session must be arranged via media to educate the parents with more emphasis on keeping dangerous objects out of the reach of children.

Another way of bringing new hope and blessings to humanity during the pandemic is via introducing electronic government in every nook and corner of this world. Electronic governance comprises electronic administration, electronic services, electronic democracy and electronic business. The sowing of seeds of biometric voting system in elections and transformation of the revenue system by replacing conventional means should be spearheaded without any delay all over the world during the pandemic. Furthermore, the social security laws and system all over world should be made more labor/employee-friendly so that the poor (excluding rich) victims of unemployment in private sector institutions during this pandemic can satisfy their mouth and stomach. It is also added that States all over the world may initiate debt-free and interest-free currencies for a short period of time to bear the expenses during this pandemic. The humanity can emulate the Bradbury Pound initiative or the Constitutional Monetary System of Lincoln for a period of two or three months. Similarly, single/solitary person tourism should be encouraged to beat the woes of anxiety and depression.

The writer is a doctor and is serving in Khyber Pakhtunkhwa.