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O leader, where art thou?

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n809 (Published 25 March 2021) Cite this as: BMJ 2021;372:n809

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Covid-19 : Some additional salient aspects

Dear Editor,

This article, "O leader, where art thou", is an eye opener of sorts [1]. Yes, the concerns are genuine. Our world is indeed passing through uncertain and difficult times and we need leaders who know what is actually the best for us, and can convincingly lead us out of our actual as well as our perceived troubles.

Unlike Ebola virus infection where mortality rate is near 100%, here in the case of Covid-19 infection (caused by SARS-CoV-2 virus) nearly two thirds of the patients fortunately remain nearly asymptomatic or have just some minor symptoms, whichever series we may look into. They have also recovered back quickly. SARS-CoV-2 virus is quite infectious, but thankfully is not as virulent. Why else many top guns and world leaders got infected, despite best protection. New figures of fresh infections daily, is just what can be expected of this highly infectious virus.

Covid-19 infection remains problematic in 'vulnerable' population, as exemplified by the association of occupational health doctors from UK (ALAMA). For easy understanding, their table lists some common illnesses and medical conditions that will make a person more vulnerable for severe Covid-19 infection. Covid-age can be calculated from their scoring system, which quantifies the vulnerability [2]. Very grave prognosis was already expected if these vulnerable individuals with multi-morbidities, who perhaps make up about 10 to 15 % of the total population, would catch Covid-19 infection. Alas, mortality figures and it's sudden steep surge proves that we have failed those most vulnerable pretty badly. Course correction now will obviously help, with priority for those vulnerable, rather than frittering away the precious resources on the whole population, as others may not overtly require any additional support. The most vulnerable would have been identified by now, if not this exercise must be undertaken now, in all earnest, so that being vulnerable they may be protected.

Advances in medical science have managed to lift the average life span in many parts of the world, especially in developed countries, to about ninety years and more. Cancer, HIV infection, organ failures, and multiple morbidities had been overcome to a large extent. People were now living for good number of years, even when some of them are unable to perform routine chores, or had other functional and cognitive problems. Ever since this SARS-CoV-2 virus appeared, it has struck upon these survivors and vulnerables like they were some kind of sitting ducks. Steep surge in sudden deaths left almost everyone flabbergasted, so much so that even the healthy stock was very worried and started fearing for their own safety, so much so that they started putting pressure on the governments and top medical bodies to do something substantial.

Unfortunately, when this Covid-19 pandemic had started, most of the heavyweights and tallest world leaders were in the midst of electioneering or some other pressing agendas like the BREXIT. As the pressure and panic were mounting up, it looks like these leaders perhaps had to play in the creases and gully, instead of going for a forefront resounding hit across the pitch. Desire to score brownie points, of the nature see I told you so, or if I were in power I would have done so, probably managed to change the course that was ultimately taken. Media too had a role to play. Sane voices were lost in the din or were purposely ignored [3-10]. Ultimately it seems that these leaders were then guided and prodded by the mass' sentiments and desires, instead of what would have been scientifically right and actually beneficial for them in the long run. Their decisions in turn initiated ripple effects right across the globe. Ditto were the advisories and insistence from world's top medical bodies. Down the line, in other parts of the world, other leaders just found it more convenient and politically astute to toe the line taken by the tallest global leaders elsewhere.

As yet there is no case definition. Because of this every individual detected sero-positive for SARS-CoV-2 virus through random sampling or during contact tracing, is getting labeled as a "case", requiring isolation and antiviral treatment just like the ones who are positive and actually sick as well. We are wondering who would be considered the right fit generating the much needed "herd immunity", if not these sero-positive patients, who may as well be asymptomatic or minimally symptomatic. Asymptomatic and all those patients with only minor symptoms, with no co-morbidities, may need just a limited self isolation and we presume that they will not need antiviral treatment against SARS-CoV-2 virus. They may require some symptomatic treatment and observation just to be sure that their condition is normal. We presume that they are our piggy deposits for the much needed herd immunity. Such cases should therefore be welcomed, rather than letting the feeling of disdain prevail and dampen our spirits any further on seeing their increasing numbers. Furthermore, WHO has found all the antiviral drugs that were being used and advocated against SARS-CoV-2 virus, are ineffective, and there is as yet no perfect medicine against this virus. Under such circumstances we do not see any reason for administering any antiviral treatment for healthy asymptomatic patients and patients with just minor symptoms and are otherwise healthy.

Lest we forget, one size does not fit all. Notably 75% of Indian population has agrarian roots. This agrarian population of India, and that of the rest South East Asian region as well, has fared very well until now, as all the available data tells us. The question is how long would the world like to keep everyone, and not just the vulnerables, under continuous wraps and be so patronizing even if not required or justified anymore? No one would have any meaningful justification for that, except perhaps for the resounding rhetoric from the frightened lot, who are in majority now and increasing by the day, and will want nothing less than everyone being locked up for donkey years so that they continue feeling safe from this virus.

Best regards.

1. Dr (Lieutenant Colonel) Rajesh Chauhan
Honorary National Professor, IMA CGP, INDIA

2. Dr VTK Titus
Professor & Head, Department of Orthopedics, CMC Vellore, INDIA

3. Dr Ajay Kumar Singh
Associate Professor, Department of Medicine, Index Medical College, Indore. INDIA

4. Dr Shruti Chauhan
Reader, Index Dental College, Indore. INDIA

5. Dr Harendra Gupta
Ex- Dean IMA CGP, INDIA & Honorary National Professor, INDIA

6. Dr Atul Shankar Mishra
MD, AFIH. Senior Factory Medical Officer, JCB India Limited. INDIA

7. Er Shivendra Pratap Sing Chauhan
IBM, INDIA

References :

1. Abbasi K. O leader, where art thou? BMJ 2021; 372 :n809 doi:10.1136/bmj.n809

2. ALAMA. Covid-19 medical risk assessment. 2020. https://alama.org.uk/covid-19-medical-risk-assessment/.

3. Chauhan Rajesh. COVID 19 : Fresh approach, initiative, and opportunity. BMJ 24 March 2020. Available at : https://www.bmj.com/content/368/bmj.m1141/rr-4 Accessed on 29 March 2021

4. Chauhan R, Singh AK, Chauhan S.. COVID 19: The last straw that broke a weak camel's back. BMJ 01 April 2020. Available at : https://www.bmj.com/content/368/bmj.m1199/rr-11 Accessed on 29 March 2021

5. Chauhan R, Titus VTK. COVID 19 : Alcatraz type maximum security for only those who really need it. BMJ 03 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1375/rr-3 Accessed on 29 March 2021

6. Chauhan R, Titus VTK. It shall be prudent to start testing seniors first for new corona virus infection (COVID-19). BMJ 04 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1392/rr-0 Accessed on 29 March 2021

7. Chauhan R, Titus VTK. COVID-19 : Stop this panic and be more reasonable fellas, huh? BMJ 08 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1373/rr
Accessed on 29 March 2021

8. Chauhan R, Titus VTK, Singh AK, Chauhan S. COVID 19 : Certain salient points. BMJ 17 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1447/rr Accessed on 29 March 2021

9. Chauhan R, Titus VTK, Singh AK, Chauhan S. COVID -19 : Lockdown should be eased and lifted. BMJ 23 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1596/rr

10. Chauhan R, Titus VTK, Singh AK, Chauhan S. Perhaps a small change in NICE guidelines could help reduce mortality COVID-19 mortality. BMJ 23 April 2020. Available at : https://www.bmj.com/content/369/bmj.m1461/rr Accessed on 29 March 2021

Competing interests: These are our personal views and have no relation with the position or appointment that we may be holding. Can't say we are leaders, but every co-author has demonstrated leadership qualities. The prime author is an Honorary National Professor and is also a Geriatrician, a Family Medicine expert, an expert in Industrial Health, an expert in disaster management, an expert in Hospital Administration, a Fellow of the Indian Society of Malaria and other Communicable Diseases, an expert in military medicine, as well as a graduate in law. He has developed over 45 different innovative medical procedures and techniques and has published six medical books describing his new procedures and techniques. He is also on the editorial board of many geriatric medical journals published from the USA. He has been recognized by biographers from USA and UK amongst the * Who's Who of the World * Who's Who of Medicine & Health (of the world) * Who's Who of Asia * Top 100 Scientists of the World * Top 100 Health Professionals of the World * Man of the Year in Medicine * Man representing India, & in many more biographies published from USA and UK

07 April 2021
Dr (Lieutenant Colonel) Rajesh Chauhan
Consultant Family Medicine, Geriatrics,Industrial Health, Disaster Management
Dr. V.T.K. Titus, Professor & Head, Department of Orthopedics, CMC Vellore, Tamil Nadu. INDIA; Dr. AK Singh, MD (Medicine), Asst Professor Department of Medicine, Index Medical College, Indore; Dr. Shruti Chauhan, MDS. Reader Index Dental College, Indore, INDIA. Dr Harendra Gupta, Honorary National Professor, INDIA; Dr Atul Shankar Mishra, Senior Factory Medical Officer, JCB India Limited, INDIA; Er Shivendra Pratap Singh Chauhan, IBM, INDIA
Family Healthcare Centre, SECTOR 6-B/ 154 (HIG), Main Road, Facing Central Park, Avas Vikas Colony Sikandra, AGRA -282007. INDIA