I am just recovering from a viral flu that kept me virtually confined to the bed for nearly four days and some of the symptoms such as joint pains have still not gone away. There really is no medication for any viral disease, even though Paracetamol and medicinal herbal drinks can help reduce fever and other symptoms.
I got Covid-19 twice, get the Common Cold all the time and also Viral Flu very occasionally. How is this possible? It is just that viruses evolve and mutate all the time – just when the body builds up immunity to one particular strain of a virus, along comes another virus with a different genetic make-up, to which the body has no immunity. Remember, the virus just wants to replicate and find as many hosts as possible. A dead host is of no use to the virus.
Just five years after Covid-19 engulfed the world, killing nearly 20 million people, there are signs of a resurgence of viruses that may possibly lead to a Covid-like emergency again. Covid’s global economic damage is estimated at US$ 16 trillion. Covid is not “dead” yet – around 1,000 people around the world get it every week, though deaths are rare.
Flu-like symptoms
The Human MetaPneumoVirus (HMPV) has apparently made a comeback in several countries. While not a “new” virus per se, HMPV is known to cause flu-like symptoms and can also present symptoms similar to Covid-19.
Some countries including the United States are battling the so-called “Quad-Demic”. Data from the Centers for Disease Control and Prevention (CDC) showed an increase in three respiratory viruses – Covid-19, flu and Respiratory Syncytial Virus (RSV) —and the Gastro Intestinal (GI) disease Norovirus. RSV is a common virus that infects the nose, throat, and lungs. The symptoms are very similar to those of Covid and the Flu.
The Norovirus is a highly contagious virus that causes sudden gastrointestinal symptoms. It is the leading cause of vomiting and diarrhoea in the United States. It is also the leading cause of food borne illness. Outbreaks can occur year-round but are most common from November to April. Norovirus outbreaks typically occur when infected people spread the virus to others through direct contact or through shared exposure to contaminated water, food, or surfaces.
Viruses are far more resilient than we think. Covid-19 is still around, though not at a public emergency or pandemic level. Viruses mutate at an astonishing rate, which means that a vaccine (or the body’s own immunity) effective for one variant of a virus will not be effective against another as mentioned earlier.
The last pandemic before Covid-19 occurred exactly a century ago, leading to the hypothesis that pandemics are a once-in-a-century event. But this gives us a false sense of security. The world is more interconnected now than it was in 1920 – it is possible to travel from anywhere in the world to anywhere else in or under 24 hours. A person who is infected with a virulent virus in Brazil can be in Sri Lanka just 48 hours later (accounting for the time difference en route), spreading it to unsuspecting passersby. This is in fact how Covid-19 spread around the globe to become a pandemic in just a couple of months.
Thus, there is a possibility of another pandemic happening sooner rather than later, at the rate with which viruses proliferate. The question is, having already forgotten the Covid-era health precautions, is the world ready for another one and even more importantly, can it cope?
Covid-19 vaccines are a work in progress
Sri Lanka must immediately assess its readiness for a viral pandemic, having learned many lessons from the last one. Despite the massive expenditure on our free healthcare system by successive Governments, Sri Lanka only had two Extra Corporeal Membrane Oxygenation (ECMO) machines during the Covid pandemic period that saved the lives of many critically ill Covid patients. At least two more ECMO machines will be a good investment. Our hospitals should also be equipped with more Intensive Care Unit (ICU) beds and emergency equipment.
Even though Covid no longer poses a threat, it is a good idea to practice some of the health guidelines imposed during the Covid period, such as washing or sanitising hands, not touching your face with unwashed hands, covering your cough and even avoiding crowded places. It is also advisable to wear a mask if you have any type of flu or the cold, to prevent its transmission to others.
On a global level too, the mistakes of the past should not be repeated. When Pfizer, Modena and AstraZeneca Covid vaccines were first developed and marketed, all the rich countries hoarded the limited supplies, depriving the poorest countries of the shots. By the time some African countries got access to the vaccines, Covid had passed the pandemic phase. The World Health Organization (WHO) must work in close coordination with organisations such as Global Alliance for Vaccination and Immunisation (GAVI), and the Coalition for Epidemic Preparedness Innovations (CEPI) to ensure equitable global distribution of vaccines. This way, no country will get favoured treatment.
Moreover, Western vaccine manufacturers must be compelled to share their technology with generic vaccine makers in the developing world (such as the Serum Institute of India), who can provide them to Governments at cheaper rates. In Sri Lanka, the health authorities should take steps to allow the private sector hospitals to import the latest Covid vaccines for customers who like to get them. Vaccination is still the best method of prevention of viral diseases.
Scientists are aiming to create so-called “broad-spectrum” vaccines that can prevent several viral diseases such as Covid and Flu in one go. This would be cheaper for both Governments and consumers as there is no need to get multiple shots for three or four ailments.
There are also genuine concerns regarding various side effects of mRNA vaccines. In depth studies must be conducted regarding this issue and any such shortcomings addressed. At the same time, there is a vast amount of misinformation on vaccines on social media, such as the debunked theory that some vaccines could lead to autism and that Covid vaccines could lead to infertility. Governments must work together to curb these myths.
Needle-phobia
Moreover, millions of people have a needle-phobia, which rules out intramuscular (IM) and intravenous (IV) Covid/other injections. Nasal sprays are a recent solution, although there already are liquid vaccines that are delivered through the nose. Sinovac Biotech, one of China’s largest pharmaceutical companies, has tested an anti-Covid nasal spray. In clinical trials, researchers gave it at least two times each day to participants who came in contact with infected people at home or work. The spray had about 80 percent efficacy at preventing infections. Some companies are also trialling needle-free vaccine patches which can be worn on the upper arm to deliver the vaccine to the bloodstream.
Testing is essential to curb pandemics. Pictures by Sulochana Gamage
In the meantime, more research is needed into viruses and viral borne diseases at university level. The University of Sri Jayewardenepura played a leading role during the Covid pandemic by contributing to global research. All other universities with Medicine or Biology faculties must initiate research into viruses and how they can be tamed.
There is no magic formula to fend off pathogens and viruses. Indeed, there really is no medication for viral diseases, apart from drugs that relieve symptoms such as fever. However, there are promising drugs such as Paxlovid and Lagevrio that can reduce the severity of viral diseases. More research is needed in this area.
It is important to remember that most people with flu experience only mild illness and do not need medical care or antiviral drugs. If you do get sick with the flu, stay home, rest, hydrate, and avoid contact with other people. If you have emergency warning signs, you should go to a doctor or hospital. Those signs include trouble breathing, chest pain, seizures, severe muscle pain, an inability to urinate, a fever or cough that goes away but then returns or gets worse, severe weakness, and a worsening of chronic medical conditions like diabetes. Do remember that flu can also cause pneumonia or sinus infections.
The Covid-19 pandemic has taught the world many valuable lessons about public health, preparedness, and global cooperation. To avoid the next pandemic and face it effectively if it occurs, it is crucial to implement a multifaceted approach involving Prevention, Preparedness, and Response (PPR).
Early detection is critical in preventing an outbreak from escalating into a pandemic. Robust surveillance systems must be established globally to monitor and identify potential viral threats swiftly. These steps must not be limited to rich countries.
This involves investing in advanced diagnostic tools, training healthcare workers to recognise unusual patterns, enhancing data sharing among countries through the WHO. In this context, it is somewhat alarming that the US has decided to pull out of the WHO, mainly because US institutions such as the CDC, Johns Hopkins, National Institute of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAD) are world leaders in this sector.
Hygiene and sanitation
Proper hygiene and sanitation practices are fundamental in reducing the spread of infectious diseases. Key measures include Regular handwashing with soap (note that some viruses are immune to sanitiser), ensuring access to clean water and sanitation facilities, educating the public about respiratory hygiene and cough etiquette and regulating the meat and wildlife trade.
The last step is important since the Covid Coronavirus is believed to have originated in an animal and then jumped to human hosts through a meat market. Hence the term “Zoonotic” associated with Covid. Scientists believe that at least 200 million viruses are lurking in animals waiting their turn to jump over to humans or advanced primates, though just nine are said to pose an imminent danger of a crossover.
There is also a widely discredited theory that the Coronavirus was a lab leak. While it is hard to imagine that happening from a BioSafety Lab-4 (BSL-4) facility such as the one at Wuhan, China, there is a remote possibility of non-State actors or terror groups getting their hands on lethal Chemical, Biological, Radiological, Nuclear and Explosives (CBRNE) materials which can be used for a terror attack. Such a possibility must be stopped at all costs. This issue was discussed at a recent pandemic forum held at Awaji, Japan.
Given the rapid proliferation of viruses, there is an acute need for developing comprehensive pandemic plans, incorporating the lessons drawn from the Covid saga. Governments and organisations must have detailed pandemic preparedness plans that outline response protocols for various scenarios, coordination mechanisms between different healthcare entities and resource allocation strategies.
Sri Lanka, which has a robust free healthcare system, was better prepared than many other countries in the region to handle the Covid pandemic. Still, around 16,000 patients died. Thousands of precious lives can be saved by building healthcare capacity, basically increasing the number of hospital and ICU beds, ensuring emergency access to advanced drugs, vaccines, equipment and Personal Protective Equipment (PPE) and training healthcare and allied professionals.
Accurate information
Clear and transparent communication is vital to maintain public trust and ensure compliance with health measures. During the Covid-19 pandemic, all TV, radio and newspaper outlets carried Public Service Announcements (PSAs) free of charge to educate the public, which alone saved thousands of lives. Many TV stations aired discussion programs on Covid where experts detailed the measures that should be taken to keep the Coronavirus at bay. Providing timely and accurate information as well as combating misinformation and baseless rumours are essential during an epidemic or pandemic.
If and when a pandemic threat is identified, immediate action will be necessary to contain the spread. Having already experienced a pandemic, we know what it looks like. Enforcing travel restrictions and quarantines or lockdowns is the first step. This was done even during the Spanish Flu, so one can wonder why it is still recommended over a century later. The answer is that we are yet to evolve a more advanced method to control viruses.
Conducting mass testing (Sri Lanka did not have any walk-in testing facilities during Covid) and contact tracing, wastewater testing and genome sequencing are also needed to identify the viruses at play. This is how scientists kept track of all the sub-variants of the Coronavirus, including Delta and Omicron.
Ongoing research during and after a pandemic is crucial to adapt strategies to face another one. Hence the need to monitor the virus’s evolution and mutation with a view to updating treatment protocols and health guidelines. For example, scientists have found that the Norovirus cannot easily be destroyed by sanitisers and only soap can do so.
As we learned from Covid-19, pandemics can have a devastating social and economic impact. Worldwide, millions of Covid patients are still suffering from Long Covid, a debilitating condition where Covid-like symptoms persist for more than one year even though the virus has long since exited the body. Scientists are still looking for a cure for this condition, which also includes “brain fog”. Millions of others who have lost their loved ones, jobs or businesses have developed mental scars that will take a long time to heal. Some persons who developed depression during the long lockdowns have still not been able to come out of it. These are all lessons that must be kept in mind.
At the rate that dangerous viruses proliferate and mutate, the next pandemic is not a question of “if” but “when”. Thus, like the Boy Scouts, it is better to “be prepared”. All countries, with the help of WHO, must adapt comprehensive prevention, preparedness, and response strategies to mitigate the impact of future viral, bacterial or even fungal (the scientifically valid premise behind the hit video game and TV series “The Last of Us”) pandemics and protect global health.
