The News on Sunday: Covid-19 has put us in a new territory. What challenges are you facing in treating coronavirus patients?

Dr Bilal Ahmed: The challenges faced by the healthcare community have laid bare the chinks in the American healthcare system. This system is designed to provide technologically advanced treatments to a population which has the means to afford it. Social safety nets and a robust public health framework are woefully lacking.

This became abundantly apparent early in the pandemic, when hospitals and healthcare workers experienced shortage of masks, personal protective equipment (PPE), respirators and even basic medication. The lack of PPE in these situations is akin to asking soldiers to go into battle with no protection or means to fight. Healthcare workers have, however, risen to the challenge and are fulfilling the Hippocratic Oath.

TNS: With the rate of infections among health workers so high, how are you balancing your professional duties with your family obligations?

BA: Over 30 percent of US physicians are 60 years and older and this age group also carries a high risk of Covid-19 associated complications. Three months into the crisis, the stockpile of PPE and masks has drained as critical needs are rising. The risks of caring for seriously ill people under the pressure of a pandemic are almost impossible to avoid. Still healthcare workers are trying to juggle their personal safety, their family’s exposure risks and their duties towards sick patients. This is causing a high degree of stress, burn out and PTSD symptoms among them.

TNS: There’s talk of treating coronavirus patients with plasma therapy in Pakistan. Do you see any impediments to this kind of treatment?

BA: There are defined protocols which have to be followed to use plasma from convalescent patients. The therapeutic agents — convalescent plasma and hyperimmune globulin — are both derived from the blood of people who have recovered from the disease.

The hard part is finding donors, making plasma and hyperimmune globulin out of their blood, and getting it to the hospitals that need it — all within the guidelines of informed consent from donors and recipients and keeping track of the resulting data.

An individual who is sick with Covid-19 and recovers has blood drawn and screened for virus-neutralising antibodies. Following identification of those with high titers of neutralising antibody, serum containing these can be administered in a prophylactic manner to prevent infection in high-risk cases, such as vulnerable individuals with underlying medical conditions, healthcare providers, and individuals with exposure to confirmed cases of Covid-19. Additionally, convalescent serum could potentially be used in individuals with clinical disease to reduce symptoms and mortality. The efficacy of these approaches is not known, but historical experience suggests that convalescent sera may be more effective in preventing disease than in the treatment of established disease.

TNS: Theories around Covid-19 abound. One theory refers to a mutated coronavirus strain infecting people in South Asia while the other claims that frequent flu attacks have toughened local immune systems. Are these valid assertions?

BA: Humans have been hosts to the COVID virus for just about four months and much has to be studied about its behaviour and possible cures. All viruses are constantly mutating. The genetic difference in these mutations is, however, small. Theories about variations in the host population’s immune response are conjecture at present. Further research will clarify these questions.

TNS: Do we know what will happen to people who survive the virus? Will it leave any long-term effect on their respiratory health?

BA: More than 85 percent of people who survive the virus will have no long-term ill effects. Most might not even know they have had the infection. It is possible that patients who survive Acute Respiratory Distress Syndrome (ARDS), and need artificial ventilation may have long-term damage to the lung architecture. These complications will be apparent as time progresses.