Pandemic Diary #2: Doctor, USA

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Second entry in the series

Could you tell us how COVID19 started in America?

From the news, it started from the city of Wuhan in China and was reported back in December 2019. We did not get the information here in the United States until the end of February. Although our government knew about it, they did nothing. The first case in my hospital was discovered the first week of March; the patient I admitted from the emergency room.

How does it feel to face the risk attached to COVID19 every day?

The risk is there and it is very scary. Right from the moment I admitted the patient who had had symptoms for about ten days. He was a school teacher who taught in two schools. He had pains, difficulty breathing and dry cough. I admitted him the third day when his fever didn’t subside, one of my colleagues decided to test him for COVID19.  Thank God I had my mask and my gloves on when I saw him at the emergency room. 

It was very scary because this was the first patient at my hospital. Due to this, I was told to stay home. That day, everyone kept on calling, my children were frightened.  I eventually didn’t develop symptoms. Regardless, we still have to see the patients and protect ourselves. However, the background anxiety and the reality of the situation is there. 

How does this affect your mental health?

Right. The first week when we had a lot of cases in my hospital, it wasn’t easy. I’m in a group of physicians and we are about ten in my group. Everyone kind of broke down in tears. People were crying all around, the day I actually cried was the day I had about 11 patients. Having to constantly change, this and that, about ten times. My head was hurting, I came down to my office and broke down in tears. My colleagues were all there and at this point, we all agreed this had to stop. Unfortunately, it has not.

To help ourselves, one of my colleagues brought in a 10-minute meditation tool to relax. We all sat in the office, put the lights off and listened; we did that continuously for three days. At this point, we just joke about it in the office because we can’t avoid the situation. So, I honestly don’t think I am affected now. I have a lot of friends who I open up to and who pray for me. I release a lot of tension by talking to my friends. That kind of helps.

What’s the typical day like working with a COVID19 Patient?

Hmm. Firstly, we have designed a protocol at my hospital. Instead of going into the room with the patient, we use a telephone. I call their room, introduce myself and give them their results.  If positive, I ask about their current symptoms. If the patient has had any CT scan done, I explain what their oxygen levels are like. I then give them the opportunity to ask any questions on the forum. After, I inform the patient that I will be coming into their room to examine them and that I would not be asking any questions in the room, as it is highly infectious.  When I go into the room, I do all the necessary examinations and between a minute or two, I’m out. That’s for a typical patient.      

How has your personal life been affected?

Well as a physician, I’m passionate about the wellbeing of my patients. It is my priority most of the time. It really affects me when I see my patients not getting better and still having to transfer them to the ICU, especially the young ones. When I come home, I think about it and I follow them on the computer to see how they are doing. Like I said, because I have so many friends that are doctors, I kind of let out my anxiety through my medical school forum and I have a lot of friendsand relatives that keep on praying and calling me to make sure that I keep safe. At the same time, I pray for my patients, just to make sure that they are okay. So far, I have not had any deaths on my list.

Do you think America has done a good job so far?

The news that you guys see over there is the international news. Over here, we get first-hand information from other news channels asides CNN.  The President originally made it political rather than listen to the scientists. Due to this, it took the government a while to believe that this was real. Initially, the government promised that the number of cases will be very low, about 15 cases and after two weeks, it should go away. The President actually mocked the Governor of Washington state, which was where the first case was recorded. 

The Governor acted swiftly on the case, as a result, he was mocked by the President of America. The President said that he was trying to gain the attention of the media and referred to him as a snake. Due to these, the government was not prepared for the tsunami attack of the virus. When it started spreading to other states, nothing was done about it till about the middle of March or something. Many people had died at this point in New York. 

The government’s response caused the majority of the lives that were lost. The President didn’t call a national shutdown, but it was done state by state. Most of the republican states did not call for a lockdown, this was because they were following the President. News stations like Fox news are largely republican and the President and other republicans speak through Fox News. Hence, most of their listeners are old, Caucasian men who do not listen to any other news besides Fox News. The result of this was a large exposure because they initially assumed it was fake news.

Many were affected because they did not stay home. As we can see, they’re getting the aftereffect of not staying home. In the next two weeks, the President will most likely call off the lock-down. There are a lot of asymptomatic patients moving around who will be the next wave of people that will be seen in America if the lockdown is called off. 

Even though many people are dying, he’s still saying that it’s better for 240,000 people to die than 2 million. If any of them were to be affected, they would be given utmost care whereas the majority of people who are affected here are really the African Americans. Those who their socio-economic class is low. They live in poverty, are uneducated, obese and usually have diabetes, hypertension, cholesterol, heart problems, etc.  They really do not have the right kind of immunity. They are dying in thousands every day. The government has obviously not done a good job.

From another angle, the so-called African-Americans who are born here usually don’t have access to good health care due to educational status. Although the republican government has tried to remove so many subsidies away that makes life easier, they still largely depend on the government for assistance. This is one of the reasons it spreads fast among them. 

For example, an African American died of Corona so a funeral was organised in honour of the deceased. More than a quarter of the people that attended the funeral tested positive to COVID19. The funeral director and about four siblings of the deceased died.  I picked up one of the family members that attended this funeral and he informed me that he was still being tested.  By the time I arrived home that day, he had been moved into ICU.

Your advice to the common man 

We should listen to all the scientists talking on the radio and on the television. One, hand washing is very important. We must wash our hands for about 20 seconds, the back of the hands, in between the fingers and the nails should be caught short. This is not the time to have fake nails. Take out the fake nails and wash underneath the nails and all that. 

We should avoid putting our hands on our faces, mouth or the nose because that’s the source of the infection.  If you have to scratch your nose or eyes, you should find a cloth or tissue.

If you can wash your hands like hundred times a day, even if you had any contact with the virus, it would have been washed out. Also, if you have the virus or you develop symptoms like aches and pains, dry cough, runny nose, bad taste in the mouth that progresses to breathing difficulty, then it’s time to go to the health department in your local community. That’s not the time to go to your doctor’s office as this may lead to a wider spread of the virus. 

If tested positive, they can be isolated. However,  it’s going to be difficult for the Nigerian government to quarantine all patients in their homes. This is because people usually live in the face-me-I-face you apartments where there are a lot of people in a home. Hence, it’s better to go where the government is isolating the patients. 

What do you have to say concerning the use of various drugs to ‘cure’ Coronavirus? 

Yeah, these drugs are just being used as a clinical trial.

From the clinical trial being done with some medications, the analysis showed that nearly 14% of recipients were unable to complete the full 14-day experiment primarily due to adverse effects like anorexia, nausea, abdominal discomfort as well as diarrhoea. Some of these drugs have a lot of side effects. It can also prolong the QT level and if not monitored, the patient can develop cardiac arrest. In conclusion, the guideline I recommend is to use these only in the context of a clinical trial; additional clinical trials or prospective outcome registry are needed to conduct research.  There’s no guideline to practice for this new virus. We isolate them, tell them to hydrate themselves and manage their temperature. without giving out medication, the majority of patients will recover and go home. 

Wow. Thank you for your time and this information.

Thank you.

Interviewed by Faridah Bakare, 17th April 2020

Removing the Barriers to Pandemic Control in Nigeria

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Pandemics are threats that still exist even with advances in medicine and technology. The closeness of the Ebola epicentre poses another risk. This country remembers too well the toll the last Ebola outbreak took on her people and health system. The relief of its successful control is tempered by the realization that it takes just an infected person and poor surveillance at ports of entry to be in the position we were in 2014.

On a wider scale, the current COVID19 outbreak has nations around the world grappling with overwhelmed health systems, a deluge of cases and deaths. It is a race against an ever-mutating virus to employ a variety of ways to protect citizens and prevent further spread of the SARSCov2 (the virus causing COVID19). This, unlike Lassa and Ebola, is transmitted via droplets and contaminated surfaces. The spread of all three can be curtailed by effective risk communication, early reporting, isolation and treatment of identified cases, personal protective measures like handwashing and debunking of dangerous myths.

There are many factors preventing the ordinary Nigerian from fully protecting himself from pandemics. Among these are widespread poverty, lack of education, poor awareness about the spread of infectious diseases, insecurity and poor health-seeking behaviour.

Busy Street in Lagos, Nigeria. (Credit: Unsplash)

Perhaps the overarching challenge many Nigerian communities face is that of infrastructure. Irregular power supply often means lack of running water. This greatly reduces the number of times people practice handwashing. When members of a household have to go long distances in search of clean water, it is inevitable that they will minimize the use of this for hand hygiene. Many communities also lack a health centre with qualified health workers who disseminate information and conduct house-to-house checks to ensure hygiene is observed. In addition, many markets and slaughterhouses are poorly designed and so infectious waste is left lying around and may even contaminate fresh produce. Many do not have adequate bathroom facilities and thus hands used to handle faecal matter are also used to touch food for sale. Improved level of facilities will surely help in this area. However, community-owned interventions could be used temporarily to bridge this gap by alternate sources of power and clean water supply, provision of containers at strategic places with soap for regular handwashing.

Handwashing is a crucial part of infection control. (Credit: Unsplash)

Many areas are cut off from communication channels. They may thus rely only on radio services to keep abreast of information regarding a new epidemic. This gap unfortunately leaves room for fake news and rumours to spread. There may also be panic and prejudice which in turn help the epidemic to spread faster. Initiatives like call centres such as that used by EpidAlert during the 2014 outbreak have been shown to provide much-needed information for communities. This equips them to take appropriate measures to protect themselves and their families. It also debunks dangerous myths, quells rumours and reduces panic and stigma often found among the uneducated public.

Every Nigerian deserves to feel safe enough in their communities to play a board game like these two men. (Credit: Canva)

Poverty is a major barrier to good health. The reduced spending power of individuals in a society without adequate welfare plans for its citizens puts them at a disadvantage. This is because, they have to prioritize their spending on perceived basic necessities like food and shelter. The global toll of the coronavirus on world economy is a further worsens the situation. This often leaves little or nothing to cover the cost of personal hygiene in soap, personal provision of water, face masks, accessing care and information, balanced diet and comfortable accommodation that is not overcrowded. This category of people are usually left on their own and this portends doom for us all. Thus, welfare packages should be considered to help them. They are also more likely to live in overcrowded slums which make it impossible for them to keep safe distance from one another. This borders on political will in providing adequate housing and jobs. But on the organizational level, packs containing hygiene products, free outreaches and community awareness programs are to be employed to include them in prevention efforts.

Another problem which exposes people to risk during pandemics is insecurity as seen in many communities during the lockdown. Entire lives are upturned, socio-economic strata are levelled and the priority is more on safety than healthcare. The insurgency in the northern part of the country has for years deterred efforts in healthcare provision. People fleeing conflict often leave property behind, are forced to stay in cramped displaced person camps where rates of infection are higher as a result of a strain on the few facilities available. Community-led vigilante efforts often employ methods like burning tires which pose grave risk to health manifesting down the line in respiratory disease and even death. Handwashing and other protective measures take low precedence in their daily lives with overcrowded quarters, loss of access to credible information and the general feeling of despondency further putting them at risk. Attacks on health workers, disruption of transportation and essential services keep the people affected away from accessing healthcare services. In this regard, the responsibility lies with the security agencies to intensify efforts at securing lives and property of citizens. Internally displaced persons camps must also be included in epidemic control strategy.

For many communities, harmful cultural practices and beliefs hold sway over proven medical information on disease spread. It is not uncommon to find handwashing and other forms of hygiene to be greeted with scorn, with the few who try to practice this being discouraged. In addition, women and children are often not included in health seeking decisions and are thus at the mercy of male and older relatives. Female children are not given an education making them less likely to practice safe health practices. In some cases, the male head of household has to grant permission before medical care can be sought. Where he is unwilling and unavailable, this leads to a huge gap in care. This causes a situation where some individuals know the right thing to do but are not able to practice it. Some cultural practices around gatherings, greetings of physical touch, handling babies and so on to be a source of infection spread. Community health workers need to be deployed to these areas with adequate sensitization and involvement of the decision makers to illustrate why it is important for these practices need to be changed.

These and other barriers must be taken care of to make pandemic control efforts become more effective. Thus collaboration is required across board to ensure that the country contains this virus.

References

  1. https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf
  2. Parveen, S., Nasreen, S., Allen, J.V. et al. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 18, 483 (2018). https://doi.org/10.1186/s12889-018-5365-1

Written by

Dr Mariam Toye

Editor, OumissaInspire

TWEETS #14

https://twitter.com/iArnavAgarwal/status/1251568130268303369?s=19

https://twitter.com/iarnavagarwal/status/1251568130268303369?s=21

https://twitter.com/BBCNews/status/1251141774682189825?s=19

ARTICLES #14

https://t.co/p53NyL2OYx

Blame Capitalist Globalization not China for Pandemic

https://www.theguardian.com/commentisfree/2020/apr/10/blaming-china-coronavirus-pandemic-capitalist-globalisation-scapegoat

https://www.wsj.com/articles/as-u-s-china-clash-over-coronavirus-their-doctors-quietly-join-forces-11586516401?mod=mhp

https://www.theguardian.com/news/2020/apr/10/world-health-organization-who-v-coronavirus-why-it-cant-handle-pandemic?

https://punchng.com/isolation-centre-doctors-others-lament-n30m-unpaid-allowances

Immigrant doctors on the frontline of Britain’s COVID19 amidst Brexit and anti-immigrant affair

https://www.ouh.nhs.uk/news/article.aspx?id=1226

https://www.theguardian.com/commentisfree/2020/apr/11/south-korea-beating-coronavirus-citizens-state-testing

Lockdown alone cannot stop spread

Boris Johnson discharged from hospital but not returning to work

https://www.theguardian.com/uk-news/live/2020/apr/12/coronavirus-live-news-nhs-staff-deaths-boris-johnson-latest-updates?CMP=Share_AndroidApp_WhatsApp

Boris Johnson appreciates his carers      

http://news.sky.com/story/boris-johnson-i-owe-doctors-and-nurses-my-life-after-coronavirus-treatment-11972103

False negative affecting testing 

https://www.aljazeera.com/news/2020/04/false-negatives-complicating-covid-19-testing-200411100741669.html

Droplets emitted by speaking in experiment published by New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMc2007800

Saliva spray during speech could transmit virus

https://amp.theguardian.com/world/2020/apr/07/saliva-spray-during-speech-could-transmit-coronavirus-study

Google thanks delivery staff for COVID19 efforts

https://m.economictimes.com/magazines/panache/google-thanks-packaging-shipping-delivery-workers-with-hearts-and-a-special-doodle/articleshow/75152738.cms

China must pay reparations over COVID19

https://www.washingtonpost.com/opinions/2020/04/16/china-must-pay-reparations-africa-its-coronavirus-failures/

G7 backs WHO leaving Trump isolated

https://apple.news/AfF91oDOjSumm_dclBwFNiQ

America’s future             

Every western system was unprepared 

Floridians flock to beach amidst highest COVID19 death toll

https://www.washingtonpost.com/nation/2020/04/18/florida-beaches-reopen-coronavirus/

Nurses suspended for refusing to treat patients without N95 masks

https://www.cbsnews.com/news/coronavirus-mike-gulick-santa-monica-nurses-suspended-refusing-covid-19-care-without-n95-masks/

The Coronavirus Is Mutating. What Does That Mean for a Vaccine?

Reduction in oxygen in lungs causing ‘sudden’ deaths

Refusing to treat where PPE is inadequate           

https://www.bma.org.uk/advice-and-support/covid-19/your-health-and-wellbeing/covid-19-refusing-to-treat-where-ppe-is-inadequate

Back in February, Nigeria’s Ministry of Health blocked from procurement of COVID19 supplies

Coronavirus: Health ministry’s preparation suffers as Presidency blocks procurement

Blame Capitalist Globalization not China for Pandemic

https://www.theguardian.com/commentisfree/2020/apr/10/blaming-china-coronavirus-pandemic-capitalist-globalisation-scapegoat

https://www.wsj.com/articles/as-u-s-china-clash-over-coronavirus-their-doctors-quietly-join-forces-11586516401?mod=mhp

Coronavirus: Germany says its outbreak is ‘under control’

https://www.bbc.com/news/amp/world-europe-52327956#click=https://t.co/8VqXMy08vE

Government ‘ignores’ UK textiles firms desperate to make PPE   https://t.co/fg4ltbLry9?amp=1

WHO and Global Politics

https://www.thinkglobalhealth.org/article/world-health-organization-and-pandemic-politics

South Korea’s New Coronavirus Twist: Recovered Patients Test Positive Again     

https://flip.it/ckjbz5

How doctors can keep families safe after caring for COVID19 patients

https://www.ama-assn.org/practice-management/physician-health/how-doctors-can-keep-their-families-safe-after-providing-covid

*COVID-19: Doctors and Nurses in the UK have been asked to re-use their gowns or treat patients without the use of PPEs this weekend, as UK hospitals are set to run of PPEs in the next few hours. Fresh supplies will be procured next week.*

https://www.independent.co.uk/news/health/coronavirus-nhs-ppe-gowns-matt-hancock-news-latest-a9471331.html

Coronavirus destroys the Myth of the Deficit

https://www.theguardian.com/commentisfree/2020/apr/17/coronavirus-deficit-american-economy

Africa lockdown

https://www.bbc.com/news/world-africa-52268320

Face mask use  

Face mask advice            

Infodemic          

On becoming a #COVID19 survivor and advocate.             

https://nhwat.ch/3boLoUo

Kidney disease, overlooked aspect of COVID19  

Knowing your limits in a pandemic          

How does the virus kill  

https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes

Seattle Coronavirus Study           

TWEETS #13

ARTICLES #13

Droplets emitted by speaking in experiment published by New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMc2007800

Saliva spray during speech could transmit virus

https://amp.theguardian.com/world/2020/apr/07/saliva-spray-during-speech-could-transmit-coronavirus-study

Google thanks delivery staff for COVID19 efforts

https://m.economictimes.com/magazines/panache/google-thanks-packaging-shipping-delivery-workers-with-hearts-and-a-special-doodle/articleshow/75152738.cms

China must pay reparations over COVID19

https://www.washingtonpost.com/opinions/2020/04/16/china-must-pay-reparations-africa-its-coronavirus-failures/

G7 backs WHO leaving Trump isolated   

https://apple.news/AfF91oDOjSumm_dclBwFNiQ

14 ways to protect your mental health  

https://www.weforum.org/agenda/2020/03/14-ways-to-protect-your-mental-health-in-the-pandemic-according-to-public-health-england

Bill Gates funding vaccines          

https://www.businessinsider.com/bill-gates-factories-7-different-vaccines-to-fight-coronavirus-2020-4

Rice dispensing ATM      

https://www.cnn.com/2020/04/13/world/coronavirus-vietnam-rice-atm-trnd/index.html

South Dakota’s governor resisted ordering people to stay home. Now it has one of the nation’s largest coronavirus hot spots.

https://www.washingtonpost.com/national/south-dakotas-governor-resisted-ordering-people-to-stay-home-now-it-has-one-of-the-nations-largest-coronavirus-hot-spots/2020/04/13/5cff90fe-7daf-11ea-a3ee-13e1ae0a3571_story.html

TWEETS #12

                s=19https://twitter.com/MBuhari/status/1249762216775159808?s=19

https://twitter.com/Tolz__/status/1248523259873804288?s=19

ARTICLES #12

Apple and Google Partner on COVID19 contact tracing

https://www.apple.com/uk/newsroom/2020/04/apple-and-google-partner-on-covid-19-contact-tracing-technology/

Pregnant in the Coronavirus Epi-centre

Coronavirus: Easter Sunday under lockdown captured in pictures

https://www.bbc.com/news/amp/world-52264772?__twitter_impression=true

Thousands of Indian seafarers stranded due to coronavirus curbs

https://www.aljazeera.com/amp/news/2020/04/coronavirus-lockdown-strands-thousands-indian-seafarers-200412093941314.html#click=https://t.co/cgQkHkw8m8

Interview: Carlo Ratti on Architecture that Fights COVID-19

Goodies star Brooke-Taylor dies with coronavirus            

https://www.bbc.co.uk/news/amp/uk-52262490?__twitter_impression=true

UK deaths were preventable.    

https://www.theguardian.com/commentisfree/2020/apr/12/uk-coronavirus-deaths-preventable-government-account

Boris Johnson leaves hospital as he continues recovery from coronavirus

https://www.google.com/amp/s/amp.theguardian.com/politics/2020/apr/12/boris-johnson-leaves-hospital-as-he-continues-recovery-from-coronavirus

99-year-old WWII veteran who survived coronavirus gets guard of honour from nurses

https://amp.cnn.com/cnn/2020/04/10/uk/war-veteran-survives-coronavirus-scli-intl-gbr/index.html

The burden of Covid-19 falls on those from poorer backgrounds in the UK

https://www.telegraph.co.uk/global-health/science-and-disease/burden-covid-19-falls-poorer-backgrounds-uk/

TWEETS #11

https://twitter.com/ScottFordTVGuy/status/1246823069743800333?s=19