COVID-19 conference: Much like global transmission, borderless exchange of information, ideas, experiences crucially important

The Royal Society of Medicine brought together international thought leaders from world over in a COVID-19 online conference on Monday, 27 July. Health experts from a handful of countries shared findings and consensus from the medical community in key areas of COVID-19 medicine, and the impact of the pandemic on physical and mental health. The conference broadly discussed the complications from COVID-19 being seen in some broad areas – respiratory complications, cardiovascular complications, thrombosis (blood clotting disorder), neurological (brain and nervous system) complications, mental health illnesses, equitable access to vaccines, and future public health policy.

Notes exchanged on COVID-19 comorbid conditions

Experts flagged a common complication in many severely-ill COVID-19 patients hypoxemia – an inadequate supply of oxygen to the lungs and the body. Treatments like high-flow oxygen therapy and continuous positive airway pressure therapy (CPAP), both of which are minimally invasive treatments, were shown to help improve the condition. 30-50 percent of cases in which hypoxia is seen don’t require invasive methods or intubation to treat, they added.

The panel on the COVID-19 complications in cardiovascular patients saw experts discussing some specific comorbidities, in those with existing heart conditions, and how the health system has responded to address them. COVID-19 and cardiovascular disease aren’t direct related, there is a lot of data from research in multiple nations, showing a strong link in comorbidities. Fewer cases of mortality and admissions in the more recent months of the pandemic were seen, compared to the earlier days, experts said. Over the last six months, researchers have also pointed to neurological symptoms affecting the brain and nervous system, which are increasingly apparent in COVID-19 patients. Early diagnosis, and differential diagnosis will make all the difference in treating these symptoms, experts said. [caption id=“attachment_7420881” align=“alignnone” width=“1280”] There’s a lot that heart attack survivors can also learn to lower their chance of a future stroke. Image: Harvard Health[/caption] Many comorbidities, experts agreed, would benefit from early diagnosis. Taking blood clotting disorders, or thrombosis, as an example, one of the panelists highlighted that if doctors and researchers know in advance who is more at risk, symptoms of the disorder can be better controlled using early-intervention and medicines like anti-coagulants or heparin. Irrespective of the comorbidity, COVID-19 patients would have a far better medical outlook if their status and risks were known early on, they concluded.

India’s learnings from COVID-19 pandemic

India has seen a relatively lower mortality rate and higher number of infections than most nations, possibly due to the younger age profile of the country, said Professor K Srinath Reddy from the Public Health Foundation of India. Comorbid conditions are ample in the population – urban diabetes, obesity and hypertension being some of the most prevalent ones. Among the people admitted with COVID-19, there have many cases of stroke, myocardial infarction have been commonly seen, Prof Reddy said.

The growth in telemedicine during the pandemic could be a positive change that the Indian health system would benefit from retaining, even after the pandemic is not longer in play, he added. Speaking about the long-term changes to the healthcare system, Prof Reddy highlighted that in all past epidemics, it is often those with comorbid conditions, older population and serious health conditions that suffer the most severely. The lesson to the health system is to attend aggressively to the most common comorbid conditions during non-epidemic periods too – diabetes, hypertension and obesity being some examples in India.

[caption id=“attachment_8572851” align=“alignnone” width=“1280”] Many parts of India are still under varying degrees of lockdown and control. But the onslaught of COVID-19 and the subsequent lockdown has acutely affected labour market in India. Image: AP/Channi Anand[/caption]

Unequal access to vaccines

In a session on global access to vaccines, a Ugandan Health Ministry official said the country is partnering with many vaccine research projects – with London and Institute of Tropical Medicine – because they’re “not sure when a vaccine will reach” them. Experts from other nations, too, said that access to vaccine is going to be a global challenge. Wealthier countries will naturally “spread their bets wide”, and boost their odds of access more vaccines and sooner, experts said. It is likely that middle- and low-income countries will benefit from a vaccine later on. As long as more vaccine distribution programs come into play, with the number of trials underway – there will be quicker and relatively equitable access to a working vaccine even in middle- and low-income countries, experts added.

Toll of COVID-19 on mental health

The global COVID-19 pandemic has affecting both physical and mental health in a variety of age groups, said the mental health expert. Vulnerable groups, like those who were already experiencing minor and major mental health issues, are being pushed further into distress from the effects of the COVID-19 pandemic. Anxiety is among of the most common illnesses experts are seeing, affecting all ages, from children to older adults, an expert said.

Some new groups in which experts are seeing mental health issues amid the COVID-19 pandemic are patients in the ICU, and frontline health workers, who are at risk of post-traumatic stress disorder (PTSD), depression and anxiety. It’s important to incorporate solutions, like public health messaging, as important additions to public health systems, the expert added, highlighting that mental health is a highly-treatable illness. For mental health treatments, there’s a lot of evidence-based therapies that have been proven to work. We need to be able to take some risks and accept what may seem unconventional – whether in the form of billboards promoting mental health awareness or a game that uses a methodology rooted in psychology – to address the needs of the people seeing mental issues as a result of COVID-19, the expert suggested. [caption id=“attachment_8514841” align=“alignnone” width=“1280”] In this 10 May 2020, Sikh volunteers take a tea break in the kitchen hall of the Bangla Sahib Gurdwara in New Delhi, India. An act of generosity or self-sacrifice. A whimsical gesture to distract neighbors from anxiety or cabin fever during COVID-19 and lockdowns. Image: AP[/caption]

Takeaways for health systems – for COVID-19 and beyond

Regular communication and information exchange between peers amid the pandemic has made a remarkable difference in the medical and research community, experts highlighted. For instance, daily meetings to discuss symptoms, the latest medical research to treat the symptoms, and bringing in international expertise and consultants, they said, are useful in maintaining a high quality of healthcare considering the quickly-evolving nature of the pandemic and medical research around it. Another consensus was that adapting the public health care system to fit the needs of the patients was important. While we’re ready to treat patients, patients aren’t necessarily presenting themselves to receive the care they need at the right time, a medical expert said. Considerations for how to care for the wide range of patients, based on the needs and behaviour of patients is important for health system to serve well. Much like the international nature of the pandemic, which hasn’t had any borders for transmission, the exchange of information and ideas and experiences globally is crucial. It has vastly improved the quality of care and approached to addressing the pandemic, an expert added, and should be ramped up. The most basic prevention tools – handwashing, masks, and physical distancing – have save thousands if not millions of lives, and can’t be emphasized enough, the panel underlined. Organizers at the Royal Society of Medicine are hoping to put together to another edition of a COVID-19 conference in the near future.