Covid-19 and deadly illusions!

Back when I was a young family physician in Lahore, a patient came to the clinic with some non-specific symptoms. He was in his mid-40s and had no history or risk factors for heart disease, but I did an ECG to be extra cautious. I took a second opinion but his ECG was clear. Later the same day, he developed chest pain and was rushed to the Punjab Institute of Cardiology (PIC). He suffered a heart attack. As a new clinician I became extremely worried for missing the diagnosis and especially how all of us were unable to read an ECG. After discharge, the patient told me that PIC used the ECG taken at my clinic as reference because until then there were no changes in the ECG. Where missing an acute condition was still a failure on my part, all of us did correctly read that ECG.

But here is where the next problem started. The patient was adamant that he does not have a heart condition and was using the ECG from my clinic as proof. I remember telling him point blank that he had an actual heart attack. It takes some time for the ECG to reflect those changes and he had to take the medicines prescribed by PIC. But he did not agree because “others” are also telling him that he may not have a heart condition. When I became firm in my advice, he stopped seeing me. Soon after I left the country and on my first return, I was informed he died of a second heart attack. A shock as he belonged to a middle-class family of which he was the only bread-earner. Someone who had a long productive life ahead of him was misled by others in an illusion of wellbeing and his family paid the cost.

SARS-COV-2, the virus which causes Covid-19, is a new virus. Uncertainty about this virus which is due to the short time available for scientists to study it has also created unprecedented doubts about it and the disease it causes in the minds of both public and governments. Is it man-made or natural, real or a hoax, and if masks are good or bad? But it has caused the most dangerous illusion in countries it was thought to be under control in. The US, Iran and now Spain are a few examples where life returned to normal and then the second spike came. In Pakistan, in the beginning I was a minority who did not agree to a doomsday scenario when armchair epidemiologists were projecting millions of deaths. Now there is a reversal of roles. Now everyone who was on the bandwagon of projecting millions of deaths earlier has moved unapologetically to a new wagon of “all is well”.

I made my earlier estimates based on our age distribution, social setup, environmental factors and how the outbreak actually progressed in any community and estimated a much smaller footprint in Pakistan. But that does not mean we have some magical protection against this disease. We squandered a good opportunity to keep the numbers lower than 100,000 back in May and now it looks like we will be moving towards another ditch. The government’s double talk of claiming victory against the virus but still asking for the people to follow SOPs has confused everyone. Now only 10-20% of the people are wearing masks in public and most believe that Covid-19 is over. This is a dangerous illusion especially when we have a very weak surveillance system which will not be able to pick the next spike in time. By mentioning SOPs the government cannot absolve itself of its responsibility to protect us.

The pandemic is not over yet. Be real and take the Covid-19 threat seriously.

Published in The Express Tribune, July 30^th, 2020.

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