Reflections of a doctor
The motivation for writing this article was primarily a severe form of coronavirus infection that I had carried over and appeared around these problem different interpretations of its appearance, spread, and assessment of measures of state character, the capacity of the health care system of countries and provocative stuffing from abroad, which did not leave me a doctor, health care organizer and an educator indifferent.
Sequential timeline of the pandemic
The first case of infection occurred on December 1, 2019 in Wuhan, China, and the first case of the disease in Europe recorded on February 4, 2020. By 10 March, scale epidemics covered 14 countries of the world, 118 thousand people infected with coronavirus infection, more than 4 thousand deaths were registered and WHO announced March 11, 2020 the COVID-19 pandemic, urging all countries to counteract to the previously unknown disease. The threat of an unknown coronavirus pandemic, mindful of the past epidemics consequences of the XX century (Spanish flu, 1918-1919, 500 million cases and 39.1 million deaths; atypical pneumonia, 2002-2003, 8096 cases and 774 deaths with mortality, respectively, 7.83% and 9.56%; Middle East acute respiratory syndrome, 2012-2015, 2494 cases and 858 deaths with mortality — 34.4%) demanded that states take urgent and effective measures, taking into account real economic opportunities and the maturity of the existing health care system. Undertaken strategy of struggle of state structures included two options for the fight: standard, anti-epidemic, aimed at the forward-looking strategy that majority of countries with advanced economies have chosen; the Swedish-Belarusian option, which provides for a soft package of limited measures, focused on a possibly formed collective (population) immunity. Analysts and specialists conditionally divide dynamics of the spread of coronavirus infection into the Chinese period (December 2019-January 2020) and European (from 20 February 2020). If the Chinese period was effective, enough, demoralized in a short time, the European period brought a serious blow to the socio — economic situation of the countries from which European countries began to quit only from mid-June. Second waves of infection were recorded in some countries and due to many factors, it is not possible to predict the development of the situation.
Tajikistan and the COVID-19 pandemic
The coronavirus pandemic has had a significant impact on the socio — economic and political processes in Central Asia. Naturally, each country of the region, taking into account the level of threat of epidemic coverage, quite intensively took measures to prevent the spread or restrict the spread of this infection in their states. Leadership of Tajikistan based on the real epidemiological situation in the country, in February 2020 created republican headquarters for countering the spread of coronavirus infection. The informational work on public awareness, methods of protection against infection began to carry out by medical workers from February 2020 and a number of restrictive measures related to massive events from the beginning of March were introduced. Coronavirus infection later than all countries of the region spread into Tajikistan. Particularly this is due to such factors as small population of cities and their level of globalization. However, given the rate of spread of the disease in the world, by coordinated decisions of the headquarters were strengthened sanitary, quarantine and migration controls at all border, medical and quarantine points have been created at all checkpoints. Ministry of Health measures were taken to create, in the context of a sharp restriction of air traffic with other countries stocks of medicines and sanitary – hygienic products. There were a number of medical institutions have been identified and put into readiness in the regions and the capital of the republic for the reception of persons suspected of infection and isolation contact. International flights have completely stopped since March 20, began targeted testing of persons with suspected coronavirus. By April 30 in the country 15 cases of coronavirus infection were identified and officially recognized the presence of coronavirus in the country. On the same day, at a government meeting, the President of country Emomali Rahmon gave decisive instructions and errands to strengthen fight against coronavirus infection, especially on the observance of sanitary- hygiene rules, disinfection of streets, carrying out explanatory work among population. Subsequently, summer holidays were announced for university students, classes in schools were suspended, a ban on public prayers in mosques, etc. With an increase in morbidity, the main efforts were aimed at identifying patients, their diagnostics and treatment, isolation of contact and intensive sanitary — educational work.
Position of the Head of State
Tajikistan in its strategy to combat coronavirus infection adopted package of minimum restrictions, closer to the Swedish — Belarusian model, which allowed simultaneously carry out sanitary — hygienic and medical measures, in conditions of the work of the main structures of the agrarian — industrial sector, which caused unmotivated then and now, politically biased reaction in separate circles of «sons» and «friends» of Tajikistan from abroad. In my opinion this position for our country was optimal and wise, which allowed to a certain extent, prevent the spread of infection and panic, which quite mobile in the eastern population, to keep the economy from falling and especially important, made it possible for the agricultural and the manufacturing sector function. Suffice it to point that according to the official statistics for 6 months of 2020, the country’s GDP grew by 3.5% (2019-7.5%), while the IMF predicted a decline in the republic’s economy to 2% by the end of the year. In these conditions, the industrial sector provided an increase of 9.2%, the agricultural sector — 8.2%.
Moreover, unlike many heads of state, the President of Tajikistan is personal example, who visited all regions and many districts of the country during this period, significantly dispelled the resulting panic among the population. On this background, unfortunately, to this day, the attacks of our opponents, associated with celebration of Navruz in Sughd region is being continued. I’m on my own participated in this grand celebration, saw the joy of people and their optimism. It is difficult to imagine how it was possible to cancel an event for which they were preparing in advance, and most important when there were no cases of coronavirus infection. Under these conditions, criticism, appeals and various provocative interpretations and evaluation of measures taken from abroad, undoubtedly had the goal of sowing panic and discord among the population, to neutralize the efforts of the government in the fight against coronavirus. Time has confirmed the correctness of the decision.
Unfortunately, many, even those who are wise by experience and life, when assessing the situation with coronavirus and the effectiveness of the measures taken, rely on amateurish, unscientific conclusions. Certainly at the first stages of data preparation and implementation instructions by the head of state, there was a sluggishness and lack of proper tactics on the part of individual structures. In terms of efficiency of efforts at peak morbidity in the republic I would like to dwell on one indicator. Today it has been convincingly proven that one of the indicators of the effectiveness of the fight against coronavirus at the epidemic stage is the timing of a decrease in the daily pace growth of infection in the country after the «explosion». So, this period at the peak of the epidemic was passed in Iran on the 13th day, in Saudi Arabia on 21th day, in Argentina on the 26th day, in Russia on day 56. In Tajikistan, the peak of the epidemic began on May 13 (103 patients, then reaching 211 patients), and the “curve bending” or decrease in the gain began on May 30, i.e. at the 17th day we managed to reduce the daily growth rate of this disease, which indicates effective coordination of efforts.
An inexplicable political culture has been formulated in our country in certain circles. The point is that by discovering some flaws in everyday life, individuals often direct their claims to the President of the country, head of Government, although this irresponsibility is allowed by the 3-4 level performer. In this regard, I would like to share the following. My student lives and works in the USA, who constantly reports on the situation with coronavirus, which acquires uncontrollable character in this country. So, his neighbor, an Afro – American with coronavirus pneumonia was admitted to the hospital, after 2 weeks he was discharged with improvement. Following this, the hospital presented an invoice for payment for medical services in the amount of 400 thousand dollars, received which the former patient died a few hours later from a stroke. Now relatives are suing this hospital and this is quite normal. Give some of our «friends» only this fact, so in all sins they will accuse the supreme power, as they make sensations out of human tragedies like “6 generals, poets, doctors died from coronavirus in Tajikistan”, etc.
Medical aspects
Coronavirus pandemic, organization of measures to prevent spread of it in many countries showed the value of the current health care system. An earlier unknown viral infection with his «behavior» caught first of all developed countries, their health care system by surprise. At this stage it is impossible to explain exactly the reasons for the high rates of morbidity and mortality in developed countries of Europe and the USA, Russia and Iran. It must be admitted that despite advancing decisions of the republican headquarters, the Ministry of Health and its structures due to the fight against still unknown infection could not ensure timely preparation of the system for high aggression of coronavirus in a proper level. Ignorance of the pathogenesis of the disease, the genetic code, patterns of development and lack of diagnostic and treatment protocols at the initial stage significantly hampered the work of the country’s medical staff. The difficulties with technological, hygienic and protective equipment also affected. However, doctors consistently learned the features of the behavior of this infection and provided necessary medical care in the most difficult conditions. Overall, my colleagues with honor and skillfully performed their duty in such a difficult time of our people lives.
An important criterion for assessing the dynamics of the struggle and its effectiveness are the following indicators such as the number and growth of morbidity, lethality and mortality from this disease. On the day of preparation of this material, the total number of patients in the republic reached 7235 with a daily increase of 40-50 patients, 60 deaths and lethality of 0.82%. A comparative analysis revealed that in the region the incidence rate in our country is the lowest, the mortality rate comparable to other countries (Uzbekistan — 0.49%, Kazakhstan — 0.7%, Kyrgyzstan – 3.9%), while in developed countries, mortality varies from 2.5% (Turkey) to 15.4% (UK). It is appropriate to note that many researchers allow some unaccounted number of cases and deaths due to a number of objective circumstances. Considering speculation around statistical indicators, WHO and UNICEF strongly recommend to use only data from official sources.
In terms of predicting the situation with coronavirus, an important point is the study of the mechanism issues of the development of the disease to the end, the duration of the response immunity, the creation of a vaccine and the possibility of forming a collective (population) immunity. Many scientific publications by American, German, British and Chinese scholars provide preliminary answers to these questions:
- To date, at least six thousand species of coronavirus have been discovered and what puzzles us doctors, especially, the growth rate evolution reaches 100 variants daily. This makes it much more difficult to elaborate treatment protocols and prognosis of the disease.
- It has been found that the hope for the formation of collective immunity is dubious, although Russian scientists talk about the level of 26%, Almaty’s- 23%.
On July 12, 2020, South Korea officially announced the impossibility of the formation of collective immunity, examining 3053 people. The British and the Germans share such position.
- According to the data above, the duration of response immunity in recovered patients is 3-3.5 months. In this case, the response immunity is formed in 60-70% of those who have recovered, which by the end of 3 months it remains only 17%.
- The above makes skeptical about the expected process of the vaccine development that focuses on «natural immunity» of coronavirus. To extend the duration of active immunity, it is necessary to interfere with the genetic code of the virus.
Instead of a conclusion
Founded at the end of 2019 in China and spread by the spring of 2020 almost around the world, the COVID-19 coronavirus pandemic has become a strength test of political, economic and social (primarily the health sector) systems of all countries, including for Tajikistan. It should be noted that in pandemic period in the modern world, the authorities of 3 countries (Sweden, Belarus and Tajikistan) have determined state policy of combating coronavirus different from the actions of other countries — without introducing strict quarantines and other significant restrictions on citizens movement, strongly recommending compliance with preventive measures. If the main ideologist of this policy in Sweden was the country’s chief epidemiologist Anders Tegnell (who became the most popular person), in Tajikistan the implementer of this policy was the President of the Republic of Tajikistan Emomali Rahmon.
This problem showed the weakness of global institutions and responsibility of national structures. Initially, most countries showed insufficient readiness to prevent this global crisis. It turned out that professionalism and responsibility at all levels, in conditions of real crisis mean more than the ideological component. Nevertheless, the population of the country due to the correct strategy of struggle, determined by the President of the country and the Government did not succumb to panic fear, mainly observing triad (personal hygiene, wearing masks, social distancing) rules preventing infection, the healthcare system quickly adapted to unknown tactics of struggle and by today we have managed to reduce the tension of epidemics and surprisingly many, ensure a stable epidemic situation in the country. We understand that the “expectations” of our opponents did not come true and it will not come true, because that is the will of our people.
Preliminary conclusions made by scientists from many leading centers in the world indicate that it is not possible to predict the development of the situation in the future. Nevertheless, it needs to be prepared for any scenario of the development of this infection. One thing is clear that we will have to reckon with the fact that existence together with coronavirus in the future is going to be a new culture of public life and in society should be harmony between anti-epidemic measures and the values of everyday life. Tactical tasks for arranging life have not changed, only they will be implemented in more tense realities associated with the restoration of the situation in health care and mitigating the economic impact of the pandemic.
Thus, the main role in consolidating efforts to combat the pandemic in Tajikistan played responsible behavior of citizens, adequate interaction of authorities and the population against the background of high people’s confidence in the definite strategy of the President of the Republic of Tajikistan.
D.R Sanginov Professor
