Jorge Arostegui *, Radio La Primerísima 4 June 2020
http://www.radiolaprimerisima.com/blogs/2749/5-puntos-sobre-la-epidemia…
MINSA medical staff at prayer before starting their shift
attending CIVD-19 patients (Photo: La Voz del Sandinismo)
Even taking into account that whatever experience we may have as health professionals cannot place us above the novelty that the Covid-19 represents, and despite the changing dynamics in its behaviour, the very different ways of conceiving and approaching its control, and recognizing that we are all learning day by day, I'm motivated to express some reflections that I summarize in the following five points.
1. As adults with diabetes, obesity, cardiovascular disease, hypertension, lung disease, among others, are the most vulnerable to complications from Covid-19, this makes caring for their natural immunity - by sleeping well, eating healthily, exercising, staying hydrated, getting sunshine (vitamin D), vitamin C, zinc, reducing stress, among others - and paying attention to their underlying diseases the most viable ways to overcome the complications of Covid-19. A diabetic person can easily become infected by some failure to use their mask correctly or to keep physical distance, but if we have taken care of their diabetes and their personal immunity, there will most likely be no complications to regret, despite some failure of external protection.
2. Beyond the protective effects of hand washing, correct mask use and physical distancing, a natural link for resolving the epidemic is the collective immunity that people acquire with the infection. And although it may sound strange, the way in which the epidemic will technically be overcome is when the virus' ability to spread generates increasingly high levels of collective immunity, which will function as a protective shield for vulnerable people (as the virus no longer finds the necessary hosts to reproduce widely). While this comes about, the strict care of these vulnerable people becomes central to preventive strategy. This epidemiological fact becomes relevant because of the total absence of previous immunity against the virus (natural or by vaccines) and applies globally, regardless of the strategy or combination of preventive strategies adopted by any given country. Obviously, the validity of this argument does not mean that the infectious potential is left to its own devices or that restrictive measures are not adopted to flatten the infection curve, in accordance with the hospital system's capacity to respond.
3. No less important is the issue of preventive self-management. I believe that self-managed prevention is more effective and sustainable than the approach of imposing confinements imposed against Covid-19, regardless of a country's socioeconomic status. This applies because preventive action under these conditions, passes through the filter of personal decision making, based on one's own knowledge and experience, instead of responding to a measure that has been imposed. Incidentally, someone respectfully said in summary "we are in the same storm, but in different boats", meaning that each household and community attends to its priorities, with its own means and its own response capacity.
4. Another aspect I would like to refer to is that of the immune response to the virus and its relationship with people's moods, mainly in those who have experienced the drama of Covid-19 at first hand. Given the natural fear that the pandemic has brought about globally, everything that feeds uncertainty increases the levels of hormones that tend to decrease the capacity for immune response and increase falling prey to the virus and its complications. Such a situation appears when mistrust is encouraged in our health system, since it tends to devalue the morale and quality of the professionals and technicians who are on the front line of the pandemic. This affects the whole population, but especially the people who need these medical services.
5. Now in early June, we are already in the eye of the hurricane of the declared pandemic and its expected transmission, with the virus raging mainly among older adults suffering from diseases that compromise their immune system, especially obesity and diabetes. The assumption that eight out of every 10 people infected will be asymptomatic or have a mild illness reaffirms the relevance of caring for our elderly as the focus of our attention, especially if they have diabetes, obesity or other co-morbidities, and taking into account that more than 60% of the adult population of Nicaragua is overweight and approximately one in 10 is diabetic (PAHO/WHO data). It is more than ever necessary to combine efforts and above all to provide social protection and solidarity to the affected families, mainly the most vulnerable ones. While the remaining days of the epidemic are naturally numbered, the physical and psychological consequences will remain and we must prepare ourselves accordingly.
I leave for another article my opinions on the issue of statistical information in the context of the epidemic, its scope, its limits and possible biases. Although it is a technically oriented topic, I think it is relevant in a context of uncertainty where a glib handling of data can generate even more uncertainty and emotional damage which will only deepen the negative consequences derived from Covid-19.
* Dr. Jorge Arosteguí is a physician