26th in the series of weekly WACEM-ACAIM Joint Group Meetings
Plant Products Nanotechnology: Integrated Indian Herbal (Ayurvedic) and Nanomedicine for COVID-19, by Dr. Shyam Mohapatra (USA)
Dr. Mohapatra opened his fascinating talk with the concept of integrated medicine: a combination of experimental and experiential, holistic and analytical, functional and structural aspects of care. He highlighted some benefits of herbal medicine, such as better membrane permeability, good bioavailability, decreased toxicity, and many more. With the advent of nanotechnology and the progress made in the last few decades, the ancient macroformulations of ayurvedic medicine can now be manufactured as nanoformulations. He gave an example of Withania somnifera (ashwagandha), a long used plant with medicinal properties. Scientific studies looking for adverse effects on multiple organ systems showed Withania somnifera to have a relatively safe drug profile, and its bioactive ingredients have been used in prevention and treatment of arthritis, amnesia, impotence, anxiety, cancer, cardiovascular disease, etc. It was shown to have immune-modulating action in other animal studies. Finally in relation to COVID-19, it is shown to engage ACE 2 receptor proteins. There are other similar examples of plant based therapeutics, which in Dr. Mohapatra's words, when explored in combination with nanotechnology, will prove to be a marriage made in heaven.
COVID 19 in Japan, by Dr. Jumpei Tsukeda (Japan)
Dr. Tsukeda regaled us with the fantastic approach toward COVID-19 which was used to good effect in Japan. He mentioned that the key to a well engaged response, was the availability of 24/7 information sharing. They implemented messaging, mobile and computer based voice applications, tele-ICU. Teams were divided to play to their strengths, and redeployed to areas that needed the redistribution. There were in-hospital teams and out of hospital teams with excellent follow up provided to both sets of patients. Hospitals were renovated to establish COVID units, COVID triage, and COVID ICU. The government and health sectors put out simple to understand messages, such as "AVOID 3 Cs - Closed Spaces, Crowded places, Close-contact settings". They, too, faced several challenges, but have continued to prove how Japanese discipline and understanding of healthcare of their people is a priority.
Metamorphosis of COVID, by Dr. Indrani Sardesai (UK)
I had the honor and pleasure to be included in this wonderful panel of speakers. My topic alluded to the metamorphosing of COVID-19 from "just another viral infection" as thought back in January, to one that has caused devastating to the global population, to the economy, to both physical and mental health. At first thought to affect just the vulnerable above-60 population, to now affecting all without discrimination. In the current climate of social connection and the power of media-driven narrative, there has been information coming out fast, sometimes too fast to the detriment of trust between the common man and the healthcare sector or those who represent it. However, in all this, we also bear witness to the rising new disease as witnessed by people who understand science and those who don't. The scientific community is so focused on this disease, papers, publications, therapeutic trials abound. We have resigned ourselves to the fact that this disease is here to stay, but we are determined in finding out more, and taking away the power of the unknowns.
COVI-Sepsis from Qatar, by Dr. Hassan Al-Thani (Qatar)
Beginning his talk about the variety of ways COVID has presented at its worst, from the fatal pneumonia raving the lung, to the necrotizing fasciitis feasting on the body, Dr. Al-Thani highlighted the serious nature of the disease. The Qatar model of healthcare is particularly inspiring in its proficient and remarkably rapid response in dealing with the disease. In their anticipation of COVID reaching Qatar, they generated surge capacity for both ICU beds and general hospital occupancy. They went from a hundred ICU beds in one week to a thousand in the next. Their inpatient capacity increased by five fold. They paid a great deal of attention to staff health and well-being, realizing very early that weaknesses in staffing (be it from illness of self or family, burn-out, etc.) would result in a domino effect to take down the whole system. The speed of the response, government support, and subsequent results prove that Qatar means business.
Malaysian COVID Response, by Dr. Mohammad Alwi (Malaysia)
Malaysia put into action the lessons learnt from its experiences with SARS, nipah virus, and MERS. Their regular table top exercises and simulation exercises kept them up to date and ready to deal with anticipated and unanticipated events. They were able to rapidly establish command centers, triage areas and communication hubs. They put a lot of effort into regular open communication which helped with a trusted and effective work environment, ultimately leading to safe and effective patient care. Dr. Alwi's hospital even managed to make their local and national news. The key to their success for regular training and good communication.
Operational Restructuring in COVID: The ED in NHS, by Dr. Joydeep Grover (UK)
Just like a lot of hospitals around the world, the NHS trust hospitals in the UK also created surge capacity at the outset in anticipation of COVID reaching the UK. Fortunately, more beds were created than utilized rather than the other way around. Secure areas or secure corridors/paths were created to limit cross contamination throughout various in-hospital areas. There was the general principle of process development, attended by experienced clinical and non-clinical staff, communication on a regular basis, and finally putting plans into operation in a systematic manner. Attention was paid to staff well-being across trusts, addressing the need to recognize and care for staff's health and morale. Risk assessment scores were developed taking into account that staff can also belong to the vulnerable groups, and due precautions taken to ensure safety. A pleasant experience for the NHS was the public lauding and "Clap for carers" initiated by the public themselves. Members of the public, local eateries and businesses would drop off spare PPE, food, cards etc, in a show that was touching and motivating to front-line workers in hospital and community based teams.
These last 3 weeks, we have celebrated the occasion of regular weekly international meetings, and the completion of 25 meetings - no small feat - with a line up of speakers from across the world, experts in their field, all invested in the betterment of our handling of COVID and the wider aspects of the practice of medicine.