Dr. Prakash Budhathoky

Now, we're going to look at what comes next following the second wave of the coronavirus that has gripped our nation. The world has reported millions of cases of the coronavirus and the WHO has come up with the largest single-day count of cases. Fewer places can say they are past the peak and some localities are already experiencing a bounce-back of fresh cases. Yet we have been in this pandemic long enough to develop a bit of familiarity with the virus and a bit of rhythm to our daily livelihood. The COVID-19 outbreak is not the first time we are facing any pandemic.
As we have overcome these deadly infections, we will overcome COVID-19 as well. The greatest risk of a global catastrophe is right on our way. The virus spreads rapidly in crowded places where proper ventilation does not exist. The crowded areas are the place where the virus is easily transmitted via droplet.

Coping With New Variant
The novel virus has changed the rhythm of the country. Learning from the experiences of other nations, our country should make proper moves to cope with the pattern of this outbreak. The coronavirus disease continues to spread across the world following a trajectory that is difficult to predict.
The country now has a unique opportunity to adopt policies aimed at achieving social justice. The health, humanitarian and socio-economic policies adopted by the state will determine the speed and strength of the recovery. Without long-term structural changes, it will be very difficult for us to fight against this pandemic and get back to our normal lives.
During the first phase of the pandemic, people were scared and confused as everything was new and the lockdown was the only solution. The fear had reduced which is a good point but this is not enough. The change in weather has also spiked the second wave of outbreak. As the virus is minute and devious we need to be very careful and follow all the healthy health guidance else, it can kill and cause suffering along with allowing enough people to escape with mild or no symptoms so that it can continue to spread like wildfire.
Previously coughing, sneezing, headache and body pain, fever, loss of appetite and sleep were major symptoms. Nowadays oral, Ear Symptoms and skin rashes, and conjunctivitis are also said to be its symptoms with Diarrhoea.

Is Remdesivir Essential ?
Remdesivir was the first drug that was granted an emergency use authorization in May 2020 by the US Food and Drug Administration (FDA) for the treatment of COVID-19 in hospitalized adults and children aged 12 years and older who weigh at least 40 kg. Remdesivir is also approved for the treatment of COVID-19 in hospitalized children.
According to the COVID-19 treatment guidelines issued by the National Institutes of Health (NIH), the administration of Remdesivir should be prioritized in COVID-19 patients in ICU receiving supplemental oxygen therapy, and it can either be administered for 5-10 days or until the discharge of the patients.
However, owing to the low uncertainty evidence for critical outcomes and the fact that different viewpoints, values, and priorities could alter opinions about Remdesivir, the recommendation panel issued a weak recommendation with strong support for continued recruitment in randomized trials.
The clinical review stated the uncertainty of the impact of Remdesivir on mechanical ventilation, mortality, and length of hospital stay; however, they reported the moderate certainty of Remdesivir for the reduced duration of symptom resolution and duration of mechanical ventilation.
Moreover, the World Health Organization (WHO) has also recommended against the use of Remdesivir in hospitalized patients, regardless of disease severity, because of the lack of evidence of reduced mortality and other outcomes in these patients. Instead, alternative treatments, including the inexpensive and widely available corticosteroid Dexamethasone and interleukin-6 inhibitors, probably confer more benefits in patients with severe covid-19.

Prevention Far Better
As we all know that vaccines are available but our country can't vaccinate every citizen with full dozes soon. Vaccines are limited so We need to work individually to fight this pandemic.
To reduce the risk, we need to find out if people are sick, or show antibody evidence of recovery; trace their contacts if they are sick; and persuade them to be confined safely, at home or in recovering housing, until they are no longer a danger to others. Recovering housing is especially important because so much COVID transmission seems to take place in close quarters, in households or spaces shared by several generations of a family.
The decision-making process of the government should be quick. Many children and young people had experienced loneliness during the lockdown and in particular, been affected by lack of physical contact with their friends, families and peers, and the boredom and frustration associated with a loss of all the activities were seen. Crime rates spiked up. Rape cases, suicide rates, murder and robbery cases increased drastically.
At last, we need to change our unhealthy habits and start to perform proper hand hygiene, wear masks properly, have a healthy diet and avoid crowded places as much as possible to avoid COVID 19 infections.

(Budhathoky is Central Treasurer of Nepal Medical Association)