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Alumni Voices: every virus is unique; every outbreak is unique

Dr Alexander Kumar (MBBS, 2008) currently works in London, between clinical responsibilities as a GP registrar at Guy’s and St Thomas’ Trust and research as an academic clinical fellow at King’s College London. He is currently working part-time in the team who help set up and run the NHS Nightingale Hospital at London's Excel Centre.

I’ve been lucky to have worked on a lot of the big infectious disease outbreaks and on neglected tropical diseases over the past decade. I worked as a medical doctor in an Ebola Treatment Centre in Sierra Leone, during the 2014–2016 outbreak in West Africa. It became the largest Ebola outbreak in history. I also worked in Brazil and researched the Zika virus during the height of that outbreak. There are key lessons to learn from history and previous outbreaks, to help deal with the ongoing coronavirus pandemic.

Although many may detest viruses, and with good reason, they are in fact beautiful yet simple characters, each with their own personality. Like every other organism or living entity on the planet, they share a sole purpose - to survive - having adapted over hundreds of thousands and likely the distant past, millions of years.

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And since every virus is unique, every outbreak is also unique. The greatest mistake would be to deal with all of them in the same way. We still don’t understand why Zika acted the way it did in Brazil and although it dropped off the media radar, it has left a trail of neurological impairment and devastation that will last a lifetime for those affected. And, early in the West African Ebola outbreak, due to a misunderstanding of how the virus spread, hospitals were inundated with those who did and didn’t have the virus who were mixed in triage. Things quickly got out of control as waiting rooms, corridors and wards became overwhelmed with symptomatic infectious patients crowding among others. A second wave came –the largest wave of Ebola cases the world will probably ever see. However, we are now fighting this with new tools and technology, and a wave of research and innovation pushed forward by political will and funding. Five years later, it is no surprise that with those four basic ingredients, we have Ebola vaccines and treatments.

At this time, we don’t fully understand this new virus. We need to understand COVID-19, its clinical impact, characteristics and patterns. This virus is new to science, but we are learning fast. That’s not a reason to be scared, but simply to take a cautious approach. A lot has been made of trying to ‘flatten the curve’ for the current COVID-19 outbreak to avoid that strain on health systems, even in countries with ‘advanced’ medical care. Though looking at the information coming out of the worst hit countries– the USA, Italy, Spain and the UK – it is obviously concerning. The virus won’t stop propagating, if symptomatic people are crowding, mixing and transmitting – it has no regard for how advanced a healthcare system is.

Humans are always on the move. It's beyond belief flights are still flying, it took so long for most airlines to stop and people to learn to stand still. Viruses cannot crawl, swim or fly – they don’t have arms, legs or wings - but infected humans who carry them and spread them can and do so. We don’t have a vaccine (we still don’t have one for other coronaviruses SARS or MERS) and won’t have a ‘safe’ vaccine via clinical trials for at least a year.

Communication is key. It is important to deal only with facts, not opinion. Intentional or unintentional fake news is dangerous. Communication is actually one of our strongest tools, but it is a poisoned chalice. It can be as destructive as it can be a positive game changer regarding public health. International transparency regarding the cases is vital. We should trust in what we know and act accordingly. The World Health Organization takes international ownership during outbreaks. We should listen to that expert advice and remain calm. Countries that have dealt with this outbreak well so far – such as South Korea, New Zealand or Taiwan - have had clear, science led messaging.

There are reasons to be optimistic. We must stay positive and keep our heads above water as we tread together, globally. Although as a species we are always a step behind nature and these viruses, it takes time to catch up and we have been able to identify this previously unknown virus, within just one week. That is phenomenal. We found and shared primers to reliably allow testing across the world, within two weeks of identifying this virus. But alongside technology we need to practice good hygiene. With technology at the standard and availability it is today, we can work together to overcome any threats to global health security.

Massive thanks should be made to those healthcare workers globally putting themselves at risk to help curtail and contain this tragic pandemic. We have to sail this storm together. We need to work together, not against each other, locally and internationally.

You can keep up to date with Alex via his website , twitter and Instagram.

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Alexander Kumar

Alexander Kumar

Contributor to alumni blog.

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