Nepal, November 21 -- On December 31, 2019, the World Health Organisation (WHO) office in China received information about a group of pneumo...
Nepal, November 21 -- On December 31, 2019, the World Health Organisation (WHO) office in China received information about a group of pneumonia cases with an unknown cause in Wuhan city, Hubei Province, involving 44 individuals, 11 of whom were in critical condition. At first, the WHO and Chinese officials mentioned that there was no clear proof of transmission between people. Later, it was established that the virus could be transmitted through coughing, sneezing, and respiratory droplets. Infection could happen if someone touched these contaminated surfaces and then touched their eyes, nose, or mouth without adequate hand cleaning.
Indeed, on June 2, 2020, during the initial phase of Nepal's encounter with the Covid-19 pandemic, I wrote an article following my observation that SARS-CoV-2, the virus responsible for Covid-19, was spreading quietly in the nation, with most infections happening without any cough. Even at Sukraraj Tropical & Infectious Disease Hospital, numerous staff members became infected one after another, despite implementing preventive measures, yet almost none displayed cough symptoms. Interestingly, people with visible coughs were seldom seen in the community, even as the number of infected individuals or positive cases kept increasing throughout the pandemic. Could there have been other ways of transmitting Covid-19 that contributed to its swift global spread beyond coughing or respiratory droplets? This thought-provoking idea sparks important questions among scientists and challenges the traditional understanding of cough as a key symptom of respiratory diseases.
The first confirmed case of Covid-19 in Nepal was identified in January 2020, involving a 32-year-old man who had recently traveled back from Wuhan, China. During our encounter, he was suffering from difficulty breathing instead of a cough. I spent a minimum of 45 minutes with him (to gather his medical history) without using any personal protective equipment, as his infection with Covid-19 had not been established at that time.
Fortunately, further laboratory tests confirmed that I was not infected with the virus. The patient received treatment for symptoms and made a full recovery without any issues. The initial wave of Covid-19 in Nepal was found to be less severe than in neighboring countries and other global regions, with almost all individuals who tested positive showing no symptoms, including the lack of a cough. The second wave, referred to as the Delta wave, which began in India, was more intense than the first wave in Nepal. A considerable number of young people were affected by this wave.
While caring for individuals with Covid-19 in the emergency department, I noticed that the majority of patients did not exhibit a cough; rather, they faced difficulty breathing and developed serious pneumonia affecting both lungs, with many passing away within a short period. This could be due to government strategies that focused on vaccinating healthcare workers and older adults, making younger adults more susceptible to severe effects. Notably, the second wave was linked to unusual symptoms like loss of smell and taste, which are rarely seen in typical respiratory conditions.
Unlike the earlier waves, the third wave, referred to as the "Omicron wave," was marked by typical respiratory symptoms such as coughing. Indeed, numerous people in Nepal initially thought their flu-like symptoms were due to the common cold or seasonal influenza before undergoing tests and confirming they had the Omicron variant. These findings suggest that the first two waves were more severe than the third Omicron wave, yet they were distinguished by a lack of significant cough, which is usually linked to respiratory diseases. This change in traditional symptoms made it challenging for doctors to identify Covid-19, often leading to delays in testing and diagnosis. As a result, the prompt introduction of preventive actions was obstructed, enabling the virus to spread more quickly.
Covid-19 stands as one of the most severe pandemics in recent history. It sparked significant discussions within the scientific community, with many experts forecasting and agreeing that the next pandemic, known as 'Disease X,' might resemble a respiratory airborne illness similar to Covid-19. Generally, it is recommended to prevent respiratory infections by avoiding coughing without a mask, practicing good hand hygiene, and refraining from touching the eyes, nose, and mouth before washing hands. Nevertheless, research on Covid-19 has shown that the virus can also spread through talking or singing in enclosed areas like rooms, restaurants, or fitness classes. Subsequently, the WHO classified Covid-19 as an airborne disease, which could help explain its swift global transmission, possibly due to limited awareness or delayed sharing of preventive measures beyond masks, hand hygiene, and social distancing.
Although cough has long been seen as a key sign of respiratory diseases, the Covid-19 pandemic, especially during its first two waves, has questioned this idea. Its broad effects have led to discussions about a possible change in traditional symptoms, particularly the lack of cough in numerous cases, which presents a major challenge for medical professionals in identifying and managing future respiratory pandemics similar to Covid-19. This could even lead to reevaluating whether cough should be included in the criteria for respiratory illnesses. Hence, there is a requirement for more thorough, high-standard research to enhance our understanding of how Covid-19 spreads, especially if it involves pathways that go beyond what we currently know. These findings would help in developing more efficient strategies to control the virus's spread and implementing more precise preventive actions.
Significantly, numerous specialists predict that the next 'Disease X' or global outbreak might resemble Covid-19 in terms of being a respiratory airborne illness. Therefore, a thorough investigation into how Covid-19 spreads is essential for prompt and efficient management of outbreaks or pandemics, as controlling any contagious pathogen is unfeasible without a deep understanding of its transmission patterns.
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