Mulazim Hussain Bukhari  ( University College of Medicine, University of Lahore, Lahore, Pakistan )

Today the higher risk of global catastrophe does not look like a nuclear war. Instead it is a viral infection in the shape of COVID19 with no remedy available. In times of war, one goes down the bunkers with enough food and water stored to keep oneself safe from nuclear radiations. The question is whether we are ready to face this new viral pandemic. It cannot be called a bioterrorism, as this would be an accusation without proof, but it is apparent that the new catastrophes may kill millions of people, greater than world war I or II. The other question is the do's and dont's in Pakistan. Can the situation be handled and containment measures taken by the local authorities and the international regulatory bodies like WHO? What ethical rules should be made by the public health authorities to cope with this disease? The current outbreak of novel COVID19 (SARS2 CoV19) after confirming from (RT-PCR.) in The People's Republic of China, with exportations was currently reported on 11th March, 2020 by WHO¹ as a pandemic. It is a major Public Health Emergency of International Concern. The current outbreak began in Wuhan, Hubei province, of China, and was different from previous outbreaks. They reported 4th generation cases in Wuhan, a city of 10.1 million and 2nd generation cases outside Wuhan, as well as some clusters outside Hubei province. The success of the Chinese health authorities, lay in the immediate actions taken by the relevant authorities, first by investigation and identification of the outbreak source and then isolation of people suspected as virus host, close monitoring of contacts, epidemiological and clinical data collection from patients, and development of diagnostic and treatment procedures.^2-6 To reduce the morality rates and spread of the infection, all the countries should follow the instructions of the World Health Organization (WHO) and take the measures to face the ethical aspects of this outbreak regarding preparedness and implementation of infection control practices in the world. These measures were insufficient in previous SARS-COV and MERS-CoV which resulted in mortalities of 8096 (37%) and 744 (10%) respectively.^7-9 The world must be explained about the gravity of this situation, stressing upon the need to adopt strong containment measures as closure of publictransportation systems are in place in Wuhan and other neighbouring cities. Which China's immediate actions to implement such measures resulted in an excellent outcome that has helped in keeping the outbreak well under control.² The devastating Ebola outbreak of 2013-16 impacted three West African countries, and enforced the declaration of "Public Health”, which brought world attention to the challenges of diseases and gathered the epidemiologists, scientists, clinicians, and societies for the preparation to handle future epidemics.¹¹ During this COVID 19, outbreak, the world does not have a group of epidemiologists ready to assess the nature of the disease and how far it will spread. Most of the countries in this outbreak, did not have a medical team ready to face the issues, or means to educate and prepare the people to combat the situation. Even in advanced countries, the situation is grave and the workers could not be trained at a speed to face the disease and its outcome. The rapid urbanization, low immunity and poor infrastructure has made COVID19 a Pandemic, which will have a strong impact on mortality, morbidity and significant social and economic disruption. There is a lot to do to save the world. For this COVID19 pandemic. It would require to have hundreds of thousands of health workers, Clinicians to look at treatment approaches, the team of Pathologists to look at diagnostics, Scientists to figure out what tool should be used as an example, to take the blood from survivors, process it and put that plasma back in the people who are suffering from the disease. Any negligence can kill millions of people, like Spanish flu in 1918, which killed between 50-100 million people worldwide in 1918-19.¹² This COVID19 is due to a new virus and still has no rapid or cheapest test except the real time PCR, which is expensive and not fully reliable, approach to this test is not easy for a common individual. Another problem, the sampling is only with nasopharangeal or oropharyngeal secretions. There is no way to test by the serum. We all know that there no vaccine till now therefore its diagnostic tests and treatment options are limited. The communication system is efficient to monitor and collect the data on the response and monitoring the progress and complications of this infectious disease. This will help countries to share their data with the WHO. This will help the scientists to work on vaccines and drugs to combat this pathogen. The experience of the Chinese scientists will provide more information on cross-government risk management measures, including crisis management systems at national, provincial, and city levels, and other domestic measures.^9,12 There is no need to panic, as this disease can be overcome by a strong immune system. Special care should be taken on cleanliness, nutritious food and social distancing. People with co-morbids as diabetes, Hypertension, Tuberculosis, Chronic Obstructive Pulmonary Disease and Hepatitis already have a compromised immune system. They have to be over cautious. Younger children and the elderly need more care. All the precautionary measures being widely circulated on the media and by mouth should be observed.¹¹ Thus, in this current situation, all countries should be prepared for containment, active surveillance, early detection, isolation and case management, contact tracing and prevention of the onward spread of SARS-2-COV-19 infection. This demands quick logistics, rapid production of vaccines and quick and economical diagnostic tests.^3,11 COVID-19 is not a problem of one nation. It is a pandemic viral infection and can take many months to decline. The required precautions should be made habitual to keep safe. A quick plan has to be made for health professionals and the public. All authorities nationally and internationally have to work together to combat this outbreak. The emergency committee members should regularly be informed about all developments being taken place regarding this outbreak. Pandemics are rare but have not disappeared. Precautionary measures are mandatory as said, "Prevention is better than cure."

 

References

 

1. Domenico Cucinotta, Maurizio Vanelli. WHO Declares COVID-19 a Pandemic. Acta Biomed.2020; 91: 157-160.

2. Statement on the meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). (Cited 1st Feb, 2020). Available from URL: https://www.who.int/news-room/detail/23-01-2020.

3. WHO. Novel coronavirus - Thailand (ex-China). Geneva: World Health Organization, Jan 14, 2020. (Cited 23 Jan, 2020). Available from URL: https://www.who.int/csr/don/14.

4. China National Health Commission. Update on the novel coronavirus pneumonia outbreak (Jan 24, 2020). (Cited 24 Jan, 2020). Available from URL: http://www.nhc.gov.cn/xcs/ yqfkdt/202001c5da49c4c5bf4bcfb320ec2036480627.shtml.

5. WHO. Novel coronavirus - Republic of Korea (ex-China). Geneva: World Health Organization, 2020. (Cited 24 Jan, 2020). Available from URL: https://www.who.int/csr/don/21-.

6. US Centers for Disease Control and Prevention. First travel-related case of 2019 novel coronavirus detected in United States. Atlanta, GA: US Centers for Disease Control and Prevention, 2020. (Cited 24 Jan, 2020). Available from URL: https://www.cdc.gov/media/ releases/2020/p0121-novel-coronavirus-travel-case.html.

7. Viboud C, Eisenstein J, Reid AH, Janczewski TA, Morens DM, Taubenberger JK. Age- and sex-specific mortality associated with the 1918-1919 influenza pandemic in Kentucky. J Infect Dis 2013; 207: 721-29.

8. WHO. Middle East respiratory syndrome coronavirus (MERS-CoV). Geneva: World Health Organization, 2020. (Cited 12 Jan, 2020). Available from URL: http://www.who.int/emergencies/merscov/en/.

9. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013; 13: 752-61. 12.

10. WHO. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Geneva: World Health Organization, 2004. (Cited on 1st Feb, 2020). Available from URL: http://www.who.int/csr/sars/country/table2004_04_21/en/.

11. Denis malvy, Anita K McElory, Hilde de Clerck, Stephan Gunther, John van Griensven. Ebola Virus Disease Lancet, 2019; 393: 936-948.

12. Borza T. Spanish Flu in Norway 1918-19. Tidsskr Nor Laegeforen, 2001, 121: 3551-4.

13. A novel coronavirus outbreak of global health concern. www.thelancet.com. Published online January 24, 2020. Cited on 1st Feb, 2020. Available from URL: https://doi.org/10.1016/S0140- 6736(20)30185-9.