Leprosy Mailing List – May 13, 2020
Ref.: (LML) More lessons for HD, from COVID-19
From: Joel Almeida, London and Mumbai
Dear Pieter,
South Korea and India have been using mobile phones and information/ communication technology for real-time mapping to help contain COVID-19.
Outcomes so far have apparently been good.
COVID-19 has an R0 (reproductive number) well above 1, because so many people have genomes conveying high susceptibility to the causative agent (SARS-CoV-2). Yet India is not doing too badly against COVID-19.
India has well over half of the world's people with HD (Hansen's disease) or sequelae. HD has always been relatively self-limiting in human populations. As discussed here previously, that is because the R0 (reproductive number) of lepromatous (LL) HD is only marginally above 1. Genomes permitting anergy and "de novo LL" HD are relatively infrequent in human populations. Incidentally, this probably explains why in affluent countries HD almost never spreads in the workplace, even when LL patients with delayed diagnosis have kept shedding astronomical numbers of viable bacilli.
Whatever the reservations about the tech-based approaches against COVID-19 in South Korea and India, outcomes so far seem good.
https://www.worldometers.info/coronavirus/
The gulf between successful countries and those less successful is conspicuous, especially when sorted by deaths per million population. In India the short-term all-cause mortality rate may even have declined as a result of the lockdowns, owing to fewer traffic accidents. Funeral service providers are reportedly experiencing a drop in demand. So, the comparatively less severe COVID-19 outcomes in India might be more than just artefacts. Time will tell.
The gulf between relatively successful COVID-19 countries and others suggests that we can all help strengthen one another's capacity. No longer is the flow of expertise necessarily in one direction, from affluent countries to others. In the face of unprecedented disasters, we are all learners.
The rich goldmine of top-notch talent in India (and similar endemic countries) could usefully be explored in our battle against HD. We need to attract them and give them elbow room to succeed. Then we will hasten the defeat of HD in India. Attracting top-notch local talent can become a central pillar of our strategy against HD. Whatever their other interests, they can be encouraged to make some room for HD work in their portfolio.
For example, the world-class management institutes in India have produced many CEOs of major global corporations. While at WHO HQ I involved them in tackling practical problems such as uninterrupted supply of high-quality drugs in TB. They were quick to get involved.
https://apps.who.int/iris/handle/10665/63546
The practical recommendations were used in the Indian Revised TB Control Programme.
https://www.nejm.org/doi/full/10.1056/nejmsa020098
Nearly 10 million lives have since been saved by the Indian TB programme, despite it coming up against problems of drug resistance and latent infections. Unleashing the best local talent against HD is likely to be similarly helpful.
Our practices and habits in HD could become more encouraging and enabling of top-notch local talent, rather than disabling. Otherwise we will be left fighting HD with one hand tied behind our back and our eyes partly shut.
The young are rarely wedded to flat-earthist views. They tend to have open minds. Once they are immersed in the wealth of clues available at the front-lines, they can help us focus on the few critical actions required for success. Equally important, they can help alert us to the fatal errors to be avoided at all costs.
Our community is characterised by not only a steadfast pursuit of the truth, but also compassion and respect for all human beings. Great efforts during the current lockdowns to ensure uninterrupted MDT, survival rations, and more, shows us at our best. These attributes are attractive and even inspiring to others. Such examples can help draw the best local young talent into efforts against HD. With their increasing participation, we are likely to succeed more surely and rapidly.
I hope COVID-19 will spare us all. Wishing good health to everyone in these challenging times,
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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