Silver linings in the COVID cloud

The government has officially announced that the young woman who died in Dhulikhel Hospital on Saturday ten days after giving birth was Nepal’s first COVID-19 fatality.

Although tests showed that she indeed was infected with the novel coronavirus, we do not know the true cause because she does not fit the demographics. There is no evidence yet that pregnant women or those who have just given birth are more prone to the illness.

Could she, while being infected with COVID-19, have died of pulmonary embolism, or did she have fulminant pulmonary TB which is always a possibility in Nepal? Similar questions will be asked about the young Nepali worker who died in quarantine in Banke on Sunday soon after returning from India, the second to die of the coronavirus.

The number of Nepalis testing positive for the novel coronavirus has now reached 291, with another 11 cases on Sunday from Rautahat. Overseas, 96 Nepalis have died of the virus, 77 of them women and 19 women. The majority of the deaths (63) were in UK, with 15 fatalities in the United States.

COVID-19 continues its relentless global rampage, but it has also helped transform medicine in more positive ways.

For example, patients with COPD (chronic obstructive pulmonary disease) are literally breathing easier because of cleaner air. Anecdotally, they are using much less supplemental oxygen, or have even stored their oxygen machines for now. Asthma exacerbations also appear to be significantly less.

Doctors had thought such relief for COPD patients was not possible. And they acknowledge that this may just be a temporary reprieve, as air pollution levels are sure to climb once the lockdown is lifted.

If people continue to wear masks (even a simple cloth masks) and frequently wash hands with soap, it will help keep in check out not only COVID-19 but other chronic respiratory and gastro-intestinal infections.

COVID-19 revives Nepal's WASH drive, Sonia Awale

There is every likelihood that because of COVID-19 precautions, doctors in Nepal will be seeing fewer patients with lung and stomach ailments once the pandemic retreats. This would be similar to the dramatic drop in orthopedic injuries at hospital emergencies post-breathalyser testing in Nepal.

There could be many before and after COVID-19 studies, especially pertaining to infectious diseases that may show these differences in stark relief.

Interestingly, there are heated debates about the efficacy of masks even though Hong Kong, China, Taiwan, South Korea and Japan have clearly shown that masks are instrumental in slowing the spread of the virus. Pro-mask advocates in the United States (where wearing one is seen as a violation of personal liberty) are fighting back with colourful twitter hashtags like #wearafuckingmask.

Together with physical distancing, hand washing and masks are practical ways to prevent against this virus, regardless of when the vaccine will be available. Unfortunately, no promising drug treatment seems to be on the horizon in the ongoing clinical trials.

Countries cooperating to find COVID-19 cure, Buddha Basnyat

Another area that COVID-19 could change in medicine would be in diagnostics. The pandemic has revealed the importance of quick, reliable test kits for pre-existing biblical diseases that still plague countries like Nepal: tuberculosis, typhoid and typhus. These are some of the greatest killers in our part of the world and yet we have no quick reliable tests. Maybe COVID-19 will speed up the development of quick test kits for these disease too.

The coronavirus crisis has also underlined the importance of universal health care which can save millions of poor in the poorest countries against catastrophic outbreaks.  Telemedicine, the importance of vaccines and properly conducted drug trials including other forms of medical research may now more clearly be understood, not only by health care professionals but the public at large.

The other area of transformational change as a result of COVID-19, is in the  field of medical publications. There are more than 7,000 papers on the pandemic and many of them have published in pre-print sites like BioRxiv, MedRxiv, and Rxiv.

Anyone can submit a paper and site managers will give a cursory look and decide to publish or not so that, if published, it is readily available to the world especially during the pandemic when speed and sharing of knowledge is of the essence.

This is potentially hugely advantageous as scientists may be able to act on the findings and make a difference. These pre-prints can later be  subjected to the regular peer review process and be published in traditional journals which are slower, more secretive and cumbersome procedure.

There is a down-side because unscrupulous scientists can make things up and publish in the pre-print format which has a greater chance of escaping the rigors of proper peer review. Indeed this is recently what happened.

In January, Indian scientists claimed in BioRXiv that the novel coronavirus  was manufactured in the laboratory because there were strong similarities between the genetic sequence of HIV and SARS-CoV-2. However many well-known molecular researchers were strongly critical of the methodology in the Indian study, which was thought to be a hoax, and was eventually retracted.

The pandemic turbocharged the pre-print process for research papers. Most scientists may not bother with the ossified ways of initial peer reviewing, even though there clearly are dangerous pitfalls.

Read also: Prevention while searching for a cure, Buddha Basnyat

Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a frequent health columnist for Nepali Times.