The Covid-19 pandemic has affected the people and economies of the world in an unprecedented manner. It has further divided a very divided world of technology-have and technology-have-nots into the vaccinated and not-vaccinated. Currently the third wave of Covid-19 pandemic is creating havoc around the world. The leaders around the world are struggling to cope with the challenges of flattening the curve. According to John Hopkins University data on Covid-19, as of June 6, 2021, globally there have been more than 3.7 million deaths, 172 million confirmed cases, and over 2 billion vaccine doses administered.
During 2020, more than $50 billion has been spent in the United States to ramp up Covid-19 testing, diagnosis, modeling, treatment, and vaccine development. Researchers are developing new mathematical models to more effectively predict the spread of viruses based on human interactions and behaviors.
Using state-of-the-art genetic technologies, the pharmaceutical community has shortened the typical 7-10 year vaccine development period to about a year, and in the process produced a number of vaccines using different techniques and strategies. The Pfizer and Moderna vaccines use the mRNA technology that delivers a piece of genetic code to cells to produce the surface protein aka spike on the SARS-2 virus; the produced proteins activate the immune system to treat as invading entities and develop antibodies to combat it. The Johnson & Johnson, Oxford University AstraZeneca, and Russian Sputnik V are viral vector vaccines that use a technique to instruct the human cells to make the SARS-2 spike protein, which in response triggers an immune response. The Chinese Sinovac and Sinopharm use conventional attenuated viruses. Researchers are also developing an inhalable artificial corona-virus antibody that restrains the ability of viruses to infect human cells.
The vaccine manufactures have claimed to have efficacy efficiency of more than 90%, but so far no one has verified these claims via a third party assessment or through peer reviewed journals. There have been some reports of the adverse effects of these vaccines; the administration of Johnson & Johnson and AstraZeneca vaccines has caused formation of blood clots in some recipients of the vaccines.
Developing countries, with their limited resources and lack of adequate medical infrastructures, are struggling to curb the pandemic with the emergence of so many new virus variants and the potential side effects and uncertainties of various types of vaccines.
The recently published Book "An Aid to the Management of COVID-19 in Bangladesh: Lessons from the Western Experience – Fighting Covid-19 on the Front Line," provides a blueprint for the medical community to manage the Covid-19 crisis. Although the book's main focus is Bangladesh, it can be used by physicians all over the world especially in the developing countries to curb the pandemic.
The book covers a wide spectrum of topics that include, Covid19 – key recommendations for Bangladesh, diagnosis and medical management, oxygen: the main therapy for management of covid, infection, medical, surgery and oncology, pediatrics and gynecology, mental health, public health measures in the context of covid, ongoing trials, FAQs, and useful online resources.
In the preface, Dr. Shakil Farid, outlining the objectives for writing the book observes: "Throughout the world, health authorities are facing unprecedented difficulties in dealing with the current Covid-19 crisis. Authorities in Bangladesh have already formulated robust national guidelines with the help of local experts. This handout is a small effort by some highly motivated Bangladeshi doctors living in the UK and USA to supplement local guidelines in Bangladesh. This will hopefully enable local experts in Bangladesh to be kept updated about local treatment protocols worldwide for this difficult group of patients. In the absence of evidence for specific drug therapy, mostly supportive treatment is provided throughout the world. Specific drug therapy is provided to only a select group of patients who are enrolled within a clinical trial. This document has been edited by two very experienced and well-respected Bangladeshi editors in order to make it more relevant for Bangladeshi doctors. We are very grateful to our authors for giving their valuable time despite being completely inundated with work during this pandemic... Most of the materials are adapted from the most recent international guidelines (NHS England, NICE, NHS Improvement, UK Royal Colleges, Public health England, WHO, CDC, Hospital Trust Intranets) and modified for Bangladesh…"
The book has been edited by Dr Shakil Farid, Consultant Cardiac Surgeon Oxford University Hospitals NHS Foundation Trust, UK, and his team that includes Dr Zahed Ikram, Consultant in Geriatric Medicine and Internal Medicine Western Sussex Hospitals NHS Trust, UK, Dr Tasbirul Islam Clinical Associate Professor, Indiana University School of Medicine, IN, USA, Prof. Dr Mohammad Azizul Kahhar Professor of Medicine, Anwer Khan Modern Medical College & Hospital. Dhanmondi, Dhaka, Bangladesh, and Prof. Dr Towhidul Alam, Chairman, Department of Surgery Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. More than 60 doctors and professors have contributed to the content of the book. Discussing the diagnosis and management of Covid-19, the authors observe:
- There is a current widespread perception that people either die, get admitted to hospital or recover after two weeks but it is increasingly clear that for some people there is a distinct pathway of ongoing effects.
- A working diagnosis that is recognised by healthcare services, employers and government agencies would facilitate access to much needed support and provide the basis for planning appropriate services. While it is too early to give a precise definition, guidance on reaching a working diagnosis is needed
- People experience a wide range of fluctuating and multisystem symptoms that need to be acknowledged. A common theme is that symptoms arise in one physiological system then abate only for symptoms to arise in a different system.
- There are significant psychological and social impacts that will have long-term consequences for individuals and for society if not well managed.
- Health and social care services are not equipped to support people living with Covid-19. Staff need better information and education on the ongoing effects.
- There is an urgent need to better understand the symptom journey and provide realistic expectations about progression.
Expounding on the use of Oxygen as the main therapy for management of Covid-19, Dr Shakil Farid and Dr Zahed Ikram observe:" Medical oxygen therapy is a core part of the treatment of patients with severe Covid-19. Particularly in low- and middle-income countries (LMICs), where supplies are likely to be inadequate in the face of the pandemic, boosting access to medical oxygen can save lives. Oxygen supply has been a long-neglected issue in health care delivery. Large hospitals in the United States, the EU, China, and many middle-income countries have onsite liquid oxygen tanks that supply oxygen to the entire hospital. Most hospitals keep some compressed oxygen cylinders as backup in case the main tank stops working. Liquid oxygen to hospitals is provided by medical oxygen manufacturers.
During the peak of Covid-19, oxygen consumption tripled in different countries, forcing considerable increases in production and installation of bulk storage tanks onsite at designated Covid-19 treatment facilities." The authors' observations are validated by the shortage of Oxygen in India during the third Covid-19 wave.
Discussing infection control, Dr Muhammad S. Tabriz observes: "Infection prevention and control (IPC) is one of the most important aspects for any healthcare facility to ensure the safety of patients, healthcare personnel, and the environment…An effective infection control program requires multidisciplinary approach, participation, commitment, and coordination among different departments administration, engineering, environmental services (cleaning, disinfection and waste disposal), Infectious disease specialists, microbiologists, and in some cases local and governmental agencies…."
Reviewing the issues related to Medical Specialties, Dr Farhana Tasneem Rimi et al state: "Patients with cardiac diseases may present with symptoms and signs which may raise suspicion of Covid-19 infection and need to be triaged accordingly so that the health care workers are protected. Covid-19 infection itself may have cardiovascular manifestations and can lead to a variety of cardiovascular complications….Patients with CV risk factors have been identified as particularly vulnerable populations with increased morbidity and mortality when suffering from Covid-19…"
Discussing the relationship between Kidney disease and Covid-19, Dr Sarah Choudhury and Dr Tasbirul Islam observe: "Initial reports from Wuhan suggested that the burden of acute kidney injury with Covid-19 infection was relatively low, ranging from 3% to 9% but subsequent analyses demonstrated incidence rates as high as 15% and the incidence of needing renal replacement therapy might be up to 15-25%. A retrospective study of 201 patients with confirmed Covid-19 pneumonia in China showed that 41.8% developed ARDS and 4.5% developed AKI…Covid-19 patients are tremendously catabolic with hyperkalemia, hyperphosphatemia, and profound metabolic acidosis. The cause of kidney involvement in Covid-19 is likely to be multifactorial, and predisposing factors (e.g., sepsis, hypovolemia, rhabdomyolysis, macrophage activation syndrome, micro thrombi and nephrotoxins) as important contributors…"
Expounding on the topic of Public Health Approach for Control of Covid-19 viz a viz metal health, Dr Enamul Karim and Dr Parveen Salam of PEN consultancy observe: "During the current Covid-19 crisis, the whole world is facing an unprecedented situation. It means that life is changing for all of us for a while. It may cause you to feel anxious, stressed, worried, sad, bored, lonely, or frustrated. There are some simple things you can do to help you take care of your mental health and wellbeing: Look after your physical well-being, continue to have treatment, Stay connected with people, Talk about your worries, Manage your media and information intake, Take time to relax and focus on the present…"
The book is a hands-on manual for guiding doctors to effectively deal with the Covid-19 patients. The authors have revised the book six times to include the present state-of-art strategies and emerging evidence in dealing with Covid-19 pandemic. In addition to strategies and recommendations for treating Covid-19 patients, the book also has a number of illustrations, flowcharts, and photos to share various medical procedures and protocols with the medical community. Dr Sajid Muhaimin Choudhury, Assistant Professor, EEE Dept. BUET, Dhaka has done a wonderful job of compiling and designing the digital format of the book. The book is an excellent resource for physicians treating Covid-19 patients all over the world especially in the developing countries, where the strategies and recommendations discussed in the book could be employed to curb the pandemic with limited available resources.