The World Health Day has been celebrated globally on April 7. This year theme of the day is ‘building a fairer, healthier world.’ Covid-19 has highlighted that some people are able to live healthier lives and have better access to health service than others. The World Health Organisation (WHO) believes that our world is an unequal one. Indeed this is the case when we see the provision of health services around the world. However, it is also recognised that this inequality can be eradicated. If we can ensure that everyone’s living and working conditions are conducive to good health, if we monitor health inequities and able to provide access to quality health services, then a government would be able to ensure health for all and build resilience for tomorrow.
I occasionally think of health inequalities also inequity among the countries. There are stark differences in health outcomes across the world. This leads to a gap of healthy life expectancy between the most and least deprived areas in world. Inequalities in power, money and resources at local and national levels can make people’s daily lives more challenging. In turn, this can make people more vulnerable to poor health. A recent research suggests that inequalities in child and adult mortality are large, are growing, and are related to several economic, social and health sector variables. The WHO data suggests that 1.2 billion people currently lack, what we would consider basic healthcare necessities, such as toilets, hand washing facilities, space and access to medical treatment. Affordable homes improve access to these facilities and services on a sustainable basis, leading to healthier populations and reducing the burden on weaker health systems. Global efforts to deal with this problem require attention to the worse-off countries, geographic concentrations, and adopt a multidimensional approach to development.In order to monitor the situation, like satellite observatory global health observatory is an option. The WHO has setup such observatory; however, more localised research-based approach is needed. For example, university and health department’s collaborative approach, which can feed research outcome to the local health observatory. Any genetic sequencing of coronavirus strain responsible for the recent surge of Covid-19 cases in Bangladesh can be feed into the Global Health Observatory database. Local universities and research institutes should play their part on this issue.
During Covid-19 pandemic, it has been recognised in Europe that sometimes homes are essential personal protective equipment (PPE) and a front-line defence against the pandemic. However, properly ventilated house is of paramount importance. In UK, poor ventilation has been considered as one of the causes of virus transmission. An affordable and climate smart home can have positive impact on the health outcomes of people. A country might consider this as a post-pandemic recovery agenda.
The holy month of Ramadan is knocking at the door. The arrival of Ramadan amidst the Covid-19 pandemic has raised questions about the safety of fasting, particularly in light of the higher level of disease burden amongst the Black and Minority Ethnic populations in Europe. Interim guidance from the WHO published in April 2020 suggests that it is safe to fast for otherwise healthy individuals who have previously fasted safely. The Centre for Evidence-Based Medicine at Oxford University has reviewed the existing data and put forward some suggestions about fasting. The question posed was- is it safe for patients with Covid-19 to fast in Ramadan? The reason for this question raised is, clinicians, who are looking after people with symptom of Covid-19 but thinking of fasting, asking for further advice. The research suggests the following: (a) There is no specific studies found looking at fasting in the context of Covid-19 (b) There is no evidence to suggest an adverse effect from fasting during the covid-19 pandemic on asymptomatic healthy individuals who have previously fasted safely (c) Patients with fever and prolonged illness can become severely dehydrated and are at risk of sudden acute deterioration. As such, these patients should not fast rather ensure adequate hydration (d) Any co-morbidities need to be risk stratified (e) A risk matrix has been developed for making decision about fasting in the context of Covid-19.
In fact the risk matrix mentioned above has started from two categories: Covid-19 type symptom and non-Covid-19 type symptoms. If there is a Covid-19 type symptom such as fever, persistent cough, loss of taste or loss of smell, then clinical advice is to break fasting or abstain from fasting and ensure adequate hydration. The American Centre for Disease Control (CDC) suggests that dehydration leads to the risk of hyper-coagulability, which increases the death of Covid-19 patients. Research published in the Annals of Thoracic Medicine (2020) suggests that, in case of healthy subject no detrimental effects on health have been directly attributed to negative water balance during Ramadan.
The WHO guidance published in 2020 suggests to follow the National Health Authority’s Covid-19 related advice, practice physical distancing, avoid physical contact rather for example for greeting during Ramadan place hand over the heart, follow national guidelines for symptomatic cases and pre-existing medical conditions. The WHO also advised for several mitigation measures in relation to venue, healthy hygiene, and use of pre-package boxes of Iftar.
Above all, the fear of vaccine resisted strain of the coronavirus remains. So, a global initiative for localised identification of the strain of coronavirus is important. Stopping mobility of people does not necessarily mean that virus mutation will stop. Virus can mutate in an individual body. This mutation can generate error in the viral Ribo-nucleic acid (RNA). Virus with this sort of mutation can give us a new variant. Please note that all strains are variants, but all variants are not strain. So, we need to find out whether a new variant becomes a strain, which can show a distinct physical properties such as transmitting quickly or binding strongly to a receptor. However, in the month of Ramadan we need to hope for the best, because as Robert Green Ingersoll, an American writer and orator said, hope is the only bee that makes honey without flower.
The writer is a UK-based academic, chartered scientist and environmentalist, columnist and author