Dr A S Bhatia
Union Territory of Jammu and Kashmir has seen unprecedented increase in the corona fatalities in the past few weeks, which have triggered a wave of panic among general population leading to shaking up of top level administration and Lt Governor Manoj Sinha paying a surprise visit to take stock of the situation. Many factors were attributed to the surge in the case mortality by the experts ranging from unsustainable oxygen pressure in the gas pipelines to excessive demand of oxygen thereby forcing the local administration to import oxygen from the neighboring states. This surge in the fatalities due to corona crisis has many similarities with the occurrence of a tsunami and the basic principles for management of both are also similar. A tsunami is a series of ocean waves caused by an underwater earthquake, landslide, or volcanic eruptions or by a giant meteor impact with the ocean. The corona infection can be equated with the series of inflammatory and immunological waves caused in the human body by the impact of corona virus. As the first wave of a tsunami is usually not the strongest, successive waves get bigger and stronger! Similarly as the history of pandemic flu in last centuries have shown that the successive wave of pandemic, as also called second wave had been stronger. As tsunamis retain their energy, and can travel across the entire oceans with limited energy loss! Similarly COVID -19 virus has travelled across the world without losing its virulence and is still as infective and aggressive as it was first reported in Wuhan! In 2004, the Indian ocean tsunami was caused by an earthquake with the energy of 23,000 atomic bombs. The killer waves slammed into the coastline of eleven countries and the total death toll was 283,000. As per the statistics available as on mid of October the corona tsunami has taken a toll of 1,099,040 throughout the world with India accounting for 111,726 deaths across the country. These figures are much higher as compared to the Indian ocean tsunami of 2004.
All world agencies including NASA are working on various projects to predict the tsunami before it can cause much damage and interestingly have developed the DART system which can detect a tsunami as small as a centimeter high above the sea level. NASA is also working madly in its quest to predict deadly tsunamis before they strike. Working on the same line in our fight to rein the corona crisis and to reduce the mortalities, we have to detect the damage caused by the corona virus to our body systems before much irreversible injury is caused and these diagnostic systems should work like the Dart system of tsunami and this is possible by detecting in blood certain natural biochemicals called Biomarmers released in response to the coronavirus. The researchers all over the world have recognized a number of such biomarkers to save the COVID -19 patients by detecting the complications at the earliest.
A welcome step has been taken by the Government Medical College Jammu to start theses blood based biomarkers in the Department of Biochemistry which will help the clinicians to predict the stage of the patient before much damage is caused by the infamous virus. The worrisome part of corona infection is the variable symptoms ranging from very mild fever to acute respiratory distress leading to death thereby complicating diagnosis, prognosis and monitoring. It has been felt that timely evaluation of a patient’s condition is very important in saving his life. With the start of these life saving blood based biomarkers for COVID -19 patients, this missing aspect will be taken care of. It was a good news for Jammuites that they can now avail the facilities of getting these tests done free of cost in government run hospitals and the poor will heave a sigh of relief as the private corporate diagnostic centers were charging amount ranging from Rs 7000 to 9000 for these tests. A corona patient suffers from multifocal trauma, First is the social stigma attached with COVID-19 positive patients, we may agree to it or not but the bitter truth is that the society is treating COVID positive patients as untouchables, and inspite of them getting turned negative, these patients are often not welcomed in social gatherings, second these patients are suffering from emotional and mental trauma apart from physical trauma of the disease and the third is the financial trauma for getting all these important investigations done from outside the hospital. With this welcoming step the poor patients will have some relief and their faith in the Government system will strengthen.
Working in this direction, Govt Medical College Jammu has started the blood based biochemical markers for COVID-19 patients and these include Interleukin -6, Procalcitonin, D-dimer, creatinine phospokinase (CPK), Lactate dehydrogenase (LDH), Ferritin, C-Reactive protein (CRP), Troponin -I among many others already being done in high end most advanced biochemistry autoanalysers.
Nightmare for most of the treating physicians is the event of their COVID patient landing into acute respiratory distress syndrome (ARDS).This most unwanted outcome is due to cytokine storm in the body, which is over exaggerated immune response involving an overwhelming release of pro inflammatory chemical mediators leading to complications like ARDS leading to low levels of oxygen in blood. This unfortunate event can be predicted by estimating the levels of different biomarkers especially Interleukin -6 (IL-6) in blood. Hence with the provision of getting these tests done in hospital will go a long way in decreasing the mortality and prioritizing the treatment along with categorization of patients into mild , moderate and severe cases. Another leading cause of death in COVID patients has been linked to hypercoagulable state of blood leading to blockage of small blood vessels supplying the lungs and patients having this complication are likely to have a bad outcome. This covid related complication can be easily diagnosed by most commonly identifiable coagulopathy biomarker , D – Dimer in the blood. In one study in Wuhan, China, patients with D -Dimer levels over 1 ugm/ml (standarad range less than 250 ngm/ml) showed an 18 fold increased risk of death, so with the availability of getting this test done in GMC Jammu will prove to be boon for the patients suffering from corona infection and will help in saving their lives.
It has been observed that many deaths in most horrific tsunamis have been averted by the most efficient meteorological forecasts. Many coastal areas are warned beforehand and people are evacuated to higher reaches. Similarly these blood based COVID -19 biomarkers are the forecasters of impending dangers, a corona patient may have and timely detection of these parameters can save a precious life and can help us in reining the Corona tsunami. One important thing will remain to be seen is, that whether the administration is able to provide the continuous supply of these important reagents and chemicals to carry on the show or otherwise may it not prove to be a flop show with discontinuous and erratic supply of essential drugs. It should be the sole responsibility of the local administration of Government Medical College Jammu to see that the people of Jammu are not made to suffer any more as already it had been a long wait to get these important investigations get started in this premier tertiary care hospital. Otherwise as Mirza Ghalib Said,
Kitni ajeeb hai nekiyon ki justuju
Ghalib,
Namaz bhi jaldi mein parhte hain
Phir se gunah karne ke liye.
(The author is Vice President Indian Academy of Biomedical Sciences, India
and Professor and Head Department
of Biochemistry, Government Medical College Jammu.)
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