COVID-19 global health security and costs: Up close and painfully personal!

Abstract

Sir, We read with existential concern, the editorial by Agarwal and Agarwal: “Quo Vadis COVID Responder – Beat the Chinese Virus,” Carpe Diem in the January–April 2019 issue of the journal.[1] The authors have very rightly highlighted the disruptive threat that the severe acute respiratory syndrome-coronavirus-2 represents through the coronavirus disease 2019 (COVID-19) pandemic. Virtually nothing has been left untouched within a few months of its onset, from significant mortality in the general population and frontline health workers, the calamitous effect on global economy, to the negative influence on individual mental health. Worse, the predicted nadir is still awaited in the Indian subcontinent and the Americas.[2] Of special interest is the focus the authors have placed on the distinct subcontinental biological ecosystem and diet, providing a putative immunomodulatory native benefit. This realistically cannot be overlooked as the present incidence of infection and mortality per million population in India is significantly low, albeit the relative undertesting.[2] The coming months will surely test this hypothesis. As clinical evidence is still emerging and fragmented, it is too soon to even analyse some of the data, and far too early to project sweeping advocacy. In this respect, the authors urge the cautious application of fundamentals and common-sense. In this respect, it is of grave concern that an epidemic could slip out of a modern city and an advanced country, resulting in half a million deaths globally within 6 months, with no end in sight. Unfortunately, the COVID-19 related-mortality in India, is now 8th overall and 4th in the last 24 h, globally.[2] This is alarming as the pandemic in India is just “beginning to surge.” There is a significant incidence of COVID-19 associated morbidity and mortality amongst healthcare workers in India. In contrast (while this maybe not completely comparable), India contained within a state, the Nipah virus outbreak in 2018 and 2019, with a cumulative mortality statistic of 16 deaths.[3] Certain truths are now inescapable: It is increasingly harder to ignore the subjective response to this disaster. When medical colleagues begin to die and others battle for their lives, the issue becomes intensely personal. Furthermore, personal, professional, and family safety is uncomfortably tested through the 'new-normal' with its pain and grim reality [Figure 1]. It is now imperative to build professional resilience and coping mechanisms into healthcare systems before the next global disaster, whose occurrence is but a matter of time. We now live in a globalized world, where even local public health actions or inactions have planetary impact. Global analysis of the pandemic reveals source issues and systemic unpreparedness as real causes for concern. While we break our backs to build system-responsiveness, a persistent, recurrent, and common source for viral pandemics requires immediate redressal. Underlining this is the negative influence of totalitarianism on global health, based on emerging evidence.[45] This represents a significant opportunity for systems improvement globally! Figure 1: Providing healthcare during the COVID-19 pandemic can be challenging - Reduced patient volumes and opportunities for trainees, reduced economic inflow to hospitals along with increased operational costs, lack of a fallback reserve / strategy for many hospitals, reduced medical-staff salaries, higher hospital bills, uncomfortable personal protective equipment, demand of strict safety protocols, lack of clear clinical guidance, frequently changing public health directives, healthcare worker sickness, hospital admissions for medical-staff, death of colleagues, mental stress, political opportunism, and a predatory media are among the many challengesInvesting in our common future by building maturity, autonomy, and transparency into public health goes a long way in creating a safer planet. Is anyone listening? Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.