Intended for healthcare professionals

Rapid response to:

Editor's Choice

Covid-19: weathering the storm

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1199 (Published 26 March 2020) Cite this as: BMJ 2020;368:m1199

Read our latest coverage of the coronavirus outbreak

Rapid Response:

COVID-19 Pandemic: Still on the difficult unresolved increasing challenges in weathering the storm

The current ‘COVID-19 Pandemic Programmatic Challenges Conversation’ is apt and consistent with the discourse: ‘Weathering the Storm’ [1]! A ‘Communication’ concerning the ‘Coronavirus Issues’ in the ‘Challenges’ to ‘Weathering the Storm’ should excite further ‘Challenges Conversation’ [2]!! In this ‘Communication’, the focus is on ‘Intervention Issues’ in the ‘Difficult Unresolved Increasing Challenges’ in ‘Weathering the Storm’. ‘Weathering’ implies ‘Success’ and ‘Possibly no untoward sequelae’ in emerging from the ‘COVID-19 Pandemic’!

Intervention Issues/ Challenges: These are ‘Challenges’ related to the ‘Interventions’ mounted to prevent or minimize ‘Contracting’ and/ or ‘Transmitting’ the Disease. They should ‘Reduce the Magnitude’/ ‘Peak of the Epidemic Curve’ and ‘Prevent the Spread of the Disease’.

1. Timely Declaration of ‘Epidemic’, ‘Global Public Health Emergency’ and ‘Pandemic’: Very early in the ‘COVID-19 Trajectory’, there have been ‘Controversies’ concerning the ‘Timeliness and Appropriateness’ of the WHO Declarations of the ‘Disease’ as an ‘Epidemic’, a ‘Global Public Health Emergency’ and a ‘Pandemic’. As ‘Time is of the Essence’, and situate with ‘Eisenhower Matrix’ in ‘Time Management and Optimal Resource Utilization’, any perceived delayed ‘WHO Declaration’ at any and every ‘COVID-19 Stage’ portends ‘Ominous Possibilities’ for successfully ‘Weathering the Storm’! The WHO is expected to ‘Raise the Flag’ to possibly ‘Direct and Galvanize’ the ‘Global Concerted Interventions’ in this ‘Pandemic’!!

2. ‘Unacceptable Delayed Reaction Time and Interventions’: From the first Case reported in December 2019 in Wuhan, China to the ‘First Genomic Sequence’ released by China in Early/ Mid-January 2020 to the ‘Evolving Expected Appropriate Responses’ by various Governments worldwide, there have been palpable ‘Government Intervention Delays’ for several reasons: ‘POLITICS’, ‘DENIALS-DOWNPLAYS’, ‘TRIVIA-TRIVIALITY’ etc! The ‘Painful Avoidable Result’? The ‘COVID-19 Pandemic’ has been consistently ahead of ‘Deployed Interventions’: ‘Reactive Interventions’! What will undergird ‘Success’ is ‘Proactive Precautionary Measures’ predicated on ‘SCIENCE’, ‘FACTS’ and ‘PREDICTIONS’ re: ‘Numbers/ Data’!!

3. ‘Previous Experience’ and ‘Missed Opportunities’: The World has experienced ‘Global Plagues, Pandemics and Scourges’ to have been caught completely ‘Off Guard’ by ‘COVID-19 Pandemic’! From ‘Previous Experience’, the World ought to have its ‘Information Armoury’ laden with ‘Déjà vu’: ‘Information is Power’ and to be ‘Forewarned’ is to be ‘Forearmed’! Some ‘Previous Experience’, as ‘Tantalizers’, include: Spanish Flu 1918, SARS 2003, H1N1-Swine Flu 2009, Ebola Virus Disease 2014 [3]! Failure to learn from the ‘Previous Experience’ constitutes a ‘Missed Opportunity’! No ‘Lessons Learnt’ [3,4]!!

4. ‘Unacceptable Conduct of Some Country Leaders and Citizens’: Some Country Leaders and their Citizens preferred to be enmeshed in, and guided by, ‘Alternative Facts’ instead of embracing the extant ‘Available Facts and Situational Realities’ and disposing the ‘Expected Rational Interventions’ and hence the resultant ‘Roaring and Soaring Gory Devastating Numbers/ Data’ concerning ‘COVID-19 Pandemic’! Countries which deployed ‘Timeously Courageous Interventions’ post better tolerable ‘Numbers/ Data’ for the ‘COVID-19 Pandemic’!!

5. Difficulty Reconciling ‘Previous ‘Critical Essentials’ Demand-Supplies Pattern’ with ‘Current Increasing Demand-Supplies Realities’: The evolving ‘FACTS’ necessitate ‘Strategic Stockpiling’ to be ahead of the ‘Pandemic’!

6. The ‘Global Proactive Precautionary Measures’: These are ‘Non-Pharmaceutical Interventions’: ‘Containment Interventions’ and ‘Mitigation Interventions’ to check the ‘COVID-19 Pandemic’. These include ‘Social Distancing’ (Avoiding contact with others or staying minimum 6 feet from every other person; Within Households? Shutdown ‘Mass Gatherings’!), ‘Social Solidarity’ (Practices possibly unimaginable/ unthinkable reflecting Equity, Fairness, Timeliness, Sacrifice, Empathy, Collective Good for All, ‘Perceived Over-Reaction’ etc) and Self-Isolation/ Quarantine! Can people STRICTLY COMPLY with these ‘Intervention-Prescriptions’? Great ‘Difficulty/ Challenges’ with these ‘Containment-Mitigating Measures’!!

7. ‘Universal and Specific Precautionary Measures’: Hand-washing Technique/ Hand Hygiene and Hand Sanitizer Use; Personal Hygiene and Environmental Health! As a ‘Pandemic’ requiring ‘Global Concerted Interventions’, ‘Available Safe and Clean Water’ may be a ‘Tall Assumption’! Water, Sanitation and Health Linkage needs some attention!! Respiratory Health with ‘Flexed Elbow Use’ and ‘Elbow Greeting-Shake’ need ‘Critical Attention’ if ‘COVID-19 Transmission’ is to be curtailed!! No ‘Contact of any Sort’ is permitted!!!

8. Peculiar status of the Elderly/ No uniform ‘Cut-Off’: 60, 65, 70 years? For ‘Uniformity of Interventions’, the ‘Age Cut-off’ for ‘Elderly’ should be clearly stated for ‘Uniform Application’ to document ‘Risk Factor-Outcome Data’!! Also those with Existing Medical/ Health Conditions and Challenges, together with the ‘Elderly’, should be particularly shielded from exposure to ‘COVID-19’ [5,6].

9. Recruitment of ‘Retired Health Professionals’ who incidentally are the ‘Elderly Group’: This is a difficult ‘Challenge’! More ‘Healthcare Staff’ are needed and the ‘Retired Workforce’ is being mobilized but, in all probability, these are the ‘Elderly’ that should ‘Stay Home and Stay Safe’: An ‘Interventional Dilemma’!!

10. ‘Precocious Graduation and Registration’ of Medical Students to Strengthen the ‘Frontline War Workforce’: Some experience ‘Precocious Graduation’ of Medical Students/ ‘Registration for Practice’ with obvious implications for ‘Guaranteed Quality Healthcare Delivery’! This is ‘Emergency Curricular Truncation’; Uphold ‘Non-Maleficence’ even if no assured ‘Beneficence’!!

11. The ‘Programmatic Expedience’ to ‘Accelerate’, ‘Abbreviate’ or ‘Abridge’ the ‘Best Practices/ Processes/ Procedures’ for the ‘Production’ of ‘Critical Essentials’: Testing/ Screening Kits that are normally produced through ‘Standard Operating Procedures’ are now available for use through ‘Accelerated Processes’ with implications for ‘Effectiveness’ and ‘Sensitivity-Specificity’!,

12. ‘Vaccines Production’ and ‘Drugs Production’/ ‘Trial’: Here, ‘Previous Experience/ Lessons Learnt’ pale into oblivion! The ‘Vaccine Production Drive’ for ‘SARS 2003’ and ‘H1N1 2009’ should be a ‘Template’/ ‘Déjà vu’ for the ‘COVID-19’. Unfortunately, the ‘Drive’ was reportedly aborted after the ‘Control’ of the SARS and Swine Flu! The ‘SARS-CoV-2 Vaccine Production Drive’ has entered ‘Clinical Trial Phase One’ (For Effectiveness and Safety!) with the ‘Moderna Therapeutics mRNA-1273’ but this MUST not be aborted as before [7,8]!! The ‘SARS-CoV-2 Genomic Diversity’ has induced ‘Vaccine Production Technology Diversity’: ‘Virus-Proteins’, ‘DNA-RNA-Genomic Sequence’, etc [9,10]!!! The ‘Epidemic Curve Peak-Panic-Vaccine Funding Triad’ disintegrates with ‘Pandemic Control’; ‘No more Panic’-‘No more Demand-Market’-‘No more Funding-Profit’!! Even with ‘Vaccine Production’, ‘Distribution Logistics Issues’ ensue; Also, ‘Inverse Equity Hypothesis’ holds sway increasing ‘Inequality”: ‘Those most in Need get the Needed the least’!! Some ‘Drugs’ are also on ‘Clinical Trials’: Hydroxychloroquine, Azithromycin; Convalescent Serum! Complications are already being reported from some ’Peddled Effective Treatments’!!!

This ‘Communication’ explores some of the ‘Intervention Challenges’ in ‘Weathering the COVID-19 Pandemic Storm’. Several ‘Other Compelling Intervention Challenges’ will be further exposed in other ‘Communications’ to be presented by the same Author!

REFERENCES
1. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 2020
2. Eregie C.O. COVID-19 Pandemic: The difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-10 of 31st March 2020
3. WHO. Disease Outbreaks. https://www.who.int/emergencies/disease/en of 12th February 2020
4. Barro R, Ursua J, Weng J. Coronavirus and the lessons we can learn from the 1918-1920 Great Influenza Pandemic. https://www.weforum.org/agenda/2020/03/coronavirus-great-influenza-pande... of 23rd March 2020
5. Yang X, Yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China. Lancet Respir Med. https://doi.org/10.1016/S2213-2660(20)30079-5 of 21st February 2020
6. Barer D. On the brink: a radical change in attitude is needed. https://www.bmj.com/content/368/bmj.m1117/rr-2 of 23rd March 2020
7. The Intercept. For Covid-19 Vaccine, Federal Government Must Break Old Patterns. https://theintercept.com/2020/03/27 of 27th March 2020
8. The Guardian. Coronavirus vaccine: when will it be ready? https://amp.theguardian.com/world/2020/mar/28/coronavirus-vaccine-when-w... of 28th March 2020
9. Shen Z, Xiao Y, Kang L et al. Genomic diversity of SARS-CoV-2 in Coronavirus Disease 2019 patients. Clin Inf Dis. https://doi.org/10.1093/cid/ciaa203 of 9th March 2020
10. Ji W, Wang W, Zhao X, Zai J, Li X. Cross-species transmission of the newly identified coronavirus 2019-nCoV. J Med Virol 2020; 92:433-440

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.

Competing interests: No competing interests

02 April 2020
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria. Also, UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementaion. Also a Technical Expert/ Consultant on FMOH-UNICEF-NAFDAC Project on Code Implementation in Nigeria
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria