|LETTER TO EDITOR
|Year : 2023 | Volume
| Issue : 1 | Page : 91-92
Supply constraints and test shortages for COVID-19
Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||01-Sep-2022|
|Date of Decision||13-Feb-2023|
|Date of Acceptance||25-Feb-2023|
|Date of Web Publication||26-Apr-2023|
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta H. Supply constraints and test shortages for COVID-19. J Med Evid 2023;4:91-2
'#Long COVID needs more research, recognition and reporting. Health systems need to be prepared to manage patients with persistent symptoms. @WHO works with global group of affected people.' – Dr. Soumya Swaminathan, Chief Scientist at World Health Organization, 30 July 2021.
Chauhan et al. review post and long COVID conditions while underscore its epidemiology, clinical symptoms, prevention and treatment in their article published on 29 August 2022 in the Journal. They highlight its clinical signs and symptoms; some laboratory investigations-none of which is specific; clinical management-symptomatic one; and afterwards its holistic case management therein. As few cases of the infection turn to be long haulers and we have only limited knowledge about the persistent condition, more and more such studies are need of the hour so that our scientific community may collate the data and share for better assessment of the emerging scenario. The authors need to be appreciated for their work to go through on the issue when uncertainty in the area is prevalent and nobody knows the direction we are headed to. Moreover, no one can predict the course of either the pandemic or its consequences-one of which is long COVID.
Nevertheless, there is a little alternate point of view inter alia where I want to draw their attention. Under the heading of clinical management, they emphasise that as headache may be one of the symptoms, a history of COVID from such patients is important. However, my point is that while the presence of such history adds to our algorithm to evaluate the presence of the post-COVID condition, the reverse may not be true. During the early months of the pandemic, several regions faced a shortage of supply chains which included running out of stock of COVID tests. Moreover, the challenge was not unique to some distinct geography but some of the most affluent regions faced it too. Due to a faulty reagent in a test kit, the initial days of the arrival of the pandemic were not informative enough so as to help epidemiologists draw its map.
On the other hand, when the pandemic reached its peak here during the frightening second wave in the spring and summer of 2021, we witnessed a similar situation. Then, I met several people who wanted to be tested at that point but could not be. Consequently, now they may not provide a typical history of COVID, nonetheless they should get the same care and support as their counterpart who availed it, I believe. If one looks at the situation in this way, the absence of a history of COVID due to the inability to undergo the test should not be a factor for the lack of extending our helping hand to them.
When an illness engulfs a society, there are a few people who are the least able to-and have bare minimum capacity to-access what is there in offer by administration. Therefore, afterwards when someone (unintentionally or subconsciously) discriminates against them on the basis of their inability to avail of the services in the first place, it is double jeopardy for the cohort. As sensitive and responsible citizens, it is our duty to recognize the fault and make every possible attempt to rectify it. Lack of inclusion of someone with corresponding symptoms but an inconsistent or atypical history may be such a scenario when an inability to access the test at the time of development of symptoms is one of the factors for the apparent discrepancy.
Another point needing underlining here is that these were patients who collaborated to coin the term – long COVID– as physicians initially did not realize the symptomatology. Hence, more inclusion of the patients should be our goal when we examine whom we are unable to classify on the basis of what we already know. As the writers mention in their review, there are still several areas needing our exploration and we will be able to do so only when listening to them patiently and in a way so as to provide them with due attention.
In box 2 under the heading of 'Mitigation strategies for post-COVID condition', the writers provide a valuable suggestion for 'At the primary healthcare facility'. There under the subheading, they want 'Training of healthcare staff on timely identification, management, referral and follow up of PCC (Post-COVID Condition) patients. While that is a laudable objective, what also should be our planning is the formation of a system of two-way communication. The sort of hierarchy we have at present provides communication only one way from top to bottom. As we become mature enough, we would develop wisdom that those serving at the periphery too have some great ideas which may provide novel insight to our compilation -- providing us useful clues. When someone lends a listening ear to them, it only enriches them. Their lived experiences while serving at the centres are a rich source of information and its underpinnings. Harnessing it may yield a fountainhead of rationality and a mechanism should be put at place.
| References|| |
Chauhan P, Pathak VK, Kumar D, Upadhyay A, Chatterjee A, Lahariya C. Post and long-COVID conditions: Epidemiology, clinical symptoms and the prevention and treatment. J Med Evid 2022;3:149-54. [Full text]
Woolston C. 'Does anyone have any of these?': Lab-supply shortages strike amid global pandemic. Nature. 2021 Mar 9. doi: 10.1038/d41586-021-00613-y. Epub ahead of print. PMID: 33750928. [Last accessed on 2023 Mar 10].
Callard F, Perego E. How and why patients made Long Covid. Soc Sci Med 2021;268:113426.