SVOA Microbiology

(ISSN 2634-534X)
Short Communication https://sciencevolks.com/microbiology/ Volume 1 Issue 4

COVID-19 Pandemic: What it showed us!

Ayush Chandra*1, MBBS; Avinash Chandra2, MD; Pooja Prakash3, MSc. Nurse
Affiliation
1
Tianjin Medical University, Tianjin, P.R. China
2
Annapurna Neurological Institute and Allied Science, Kathmandu, Nepal
3
Gandaki Medical College and Teaching Hospital, Pokhara, Nepal

*Corresponding Author: Ayush Chandra, Tianjin Medical University, Qixiangtai Road No. 22, Heping district, Tianjin, P.R China 300070 ,
Email: ayushchandra1995@yahoo.com

Received: October 15, 2020

Published: Ocober 28, 2020

Keyword's: COVID-19, Pandemic, Experience, LMICs, Nepal

COVID-19 Pandemic: What it showed us!

It all started on 12 December 2019, when a case of pneumonia of unknown etiology was detected in Wuhan City, Hubei Prov-
ince, China. On 31 December 2019, the outbreak was first reported to the World Health Organization (WHO). Most cases from
the initial cluster had an epidemiological association with a live animal market (Huanan Seafood Wholesale Market), sug-
gesting that the SARS-CoV-2 is animal-derived. However, the source of the virus is still controversial. [1]
The novel corona virus has also been named ‘severe acute respiratory syndrome corona virus 2’ (SARS-CoV-2), while corona
virus disease associated with it is referred to as COVID-19. These names were selected to avoid stigmatizing the virus's origins
in terms of populations, geography or animal associations. According to World Health Organization (WHO) people infected
with the nCoV experiences most common symptoms like fever, dry cough, tiredness; Less common symptoms like aches and
pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, a rash on skin, or discoloration of fingers or toes;
severe symptoms like difficulty breathing or shortness of breath, chest pain or pressure, loss of speech or movement. Older
people and those with underlying certain medical conditions like cardiovascular disease, diabetes, chronic respiratory disease,
and cancer are more likely to be in risk.

Spread History of COVID-19 in Nepal

Around 2nd week of January 2020 first case of corona virus was recorded in Nepal (a Nepalese student came back from Chi-
na). After that until May 2020, Nepal was a country having least number and slow rise of confirmed COVID cases all around
the world. As India neighboring country of Nepal from east, south, and west and having open border started to have rise in
COVID cases, the country decided to go into strict and complete lockdown around mid March. But the lockdown didn’t help
much because the migrant workers entering from India were COVID positive as they travelled for many days. Due to lack of
proper vision for responsible authorities of Nepal these COVID positive people were not isolated or quarantined and ended up
spreading nCoV in the community. Still the cases were under control as remaining population with the help of having exposure
of online medias were aware of ongoing pandemic situation and obeyed the lockdown which helped in cases to remain under
1,000 up until end of May in some way. However, now cases have increased over 10-20 times more since then as tens of thou-
sands of migrant workers, students from other countries such as Gulf countries, Australia, USA, China, etc. began to return
home as Nepal government managed the extracting flights for these countries, although, the death rate remained low with
around 40 as last recorded on mid July. The lockdown was lifted on around first week of June as the responsible authorities
stated that the lockdown has not helped in control of COVID cases and they said as there are more asymptomatic cases which
does not spread. But this is still controversial. In recent times there has been rise of new controversy when WHO announced
that nCoV is also found possibly as airborne transmission. There is possibility that nCoV may be transmitted by airborne trans-
mission (aerosols) even if the aerosol-generators (for example intubation or noninvasive positive pressure ventilation) are ab-
sent. In demonstration done by some investigators speaking, sneezing, coughing produce a mixture of both droplets and aero-
sols in a range of sizes, that these secretions can travel together for up to 27 feet, that it is feasible for nCoV to remain sus-
pended in the air and viable for hours, that can be remain in air in places like hospitals, and quarantine centers, etc with poor
ventilation prolongs the amount of time that aerosols remain airborne and can travel to other areas too causing transmission
to uninfected person. [2]

SVOA Microbiology
COVID-19 Pandemic: What it showed us!

Role of Immunity and Pandemic Fatigueness

In human body, a hormone called Cortisol works to manage our stress. The level of this hormone in our body remains high in
the morning and starts decreasing as the day passes, but it is produced in excess due to fear when general population faces a
situation like Pandemic, disaster-crisis. The excess secretion of Cortisol causes physical and mental troubles like muscle pain,
high blood pressure, stress, anxiety, fatigueness and depression. [3]and we see that today, majority of the world population is
experiencing aforementioned symptoms. As there is absence of any vaccine for nCoV, own individual immunity is more relia-
ble to be able to protect, which makes the immunity stand as the biggest need of the day.

In Nepal thousands of people are infected by nCoV, but more than that people has been exhausted because of constant and
long confrontation of this deadly virus spread and news. COVID-19 pandemic induced mental and physical exhaustion which is
now increased leading to fatigueness which we termed as “Pandemic Fatigueness”. The result of this exhaustion also can be
seen all around the world as people in large numbers are moving out as lockdown conditions are eased in most of the coun-
tries including Nepal. Now people are hardly scared of getting infected. Restaurants, cafeterias, parks, etc. have been opened.
People are gathering in large numbers without being bothered or worried about social distancing. Notably, when COVID-19
cases here and across the world are still increasing with massive number of death toll people are coming out, partying, mass
gathering. Rather of taking precautions, people are ready to take precautionary medicines that can assure them of protection
against this pandemic even though it lacks the scientific base. They are also running after instant solution rather than taking a
long path of discipline because they have accepted the fact that this pandemic is not disappearing any time sooner.

Hurdles in Preventive Strategy and Response

Several different containment measures were implemented by the Nepalese government as directed by WHO. This included
social distancing, domestic and international travel restrictions, quarantine/isolation for domestic population from high-risk
locations, and closure of schools and workplaces. The government declared on beginning of March that all schools including
universities were to be closed. Learning from both neighboring countries actions (India and China) put into place several
measures to limit the people to people infection. Earlier, it was told that citizens 65 years old or older, patients with immune
system deficiency, chronic lung disease, asthma, Chronic obstructive pulmonary diseases (COPD), chronic cardiovascular dis-
ease, chronic renal disease, hypertension, chronic liver disease as well as users of drugs that disrupt the immune system were
restricted from leaving their homes. These were considered as major containment actions taken. All ministries and other gov-
ernment health authorities published general instructions on COVID-19 prevention and control measures in their organiza-
tions as awareness for general population.

Like many LMICs that are now suffering from this pandemic, Nepal is to facing some hurdles in managing Corona virus as of
lacking enough resources out there for public. The health systems here are much too weak to handle an outbreak of COVID-
19. Analysis has found that at the peak of the epidemic, Wuhan, China, required 2.6 beds in intensive care unit (ICU) for every
10 thousand adults [4] and similarly Italy has less than half that capacity [5], and was in trouble. But LMICs like Nepal have just
some thousands of ICU beds per million populations according to a MoHP Nepal. Without proper intensive care for COVID
patients, many have faced trouble than in the countries where the pandemic hit hardest so far such as China, United states of
America (USA), Italy, Spain and now on number three India.

COVID-19 testing in Nepal included two methods Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). These
two tests processes are being widely used to test the corona virus patients worldwide. Earlier in Nepal RDT was widely prac-
ticed for testing of corona virus as directive from the MoHP. However, this strategy was based on the poor research evidence
and the method gave frequently inaccurate results. RDT can show false negative results in patients for up to a week after in-
fection because their body has not produced sufficient anti-bodies to get detected. [6] It took at least 6 days for IgM and 15
days for IgG to develop after nCoV enters the body of the individual through respiratory tract of individual which is why rapid
tests conducted in the early stage of infection gave more negative results even if the individual is actually infected from nCoV.
So, as for alternative of RDT and under the recommendation from WHO, the PCR is recommended for the COVID-19 testing.
Later health experts in Nepal also started to advocate for the use of the more reliable PCR on a wide scale of testing. As of
now (25th May 2020) in Nepal total of 75,343 PCR tests and 116,345 RDTs have been performed (source: MoHP Nepal).

What we learnt?

COVID-19, which is deadly new viral disease with not having approved treatment or vaccination so far, implementation of
preventing methods as directed by WHO in order to stop from spreading is very important. Occasionally WHO has failed to
reckon the impact of COVID and hence missed to halt the speed of its spread. LMICs should actively decide on using the re-
sources available with them and increase the mass testing capacity, detecting more positive patients in the community with
stricter quarantine rules.
43 SVOA Microbiology
COVID-19 Pandemic: What it showed us!

Not discriminating the symptomatic or asymptomatic patients. Research for COVID vaccine and public health should be
stressed on. Rise in pandemic fatigueness in general population results to disobeying the anti-spread rules should be main-
tained and monitored by health authorities of the country.

Conflict of interest: None to declare

References

1. Pan J, Yao Y, Liu Z, Li M, Wang Y, Dong W, Kan H, Wang W. Effectiveness of control strategies for Coronavirus Disease
2019: a SEIR dynamic modeling study. medRxiv. 2020 Jan 1.

2. Klompas M, Baker MA, Rhee C. Airborne Transmission of SARS-CoV-2: Theoretical Considerations and Available Evidence.
JAMA.

3. Dahlgren A, Kecklund G, Åkerstedt T. Different levels of work-related stress and the effects on sleep, fatigue and cortisol.
Scandinavian journal of work, environment & health. 2005 Aug 1:277-85.

4. Li R, Rivers C, Tan Q, Murray MB, Toner E, Lipsitch M. The demand for inpatient and ICU beds for COVID-19 in the US: les-
sons from Chinese cities. MedRxiv. 2020 Jan 1.

5. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next. The Lancet. 2020 Mar 13.

6. Hoffman T, Nissen K, Krambrich J, Rönnberg B, Akaberi D, Esmaeilzadeh M, et al. Evaluation of a COVID-19 IgM and IgG
rapid test; an efficient tool for assessment of past exposure to SARS-CoV-2. Infection Ecology & Epidemiology. 2020
2020/01/01;10(1):1754538.

Citation: Ayush Chandra, et al. “COVID-19 Pandemic: What it showed us! ”, SVOA Microbiology 1:4 (2020) 42-44.

Copyright: © 2020 All rights reserved by Ayush Chandra, et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

44 SVOA Microbiology