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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

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

The WHO declared the ‘COVID-19 Pandemic’ 11th March 2020. The current ‘Challenges Conversation’ was excited by ‘Weathering the Storm’ [1] and the ‘Coronavirus Issues’ and ‘Intervention Issues’ were presented recently [2,3]! The ‘Concluding Part’ on the ‘Intervention Issues’ is now presented to assure ‘Weathering the Storm’.

1. Shutdown-Lockdown, Stay at Home Orders, Shelter-in-Place/ ‘Ease of Compliance’: The more impactful ‘Interventions’ are those geared towards preventing the ‘COVID-19 Spread’: ‘Containment Measures’ and ‘Mitigation Measures’. The ‘Drastic Government Interventions’ amplify ‘Social Distancing’, ‘Social Capital’ and ‘Social Solidarity’ and are unavoidable: Shutdown-Lockdown, Stay at Home and Shelter-in-Place and are quite effective from previous ‘Epidemics-Pandemics Experience’ [4,5]! The real ‘Intervention Challenge’ is ‘Strict Compliance as ‘Mitigation Measures’ are perceived as ‘Draconian/ Unimaginable/ Unthinkable’ and possibly ‘Over-Reactions’; ‘Under-Reaction is more Catastrophic than Over-Reaction’ is known!!

2. ‘Interventions and Heavy Toll on ALL Spheres’: Globally, ‘Economies’ are down with threats of Recession and Depression. All Sectors of ‘Economies’ are ‘Shutdown’; Stocks are crashing, Unemployment at impossible highs and Inflation bothersome. Countries deploy ‘Economic Stimulus Packages’ with ‘Cash Handouts’ and the ‘Needed ‘Pay Cheque’ Timely Delivery’ remains questionable; ‘Money in Need is Money in Deed’! Global Meetings have been Cancelled, Postponed or Rescheduled with ‘Huge Economic Losses’/ ‘Programmatic Dislocations’: Sporting Events-Championships, Scientific-Professional Conferences, World Summits, etc!! With these ‘Huge Economic Impact’, ‘Weathering the COVID-19 Pandemic Storm’ becomes a mirage!!!

3. ‘Globalization/ Borderless World’ and ‘Country Lockdown-Shutdown Interventions’: The gains of a ‘Globalized Borderless World’ are being rapidly eroded by ‘Country Shutdowns-Lockdowns’ with ‘Prohibited Country-to-Country Travels-Movements’! This undermines ‘Global Integration-Partnerships’ necessary for ‘Sustainable Development’!!

4. The ‘Difficulty with Reliable Numbers/ Data’: There are great ‘Difficulties/ Challenges’ with the ‘Numerators’ and ‘Denominators’ for computing ‘Reliable Numbers/ Data’! What is the ‘Reliable Infected Population’? ‘Reliable Effective Tracking/ Tracing Mechanism for the ‘Infected Population’? ‘Reliable Reach and Adequacy of the Screening/ Testing for the ‘Infection’? ‘Sensitivity-Specificity of the Screening/ Testing Kits’? ‘Pandemic-related Death Rates’ assuring cognizance is taken of ‘Other Confounding Mortality Contributors’? The ‘Reliable Responses’ to these ‘Questions’ have implications for the ‘Paraded Numbers/ Data’ for the ‘COVID-19 Pandemic’!!!

5. For ‘Programmatic Interventional Expedience’, as known, ‘Failure to Plan is Planning to Fail’ and again ‘Planning with the Wrong Numbers/ Data is also Planning to Fail’! This amplifies the ‘Determinant Importance’ of assuring ‘Reliable Numbers/ Data’ for ‘Weathering the COVID-19 Pandemic Storm’!!

6. For impactful ‘Mitigation Interventions’, the ‘Starting Locus’: ‘Everyone’ to regard themselves as ‘Possibly Infected’ taking steps to prevent ‘Transmission’ to every other person and also every other person should be assumed as ‘Possibly Infected’ and steps taken to prevent ‘Contracting’ the Disease! This is particularly important re: at least 25% ‘Pre-Symptomatic and Asymptomatic Transmission in ‘COVID-19’ [6]!!

7. Healthcare Staff/ Frontline Staff/ First Responders and ‘Inadequate Protective Supplies’: Increasingly, these ‘Healthcare Staff’ are yelling about ‘Inadequate Supplies’ of the critically needed ‘Protective Items’: Personal Protective Equipment (PPEs), Masks (Respirators N95 and FFP3,Medical Masks, Surgical Masks, Cloth Masks), etc. There are also the ‘Challenges’ of ‘One-Person Single-use Disposable Items’ and ‘Reusable/ Recycled Masks’, etc!! The ‘Mask Use Intervention’ is now ‘Controversial’ and the WHO and CDC have possibly ‘Reviewed/ Reversed’ their ‘Earlier Positions’; ‘Possible Value for Mask Use’ for those who leave their homes during the ‘Stay at Home Order’ [7]!

8. Health Facilities/ ‘Limited Critical Care Essentials Supplies’: There is great ‘Difficulty’ with ‘Supply Chains’ for ‘Critical Essentials’ of ‘Ventilators’, ‘PPEs’, ‘Masks’, ‘Hand Sanitizers’, ‘Test Kits’, etc! There are increasing ‘Controversies and Suspicion’ raised, in some places, concerning ‘Evidence-based Demand-Supply Realities’!!

9. Health Service Delivery, ‘Prioritized Service’ and ‘Ethical Issues/ Dilemmas’: It is becoming an ‘Increasing Difficult Challenge’ with the ‘Prioritization’ of ‘Critical Care Service Delivery’! The ‘Elderly’, ‘Existing Chronic Medical Conditions’, ‘Immunocompromised Persons’ are ‘Scored Low’ for ‘Assignment of Critical Care Essentials’ with the ‘Ethical Implications’!! Healthcare Staff are being counselled to avoid CPR in ‘COVID-19 Patients’!!!

10. ‘Repurposing of Manufacturing/ Service Lines’: Several ‘Production-Service Lines’ are being ‘Repurposed’ for the ‘Critical Care Essentials Production’ of ‘Sanitizers from Winery/ Perfumery’, ‘Masks from Fashion Lines’, ‘Stadia for Health Delivery’, ‘Cold Room Facilities for Morgues’, ‘Vehicular Lines for CPAPs’, etc!

11. ‘Flattening the Curve’/ ‘Peak and Duration’: With the ‘Scientific Mathematical Projection Models’ and ‘Disease Predictions’, the ‘Epidemic Curve Peak’ is days and weeks away making ‘Intervention Duration’ nearly indeterminate for now! Several Countries are grappling with ‘Difficult Challenges’ with ‘Successfully Flattening the Epidemic Curves’!! The ‘COVID-19 Pandemic’ is ‘Rapidly Dynamically Ragingly Ravaging and Devastating’!!!

12. WHO and CDC/ Healthcare Staff and peculiar ‘Difficulties with Healthcare Staff’: There appear to be ‘Gaps’ in ‘Recommendations’ which have possibly unduly exposed ‘Frontline Healthcare Staff’ with the ‘Unacceptable Infection and Mortality’ among Doctors and other Healthcare Staff! Gory Numbers/ Data indeed!!

13. ‘Symptomatology-led Facility Interventions’: Some Health Facilities have set up ‘Screening Interventions’ that are ‘Symptomatology-denominated’, particularly ‘Fever-Cough-Sneeze’, with a ‘Parochial and Palpably Uninformed Approach’ to the ‘Pandemic’ with significant ‘Pre-Symptomatic and Asymptomatic Transmission’, ‘Neurological Symptoms’, ‘Coagulation Disturbance Features’, ‘Gastrointestinal Symptoms’, etc! Some ‘Clients’ out-rightly deceptively deny ‘Symptoms’ with ‘Avoidable Unimaginable Unjustifiable Healthcare Staff Exposure’ [6,8,9]!! To worsen the ‘Undue Exposure of Healthcare Staff’ is inexcusable and beyond reason!!!

14. ‘Stay at Home Order’/ ‘Emerging Difficulties’: There are ‘Emerging Difficulties’ with the ‘Stay at Home Order’ including ‘Inappropriate Weight Gain’, ‘Mental Health Issues’, ‘Undeserved Family Dysfunction’, ‘Domestic Violence’, ‘Alcoholism’, etc but people MUST ‘Stay Home, Stay Safe, Stay Well and Stay Sane’!!

15. WHO, CDC, Country Ministries of Health and ‘Information Communication’: There should be ‘Communication’ of ‘Timely Appropriate Scientific-Factual Information’ by these ‘Revered Authorities’; ‘Discordant Tunes’ should be avoided!

16. UN/ Call for ‘Global Effort’ and ‘Global Ceasefire’: The UN has called for ‘Global Concerted Efforts’ and ‘Global Ceasefire’ in these trying times!

17. Interventions as ‘Imperatives’ and not ‘Politics’/ ‘Economy’ as the ‘Arrowhead’ undergirding ‘National Considerations’; ‘Health-Human Life First’!

18. ‘COVID-19 Infodemic’: Misinformation, Disinformation, Rumours, Myths, Memes, Misleading Communication, Inappropriately Contextualized Concepts, Information Toxicity, etc. ‘Information is Power’ but ONLY the ‘Right Information’ should be communicated! The feared ‘Hantavirus Disease’ should not derail our focus, this moment, on ‘COVID-19 Pandemic’!!

This ‘Communication’ concludes the ‘Challenges Conversation’ on the ‘COVID-19 Pandemic’ relating to the ‘Intervention Issues’.

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. Eregie C.O. COVID-19 Pandemic: The difficult unresolved increasing challenges in weathering the storm. https://www.bmj.com/content/368/bmj.m1199/rr-13 of 2nd April 2020
4. WHO. Disease Outbreaks. https://www.who.int/emergencies/disease/en of 12th February 2020
5. COVID-1: Lessons and Recommendations. www.isglobal.org/coronavirus of 12th March 2020
6. Tian L, Li X, Qi F, Tang Q-Y. Presymptomatic Transmission in the Evolution of the COVID-19 Pandemic. https://www.researchgate.net/publication/339972752
7. Wetsman N. CDC recommends people wear cloth masks to block the spread of COVID-19. The Verge of 3rd April 2020
8. Talan J. COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurological Conditions in Patients with the Coronavirus. https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.a... of 27th March 2020
9. Jin X, Lian J-S, Hu J-H et al. Epidemiological, Clinical and Virological Characteristics of 74 Cases of Coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut Epub ahead of print doi:10.1136/gutjnl-2020-320926 of 17th March 2020

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

05 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