Among the miseries of our planet, the mortalities and morbidities caused by the combination of covid-19 and diabetes mellitus are considered the most tragic.
Since the beginning of the 21st century, Nidovirales order viruses have affected humanity thrice: SARS-CoV in 2002, MERS-CoV in 2012 and SARS-CoV-2 in 2019-2020. Coronaviruses are large, enveloped and positive-stranded RNA viruses
The SARS-CoV-2 consists of an envelope which is made of Spike, Membrane and Envelope glycoproteins. Inside the envelope, there is the Nucleocapsid that is formed from multiple copies of the N proteins. The Nucleocapsids are perennially attached with the RNA of the virus. The Spike (S) protein is implicated in binding to the ACE2 receptors that are located on the cell surfaces of the human respiratory tract. The pinioning of the viral envelope and the human cell membrane is followed by the release of the viral genome into the target cell.
The clinical symptoms are fever, dry cough, malaise, diarrhea, dyspnea and pneumonia. Lab findings include lymphopenia and bilateral ground glass opacity or consolidation that is observed in Chest CT-scans.Covid-19 can be confirmed by real time RT-PCR and IgM plus IgG antibody tests.
As a doctor, I made some observations regarding diabetes mellitus and unintentional childhood injuries. Diabetes mellitus is a group of common metabolic disorders sharing the phenotype of hyperglycemia. Factors for hyperglycemia are reduced insulin secretion, decreased glucose utilization and increased glucose production. Type 1 DM is a subtype which occurs due to an autoimmune beta cell destructive process mediated by T- lymphocytes. It can transpire at any age but it frequently manifests itself before 30. It is estimated that between 5 and 10 percent of individuals who develop DM after the age of 30 have Type 1 DM.
Fulminant Diabetes is another form of Type 1 Diabetes which is usually noted in Japan. Its etiology is related to the viral infections of Islets. Another subtype of Diabetes Mellitus is called Maturity–Onset Diabetes of the Young (MODY) that is characterized by autosomal dominant inheritance, early onset of hyperglycemia (usually under 25 years) and impairment in Insulin secretion. MODY is further divided into MODY 1, MODY 2, MODY 3, MODY 4, MODY 5 and MODY 6 and so on. Other subtypes of DM are Gestational Diabetes and Type 2 Diabetes Mellitus. Type 2 Diabetes Mellitus is characterized by Impaired insulin secretion, insulin resistance, excessive hepatic glucose production and abnormal fat metabolism.
The acute complications of DM are diabetic ketoacidosis and hyperglycemic hyperosmolar State (HHS). The microvascular complications of DM are retinopathy, neuropathy and nephropathy. The macrovascular complications are coronary heart disease, peripheral arterial disease and cerebrovascular disease. Other complications include diabetic foots and ulcers. In the light of all the aforementioned complications of DM, simultaneous covid-19 disease can lead to dreadful effects. This group of patients needs our sympathy.
States all over the world may initiate debt-free and interest-free currencies for a short period of time to bear the expenses during this pandemic. The humanity can emulate the Bradbury Pound initiative or Constitutional Monetary System of Lincoln for a period of two or three months. Similarly, the single-person tourism should be encouraged to beat the dreads of anxiety and depression.
Another point of interest are the unintentional injuries of children at home especially under the age of five. These injuries mostly occur due to burns, drowning, poisoning and fals,l and are responsible for the mortality of round about 7 percent among about 875000 deaths of children each year. According to a report of the Centers for Disease Control and Prevention, In the USA, more children between the ages of one and four die annually from unintentional injuries than from all childhood diseases combined.
Furthermore, for every childhood death caused by injury, there are approximately 18 hospitalizations, 233 emergency department visits, many more visits to medical facilities, and a much larger number of home-treated injuries. The factors associated with unintentional injuries at home are physical, biological and social environments. During the coronavirus pandemic, there is a dire need to minimize such types of injuries to reduce hospital admissions and stays which are create a greater risk of covid-19 contamination in Third World countries.
To beat the extremes of agoraphobia and purgatorial scenes around the world, philanthropists and scientists must come forward with a pragmatic screenplay of active and passive immunity against SARS-CoV-2. While several vaccines have arrived, the rollout shows more needs to be done.
Research should be carried out to discover a meaningful vaccine and synthetic immunoglobulins. Though several vaccineshave been discovered, still much more endeavours are required from brains and brawn of humanity. Antivirals are already approved for elimination of this menace in some countries but the pharmacists and biotechnologists should find a true antiviral that should eradicate the disease once and for all. Furthermore, the inhabitants of the globe should come forward to voice their apprehensions regarding any possibility of biological warfare in the New Cold War era that has already exhibited and manifested itself since the beginning of the 21st century.
In order to bring a flicker of amusement in the eyes of diabetic patients who also suffer from covid-19 infection, the whole health community should devise plans to search and research selective TGF-β inhibitors. Studies should also be carried out on inhibition of inflammatory signalling pathways such as the nuclear factor kB (NF-kB) pathway.10 Similarly, gene therapy by viral vector or by non-viral transduction and stem cells curing techniques should be explored worldwide for the best results.
VEGF-A inhibition therapy in retinopathic cases should be provided at nearby primary health care centres by a covid-19-free health care professional if possible. Incretin analogues may also be supplied to deserving patients. The depression and anxiety of these patients need to be reduced and for this purpose, the psychiatrists and psychologists are advised to play their lead role.
Though Duloxetine is the drug of choice for curtailment of neuropathic pain but the clinicians and policy makers should ponder over the scenario as an organic whole that also includes factors like poverty, environment and trust capital. Vitamin B-12 (Cobalmin) should be proffered free of cost to the diabetic patients. Antibiotics that can act against MRSA should be included in the essential drugs list of hospitals during the pandemic. Policies should be shaped to bring into existence a safe environment within abodes for children during the pandemic and an awareness session must be arranged via media to educate the parents with more emphasis on keeping dangerous objects out of the reach of children.
Another way of bringing a new dawn of hope and blessings to humanity during the pandemic is by introducing Electronic Government in every nook and corner of this world. Electronic governance comprises electronic administration, electronic services, electronic democracy and electronic business. The sowing of seeds of a biometric voting system in elections and transformation of the revenue system by replacing conventional means should be spearheaded without any delay all over the world during the pandemic. Furthermore, The social security laws and system all over the world should be made more employee-friendly so that the poor victims of unemployment in private sector institutions during this pandemic can fill their mouths and stomachs.
States all over the world may initiate debt-free and interest-free currencies for a short period of time to bear the expenses during this pandemic. The humanity can emulate the Bradbury Pound initiative or Constitutional Monetary System of Lincoln for a period of two or three months. Similarly, the single-person tourism should be encouraged to beat the dreads of anxiety and depression.
