CONCERNS IN THE TIME OF THE VIRUS. A letter from a German medical student in Riga.

By now, you sure have heard about COVID-19. Everybody has an opinion, warning, or precaution they must share with the world. COVID-19 is omnipresent, and it will keep us busy the next months. But what is this virus from a medical perspective and, more importantly, how can it affect the health care community here in Riga now and in the future?

BACKGROUND

Coronaviruses are sub-grouped in alpha, beta, gamma, and delta. With COVID-19, which means "coronavirus disease - 2019", we are dealing with a betacoronavirus. Maybe some of you remember the SARS-CoV outbreak in the Guangdong province of southern China in 2002? You could say COVID-19 is a very close friend of SARS, because they share a similarity in the structure of the receptor-binding gene region. If you remember the virus in 2002, there is a theory that it transfers from bats to other animals, and afterwards infects humans. Again, something similar is suspected in COVID-19, but is not completely proved yet.

The main problem with viruses in general is that they have the ability to adapt. They can, for example, transform the proteins on their surfaces and this little change can lead to non-recognition by the body's immune system. The system that helps us to fight diseases and keeps us going, in the best-case scenario, without getting sick. This ability to change is mainly the reason we are struggling now.

In comparison to the flu, there is no vaccine on the market for COVID-19. For the flu we can use antiviral agents, but with COVID-19 there is no specific antiviral treatment recommended because the clinical trials are still running. Full development will take at least 12-18 months from now. So, it's 2021 the earliest, and the mortality rate will only grow for COVID-19.

As most of you probably know, the transmission is person-to-person contact. That means when you talk, sneeze or cough, small droplets of, for example, your saliva can spread out up to two metres. This form of spreading is the reason health care workers recommend sneezing in your elbow, washing your hands with soap (also in non COVID-19 times), and not using handkerchiefs, to say nothing about putting them in pockets or using several times.
You can convince yourself that you follow all the rules, therefore nothing has happened. But we are not in the “nothing happens time period” now. The virus is spreading even when you practice all the necessary precautions.
As for fighting the virus, keep in mind - we only have the supportive treatment now. That means we can do something about the fever, the cough, the shortness of breath. But we cannot fight the virus itself, it is still a mystery. Will we be fully immune against the virus after the infection in the future? The latest WHO statement points out that there are not enough sources whether the immunity builds up, and, if it does, for how long.

People at higher risk are the elderly population over 60 years, but that doesn't mean you cannot get infected when you're younger or even a child. According to the latest information, children tend to have an asymptomatic course of the disease. But still there is a threat of them carrying the virus to their grandparents.

What is the reason the elderly population is prone to get infected more severely? It's simply because the chance of getting ill increases if you suffer from another chronic disease that weakens the body and immune system (According to a study by Italy's national health authority, more than 99% of the country's coronavirus fatalities were people who suffered from previous medical conditions. More than 75% had high blood pressure, about 35% had diabetes, and a third suffered from heart disease - CR).

The WHO Country Health Profile of Latvia in 2019 noted that “half the population aged 65 and older report having at least one chronic condition”. That includes heart attack, stroke, diabetes, Parkinson's disease, rheumatoid arthritis, or osteoarthritis. It's important to be sure now if we have the physical and financial access to basic medical care, if we have access to a balanced nutritional diet, or if we have behavioural risk factors like smoking.

CONCERN

I managed to talk a lot with Latvian and international medical students in Riga around the time the first measures from the government were taken until approximately one week later. I have to stress out one common factor all of the questioned shared - the border closure was an appropriate reaction to prevent a further spread of the virus; quite a lot thought the action was done even too late.
I can say, without shame, my first reaction was panic. For me, a woman in her early thirties and growing up in West Germany, it was a drastic experience to hear there will be any border closures at all. Not that I don't understand the reasons. But I have never experienced anything like that. After all, we try to create and protect a European society where we strive to give people rights to travel where they want, have contact with different people and nationalities, and have the option to express themselves through internet platforms.
The first reaction from most international students I spoke with was also fear and uncertainty. But can you blame anyone for that? Not living in their home country, with unclarity how the situation will continue here? It's not surprising how many students tried getting home, taking the last buses, ferries, or planes. Maybe they had an increased risk of getting sick or infecting others on the road, but can you judge the urge of going home?

Apart of the students who already left or are about to leave, there is also a certain number of those who share a more relaxed, even bored attitude to all of this. It has created tensions among the international student community. Although, a week after the first wave of students went home and Latvia closed the borders, many, who stayed, instead decided to help out at hospitals if there was any need for it.

The most shared concern among Latvian students, whether working in hospitals or staying at home with their families, was about the infection risk for their relatives. Other Latvian citizens simply don’t stick to the precautions, there is a concern about insufficient supplies of ventilation machines, medical staff getting infected, and that people might be lying about their recent travel history. All of that again increases the risk of spreading the disease. Some are disappointed in the measures of the government so far and would expect a more drastic tactic and timelier managed situation.

A lot of Latvian and international students have many questions about the aftermath of COVID-19 that are similar to mine. Now there's a period of social distancing ahead of us - will the birth rate rise in about nine months, or, instead, the cases of abortions? Many people are losing their jobs now or having restrictions on their income - will they be able to take care of the youngsters and themselves? Will the need for child protective service rise?

“Access to health care in Latvia remains limited for a sizeable proportion of the population”, and “Latvia records the second highest suicide rate in the EU after Lithuania”. Will there be an increased rate after the social distancing period or economical difficulties? How will it change people's mental, physical and social status? Will there be changes in health care system? Many will be staying at home with their families or partners - will it lead to more break-ups, divorces or domestic violence in Latvia?

This is what any country all over the world could experience in the future. To make it more depressive, hospitals could not take care any more because the number of infected people has reached critical mass. The ICU units are overcrowded, or nurses and doctors get infected with COVID-19, but are unable to stay at home because there are shortages of them in hospitals. The question is - who will provide care when they are too sick to work?

Most often the professionals, now working overtime while others comfortably self-isolate, are the ones not paid well enough in Latvia or without decent social security and proper health insurance system. In the next few months, we could be very dependent on people in occupations like caretakers, nurses, doctors, cashiers, cleaning staff, or bus drivers; many in small businesses or the self-employed will loose their jobs.

We are facing some tough times coming, and the self-isolation could be only a small part of it. That's why it's more important than ever to focus, even a little, on humanity. Show some empathy. No one will lose themselves when helping others, looking after your friends and relatives will hurt no one.

And, most importantly, don't lose your sense of humour.

Marleen Heiß
medical student at Riga Stradins University




* Sources: Uptodate, WHO, amboss, CDC, SPKC

Comments

  1. Excellent. Thank you for the arcticle ...
    Michael (Bremen)

    ReplyDelete
  2. Good recap on the situation!

    ReplyDelete
  3. Thanks so much for your comments!

    ReplyDelete

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