Being a retired but busy practicing physician I could not see my patients for almost twelve days due to the lockdown. I tried my best to remain available on phone and WhatsApp but sometimes it becomes too much because not every patient contacts for a genuine reason and every single problem cannot be solved over the phone. Ultimately I decided to do my consultation once or twice a week despite all the opposition from my family and friends. I was astonished to see the number of patients present at my clinic, and to my surprise many of them had come from Lasbella, Gadani, Gadap and even Turbat, besides Karachi. I can only imagine the difficulty they must have faced to reach here.
Although as expected, many of the patients were suffering from corona phobia but then there were truly genuine patients, some of which rarely needed even emergency medical care. The patient from Turbat had had fever for the last few months and he had been waiting to see me for the last six days, which made me feel extremely guilty. Another patient who had come from a village near Sakro was hypertensive and couldn’t get his anti-hypertensive treatment done, developed a stroke in consequence to intracranial bleeding. He reached Karachi with great difficulty and seeked treatment from at least four hospitals on the way but was turned down. What does this mean? Should we shut the doors of medical care for all other patients in the scare of COVID-19? Is this what the Hippocratic Oath is about? Where have medical ethics gone? I have never seen the medical fraternity on the verge of such an attitude, truly to an extent never seen or heard. I have no reason to put the lives of my colleagues and juniors at stake but the question that arises now is who is going to address the concerns of patients other than those who have coronavirus? Some guidelines can be followed for the care of such patients to save them from morbidity and mortality and overall undue mental torture and botheration.
I strongly recommend that all necessary preventive measures should be taken for all those attending to patients and it is the utmost responsibility of the authorities and hospital administrations to take interest in this matter without compromising on the lives of all the caregivers who are making great sacrifices as well as fulfilling their responsibilities and performing their duties with extreme fervor and diligence, proving to be real heroes. Unfortunately, we have lost a very senior and respectable practicing physician due to corona infection, which he contracted from some of his patients in Gulshan-e-Hadeed, Karachi. It was a great loss.
A middle aged patient came with symptoms of vomiting and was reluctant to admit that he had taken four tablets of hydroychloroquine out of sheer panic, to prevent him from coronavirus infection. On my inquiry he told me that he had received innumerable messages on WhatsApp and Facebook that it is proved to prevent as well as treat the infection! This is one of the adverse effects of spreading inaccurate information. Regarding the efficacy of Hydroxychloroquine and Chloroquine to treat coronavirus infection, it is just too good to be true. We cannot justify its use, that too without supervision and weighing the pros and cons, just on the basis of one weak study. If anyone is at odds with my opinion they can listen to the interview given by Professor Anthony Fauci, an infectious disease specialist in CDC and the author of Harrison’s Textbook of Medicine. We have been using these two drugs for decades not only to treat malaria but other parasitic infections and autoimmune disorders as well, and some anecdotal evidence is present regarding their probable efficacy in viral illnesses like influenza but then again authentic scientific evidence is needed. The recent studies on efficacy of these drugs in treating coronavirus infection are scientifically weak and heavily criticized. But one thing is for sure that these are not of those drugs meant for self-medication as they can have dangerous side effects, especially on the heart. I believe some deaths have been reported from Nigeria after a similar situation was created there due to misinformation regarding the efficacy of Hydroxychloroquine in COVID-19. I am aware of the fact that some trials are being carried out in some countries by using these drugs on patients with severe corona-induced pneumonia, producing variable results but it is too early to deduce anything from them. Controlled and supervised studies are needed to confirm the efficacy of these drugs.
The phobia caused by COVID-19 is another major mental health issue which I can foresee in a substantial proportion of the population. Quite a number of patients have been contacting their doctors with symptoms resembling those of coronavirus without any objective evidence. Even many of my patients complained of difficulty in breathing, increase in heartbeat, inability to concentrate and lack of sleep, all because of fear of contracting this viral infection. I think mass scale psychotherapy should be provided by trained psychiatrists and psychologists alongside infectious disease specialists/physicians who can devote their time on social media and television to help reduce the anxiety of masses regarding this problem. As the number of psychiatric illnesses is already very high in our country, I suspect this will have a long lasting effect on such patients as well as increase their number to a great extent. Some cases of suicide have been reported from different parts of the world due to phobia of contracting COVID-19 and I am afraid that the same story might repeat here too. Careful counseling of patients and masses is the need of the hour. Patients with Obsessive Compulsive Neurosis and depression are especially at the risk of experiencing worsening of their symptoms.
The lockdown in itself and sitting idle at home is also triggering psychiatric problems in otherwise healthy people. One should find ways to keep oneself busy in healthy activities like reading, writing, talking to friends and relatives, exercising and most importantly, reducing the amount of time spent watching TV and on social media as these are the main platforms where incorrect information is being circulated, creating further chaos, confusion and scare in the masses. We don’t know how long this situation is going to continue for and while we should be prepared for the worst to come, it is also necessary to keep hoping and praying for this disastrous pandemic to end soon without causing any more harm than it already has.
Professor Khalid Mahmood
The writer is former Dean and Meritorious Professor Medicine Dow University of Health Sciences, Karachi.