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EDITORIAL
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 726--727

The Need to Change and the Necessity to Evolve During the COVID-19 Pandemic

Randeep Guleria 
 Director, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Correspondence Address:
Dr. Randeep Guleria
Director, All India Institute of Medical Sciences (AIIMS), New Delhi
India




How to cite this article:
Guleria R. The Need to Change and the Necessity to Evolve During the COVID-19 Pandemic.Neurol India 2020;68:726-727


How to cite this URL:
Guleria R. The Need to Change and the Necessity to Evolve During the COVID-19 Pandemic. Neurol India [serial online] 2020 [cited 2020 Sep 29 ];68:726-727
Available from: http://www.neurologyindia.com/text.asp?2020/68/4/726/293450


Full Text



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Pandemics are a known phenomenon in the history of this planet. We have been able to record some pandemics in history, but several others have gone undocumented. Several civilizations in the past have disappeared likely because of pandemics. Most of the pandemics in human history have arisen due to zoonoses. The most well-known are influenza, tuberculosis which have resulted from the domestication of animals. Few of the historically documented pandemics include Plague of Athens (430--426 BC). The sheer virulence killed several hundred and paradoxically prevented its spread. A recent dental analysis of corpses from mass graves confirmed that the cause was typhoid.[1] Others to follow were the

Antonine “plague” (165--180 AD, probably measles, killed five million),Cyprian “plague” (251--266 AD, possibly measles, killed up to a quarter of the population of Rome).Justinian plague (541--750 AD, bubonic plague eliminated a quarter of the existing human population and dropped Europe's population by 50%).Black Death (1331--1353 AD, 200 million deaths). The last was followed by series of epidemics which finally culminated in the great plague of LondonThird plague pandemic (1855, started in China and spread to Indian and then the USA killing about 10 million).

The Spanish flu pandemic in 1918 was the last of pandemics and killed up to 100 million.[2] The increased transportation and onset of modernization increased the spread of this pandemic. At this time, the largest number of deaths that were reported by any country was in India (10--20 million). India also had the highest percentage of excess deaths (4.39%). In 1918, the world had no knowledge of influenza. Many believed that a bacteria “bacillus influenza” was causing the pandemic. The world is much better prepared this time as compared to a hundred years ago.[3]

Coronavirus is widely prevalent in animals and had caused two major outbreaks in humans (SARS 2002, MERS 2012). COVID-19 (so named by WHO) may present with Severe Respiratory Distress Syndrome (SARS), and because of the shared receptor (Angiotensin Converting Enzyme 2), it was named SARS Coronavirus-2 (SARS Co V2) or simply COVID-19.

COVID-19 apart from being the first pandemic in the age of “social media” also has several unique features

The disease is highly infectious and even spreads through asymptomatic individualsThough the mortality is low (generally 2--3% but some countries like the UK to as much as 15%; https://coronavirus.jhu.edu/data/mortality), the rapid spread in population presented a challenge of the existing health infrastructureThe role of herd immunity was not clear, and countries which attempted to strategize the management on these fronts had higher mortalities (e.g., UK)The exact nature of etiopathogenesis was not precise. The systemic involvement including the CNS involvement implied mechanisms still not clear.[4],[5]While the mode of spread was aero-bronchial, again the exact mechanism of airborne (droplets, microdroplets, etc.) transmission is not clear.

Every pandemic leads to two significant repercussions: The first includes politico-economical, which will not be discussed here: the second, a fundamental change in human behavior.

By “behavior” here means a change in a typical pattern of the entire race which is a natural response to such pandemics.

When the initial cases of COVID-19 started appearing in India, the government decided to implement a Nation-wide lockdown. This was indicated for several reasons, many discussed earlier, but the most relevant is mentioned here

To prevent or slow the spread of the pandemic considering the vast population footprint in our countryThe more important reason was to provide the health administrative authorities enough time to consolidate and organize the health infrastructure facilities and also to understand the pattern of spread of the disease in India.

While preparations to tackle the pandemic started several months before it hit India, the “buffer” time during the lockdown provided the necessary impetus. It also increased our knowledge about the pandemic.

The lockdown looking back was well worth its implementation, not because the disease did not follow our initial predictions,[6] but because it empowered us with the greatest weapon-Time.

It gave us time to empower ourselves. These included the development of our own's institute's “war readiness” (PPE kit assembly, creation of COVID ICU's, COVID centre, triaging faculty and staff, the establishment of diagnostic readiness, education and training of staff), creating National protocols, encouraging the industry (India is now one of the largest manufacturers of PPE) to most important factor---change of public behavior in the shortest span of time.[7],[8]

Perhaps in no other situation have a one billion population responded so quickly to implement the preventive strategies. Every citizen promptly became aware of the importance of wearing masks, hand hygiene, and social distancing. The media equally rose to the occasion of rapidly spreading this awareness. The National lockdown was no doubt not the as usual life, but in future will be seen as the most proactive step taken by any country. This factor of “time” provided the window for a steady increase in recovery rate, which currently stands at an impressive 65%. (https://www.worldometers.info/coronavirus/#countries).

Overall, I think that the world will change, and is changing. The platforms on which humans will now interact will also change. Better universal precautions in hospitals will also bring down other infections; physical traffic world over is likely to reduce with a shift towards video teleconferencing, digital platforms for exams, meetings and teaching and countries hopefully will come together and work to invest more in healthcare and disease preventive strategies.

Wikipedia states that a perfect storm “refers to the simultaneous occurrence of weather events which, taken individually, would be far less powerful than the storm resulting from their chance combination. Such occurrences are rare by their very nature so that even a slight change in any one event contributing to the perfect storm would lessen its overall impact.”

Many have called the spread of COVID-19 as a “perfect storm.” It shut down the industry, many lost livelihoods, the hospitals and doctors were tested to their limits of functioning, and even Nations braced against each other. The storm is still not yet over, but the worst seems to have passed.

The recovery rates are increasing, business houses are opening up, and a vaccine appears to be around the corner.

But only when the storm passes over, will we have time to brood and ponder. Only then, will we learn from all this, and emerge wiser, stronger, and better.

Events like these have pushed us to change and evolve. It will be a lifetime of learning for this generation.

For Earth, it is just another day of recuperation….

Disclaimer: The opinion expressed here is a personal view

References

1Biello D. Ancient Athenian Plague Proves to Be Typhoid. Scientific American; 2006.
2Morens DM, Taubenberger JK. The mother of all pandemics is 100 years old (and Going Strong)! Am J Public Health 2018;108:1449-54.
3Kant L, Guleria R. Pandemic Flu, 1918: After hundred years, India is as vulnerable. Indian J Med Res 2018;147:221-4.
4Garg RK. Spectrum of neurological manifestations in Covid-19: A review. Neurol India 2020;68:560-72.
5Romero-Sanchez CM, Diaz-Maroto I, Fernandez-Diaz E, Sánchez-Larsen Á, Layos-Romero A, García-García J, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020. doi: 10.1212/WNL.0000000000009937.
6Tiwari S, Kumar S, Guleria K. Outbreak trends of coronavirus disease-2019 in India: A prediction. Disaster Med Public Health Prep 2020:1-6. doi: 10.1017/dmp.2020.
7Sryma PB, Mittal S, Madan K, Mohan A, Hadda V, Tiwari P, et al. Reinventing the wheel in ARDS: Awake proning in COVID-19. Arch Bronconeumol 2020:S0300-2896(20)30203-9. doi: 10.1016/j.arbres.2020.06.002.
8Gupta P, Muthukumar N, Rajshekhar V, Tripathi M, Thomas S, Gupta SK, et al. Neurosurgery and neurology practices during the novel COVID-19 pandemic: A consensus statement from India. Neurol India 2020;68:246-54.