Caring for the COVID warriors: A healthcare's perspective in the challenging times.

Pandemics have been known to mankind since time immemorial. They were responsible for significant socio-cultural upheavals and helped in reinforcing our beliefs in the forces of nature. Systematic documentation of pandemics post “Anno Domini nostril Jesu Christi,” i.e., 0000 AD revealed that most pandemics occurred concurrently with large scale military and economic pursuits. They led to rapid spread of infection and changed the course of history. They halted expansion of Roman Empire during first millennium.[1] The first of these was the Antonine Plague, between 165 and 180 AD, and the second was the Plague of Justinian, between 541 and 542 AD. During the Haitian Revolution in 1802, Napoleon's efforts to retake the French colony were thwarted due to Yellow fever and he was forced to sell Louisiana Territory to the Americans.[2] By nature, pandemics are divisive. In the absence of clear source of infection or routes of transmission, fear and suspicions overtake rational thought process. The friend you might turn to for help in normal times, becomes a possible source of infection. Our chores of daily life become opportunities for transmission, our conventional methods of expressing our feelings are questioned and an innocuous handshake or our favorite “Jaadu ki Jhappi” can actually be a route of transmission for the deadly disease. The authorities and medical professionals enforcing restrictions become agents of oppression and often have to bear the brunt of the people they serve. Society may be pushed into mass hysteria and anomie, thus setting the stage for widespread distress and disruption. Jews of Strasbourg had to face death and migration on account of mere suspicion that they were responsible for the pestilence by poisoning the wells during Black Death in 1349.[1] They were offered a choice: Convert or die. Half of the Jewish population had to lose their life as they refused to convert. White scapegoating of black South Africans in 1918 precipitated the first legislative steps toward apartheid and laid the grounds for their subsequent marginalization from the mainstream.[1] The ongoing disaster caused by Corona Virus also known as COVID-19 is taking a toll on our minds due to uncertainty and insecurity.[3] Social restrictions and lack of conventional stress busters make things more difficult. Loss of work, economic hardships, school closures, and loss of supply chains translate into range of emotional symptoms ranging from persisting anxiety, depression, sleep problems, irritability and anger outbursts.[4] They predispose to negative stress behaviors in the form of smoking, drinking, and physical abuse of close family members. Persistence of such symptoms and behaviors lowers immunity and hence can predispose to contagion.[5] The inaccessibility of medical services further adds insult to the injury. All in all, these symptoms may lead to sense of desperation and noncompliance with official directives thus fostering a vicious cycle of propagation of pandemic and social anarchy. Cholera epidemic in 1832 in Paris gave rise to conspiracy theory against the rulers that they were poisoning the wells.[6] It led to mass protests and death of about 19,000 persons and eventual fall of King Louis Philippe. So, it is important to keep the public well informed about the latest information and to educate them about negative stress behaviors. The duration of quarantine and social isolation should be limited so as to reduce long term psychological consequences to bare minimum.[7] Symptoms of stress are in most probability transient and self-limiting in nature. If identified early, they can be easily managed. Their beneficial effects in promoting immunity and survival have been proven time and again.[5] Pandemics offer an excellent opportunity for mid-way correction and modification of our lifestyle. Reinforcing age old practices of simple living, greetings with “Namaste” rather than a hug or a handshake, maintaining clean and hygienic surroundings and removing unnecessary clutter should be a good beginning in these changing times. Yoga and meditation have passed stringent scientific scrutiny to ascertain their role in boosting immunity so deserve special mention for inclusion in our daily life.[8] The experience of going through a pandemic has added few words to our vocabulary such as stay at home, social distancing, and hand hygiene. They are likely to have a salutary effect on our lives in the times to come. For the younger generation it offers new ways of learning. Work and learn from home culture has opened new opportunities for the 21st century. For older generation, it is time to introspect and open minds for spiritual enlightenment. The situation does not permit traditional ways of bereavement for the grief stricken families and alternative methods may have to be adopted to meet their emotional needs.[9] The environment needs to be suitably modified to meet this challenge.

So, how do we clearly define role of health care givers during these challenging times? Unlike previous major pandemics, the public is equally aware about the nature of illness, routes of transmission and preventive strategies. Thanks to information explosion, access to the latest developments is just a click away. However, medical professionals must segregate grain from the chaff and serve correct and easily digestible information to their clientele. Unlike previous pandemics, general public still relies on us as far as their medical needs are concerned. It is also important to safeguard ourselves by optimum precautions against spread of disease without being unduly paranoid about it.[8]

Humanity survives and thrives in the face of newer challenges. The attribute of adaptability and new learning keeps the cycle of evolution in motion. As the pandemic unfolds, we will come across various challenges and breakthroughs and we must maintain the energy to see it for ourselves. As has happened in the past on multiple occasions, it shall pass too.

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Conflicts of interest

There are no conflicts of interest.