MAY 21 — The virus is mutating. It is learning and adapting to our response. Question is, are we adapting too?
With daily numbers breaking the 6,000-mark threshold, hospitals have reached 80 per cent of their capacity with some already at 100 per cent.
News reports cite long queues at low-risk centres where patients wait hours for a bed. The army is setting up field ICUs to cater for the volume.
Private hospitals, often seen as the reserves and support to our healthcare system, are also nearing — if not already at — capacity.
Our resources are stretched thin, any thinner we will not be able to manage non-Covid-19 patients that equally need urgent treatment and care.
Many call Covid-19 our enemy, and liken current times to war times. But we have yet to instil discipline among our citizens... something that is required to defeat this virus.
Complacency still reigns.
Discipline is the bridge between goals and accomplishments. It is about doing what you don’t want to do, in pursuit of what you want. Or in this case of what the country wants.
Machiavelli said, “In war, discipline can do more than fury.”
He couldn’t have said it better.
The race against time
There is a behavioural shift happening among Covid-19 patients as to when they seek treatment. More and more are asymptomatic and only diagnosed through routine screenings we carry out before admission.
While the older population and those with pre-existing conditions are more at risk, we are seeing a worrying trend in the increase of Covid-19 in young people who require admission and medical interventions, some succumbing to the virus.
This is stretching the already finite resources we have in the healthcare system.
Many may have forgotten that apart from Covid-19 patients, there are patients with other long-term or chronic illnesses such as diabetes and heart conditions who equally require medical treatment, hospital beds, ventilators, functioning operating theatres, which are now being allocated to Covid-19 patients.
I remember my clinical days when the ward was full and corridors were lined with patients. Depending on the season, you would find different types of patients. There was a dengue season when you would find dengue patients on almost every bed.
And then, just as now, there is Raya season.
Raya is special because of the mouth-watering delicacies — kryptonite to many diabetics. It is also a time when patients refuse to come to the hospital anticipating a long admission.
When they finally do come, it is with multiple complications requiring ICU care including urgent amputations because of gangrenous limbs.
There are also patients who engineer their admissions by skipping their medications, due to loneliness or search for shelter and food.
I remember patients who stopped taking their epileptic medication and hung around the hospital waiting for the impending seizure.
And patients with heart conditions who “forgot” to restrict their fluid intake close to Raya, going into heart failure and spending Raya with doctors and nurses in the hospital.
Assuming that all this is still the case, I wonder what the wards look like now.
The Covid-19 deaths reported daily don’t paint a complete picture. We do not know the full impact it has on non-Covid-19 patients who are also affected nor the number who develop complications and/or are dying from sub-optimal and delayed care due to reallocation of resources to battle Covid-19.
And while doctors are generally trained to know their limits and when to call for help, the fear now in this pandemic is that no one will come when we do.
Because we do not have enough resources.
Learning from the past, anticipating the future
Which is why we need to share resources. And it goes beyond beds, ventilators and staff — we need to share information.
Where are hospital ICU beds and ventilators available, for example? We need a command centre — with real-time information on availability of resources, by regions.
If not in real-time, then frequently so we know where to send patients and resources if need be.
It was mooted during the first two waves, but the implementation hasn’t been uniform across the country.
And we need to use more AI to fight this pandemic. Other countries are using machine learning to help them make more informed decisions in the face of Covid-19 by answering questions like, “How many hospital beds will we need?” or “When, where and for how long should we issue a lockdown?”
AI can help us understand the volume of exposure, infection and hospitalisation so we can mount better response plans.
AI is also helping healthcare data identify those at the highest risk of severe complications from Covid-19. I’ve read of an AI-based predictive model that identifies people most at-risk of severe complications from Covid-19.
This is being used by healthcare systems to identify high-risk individuals, then calling them to share the importance of handwashing and social distancing.
Some are also offering to deliver food, toilet paper, and other essential supplies so they can stay at home.
We need to learn from our past experience. Because the only thing more painful than learning from experience, is not learning from them.
And there is a lot to learn from the viruses.
Extinction is the rule. Survival, the exception
Viruses have existed for billions of years.
In fact, geneticists say that eight per cent of our DNA consists of remnants of ancient viruses, and another 40 per cent is made up of repetitive strings of genetic letters that are also thought to have a viral origin.
The extent viruses go to survive their predator — the human immune system — is impressive and amazing.
Every time the virus replicates and transmits to a new person, there’s an opportunity for new mutations to occur.
And while some mutations make the virus more unstable and more vulnerable, others increase the rates of transmission and severity. The concern is when mutations make the virus more deadly, more contagious, or both.
Which is why it is important for us, humans, to break the chain of infection.
To survive, our response too must evolve. Our defence, communication, and attack strategies must change to meet the challenge.
It was Darwin who said, “It is not the strongest of the species that will survive, nor the most intelligent, but the one that is most responsive to change.”
In this war against Covid-19, well, time will tell.
* This is the personal opinion of the columnist.
