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SICKLE CELL DISEASE AND COVID-19
“What do I need to do (or know) as a person with Sickle cell disease?” The enquirer is health care student. In response I came across nice piece written by Nitin et al published in the Pan African Medical Journal (Vol 36, May -Aug 2020). The World Health Organization (WHO) has identified sickle cell disease (SCD) as a major concern of public health significance. It has been estimated that around 5% of the global population carry Sickle Cell Trait genes. About two-thirds of the sickle cell disease patients of the global burden reside in sub-Saharan Africa. COVID-19 Pandemic caused by Corona virus 2 (SARS COV2) is having a devastating effect on socioeconomic and health indicators in counties worldwide. The additional financial burden of supporting health care management system in tackling COVID-19 impact at the same time preventing mortality rate of COVID-19 deaths is a matter of great concern to all.
The pathogenesis of the sickle cell disease is attributed to the polymerization of the deoxygenated haemoglobin S(HbS). The polymerization leads to alteration in the normal biconcave shape of the red blood cells making them rigid and more prone for intravascular haemolysis. As a consequence of repeated hypoxia driven polymerization of HbS there is development of cyclic cascade leading to blood cell adhesion, vaso-occlusive crisis and ischaemic reperfusion injury. SCD patients may develop complications such as Acute Chest Syndrome, pulmonary embolism and stroke
About two thirds of new borns born with SCD worldwide are found in sub-Saharan Africa. The sickle cell gene HbSS is commonly identified in Africa in SCD while HbSC and HbS/ beta+thalassemia has been observed in West Africa. SCD had led to the death of about 50-90% of the affected as the disease remained undiagnosed during the childhood. The various studies done in Africa were found that SCD patients have higher mortality rates. In Ghana-the programme to enhance health care for sickle cell disease is a big relief.
The development of knowledge of understanding the pathology and management protocol of SCD has been helpful in management of the disease. The presence of malaria, undernutrition and other infectious diseases also contribute towards mortality rate in Africa. Of late it has been seen that because of the devoted and dedicated health care services provided by the health personnel the mortality rates are declining and this life-threatening disease of children is now progressing to chronic disease of the adult.
It has been observed that pulmonary functions are decreased in SCD. Lung functions are compromised in patients of sickle cell disease and Sickle Cell Trait (SCT). Repeated chest infections in SCD and SCT lead to alteration in geometry of lung parenchyma and physical properties of elastic and collagen fibres thus decreasing pulmonary function parameters such as Forced Vital Capacity, Forced Expiratory Volume and Forced Expiratory Volume 1%. Moreover the pulmonary vasculature is highly sensitive to hypoxia (absence of enough oxygen) driven micro-occlusion of pulmonary vasculature which along with cell adhesive changes may cause pulmonary hypertension and further compromise lung functions]. Persons with SCD have an increased susceptibility to infection. The impaired leucocyte function and humoral and cell-mediated immunity loss have been reported to account for the immunocompromised state in patients with sickle cell disease. The SCD patients being immune compromised are more prone for recurrent chest infections. The major cause of mortality in patients of SCD is acute chest syndrome, pneumonia and acute respiratory distress syndrome.
COVID-19 is the acronym for corona virus disease 19 and has been termed as SARS-COV-2 by International Committee of Taxonomy on Virus (ICTV). The common clinical manifestations observed in patients of sickle cell disease include cough, fever, shortness of breath, loss of smell perception and loss of taste sensation. Most of the patients of COVID-19 may have a mild course of disease while few may develop severe clinical manifestations. The clinical manifestation of severity in COVID-19 patient includes Acute Respiratory Distress Syndrome (ARDS), Pneumonia, Multiple Organ Failure, Septic Shock and Sepsis. The severity of pneumonia manifests with dyspnoea (difficulty or laboured breathing) and tachypnoea (abnormally rapid breathing)
COVID-19 infection can worsen the pulmonary manifestation in SCD patients especially in those having pulmonary complications such as Acute Chest Syndrome, Pulmonary Hypertension and ARDS. COVID-19 infections in SCD can also increase morbidity and mortality risk in these patients.
The main cause of concern in patients of SCD is that these patients are immunocompromised and may suffer from both acute and chronic complications which require hospitalization and close contact with the medical system. There is overlap in clinical manifestations of fever and lung disease in COVID-19 and SCD. The increased complications will amplify health care utilization-e diagnostic, management and logistic challenges. In view of the above facts it is necessary for health care workers to educate SCD patient registered in their areas regarding care and precautions to be taken during COVID-19 pandemic to prevent getting affected with COVID-19 infection. Although the education applies to everyone, there should be more emphasis for persons with SCD.
All persons with SCD need to be educated regarding COVID-19 signs, symptoms and mode of spread. They should be explained regarding the increased risk of contracting COVID-19 infections in them due to their immunocompromised state. All patients of SCD should be advised to strictly adhere to social distancing, isolation polices, use of face mask, and frequent hand washing with soap to prevent COVID-19 infections. They should keep adequate medication of SCD such as analgesic and antipyretic drugs, hydroxyurea. They can be advised regarding use of clinical thermometer at home as fever is common sign in SCD patient and thereby these persons can take appropriate precautions and medication after seeking telephonic consultation with their health care providers. They can use pharmacy home delivery services in case they require medication during emergency situations.
Until then regularly/daily consume polyphenol-rich cocoa. It is been useful for persons with SCD.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
A haircut I had about a week ago didn’t go down well with many. Someone quite close to my heart saw it, examined it critically and felt dizzy.
“What’s this?” she proceeded to ask me.
“An international hairdo,” I replied.
She was disgusted, in fact disappointed. The problem with the haircut is that the style is neither Punk, Tokyo Joe nor Show Your Back. If anything, it is a combination of all—and I liked it, for a change.
It was when I bounded downtown that someone called me and enquired whether I was no longer a journalist. He said I looked like a well-fed Warrant Officer.
“Class One or Class Two?” I asked.
Another studied my head as if he was studying physical geography and pronounced that I looked like a boxer who can throw dangerous punches. Still, someone was of the opinion that the haircut didn’t quite fit me, but admitted that I looked like a prosperous merchant.
Commendation
I remember some three months ago, I had a haircut that made two girls fall in love with me. In spite of the fact that the barber was not a graduate, the cut was such that they couldn’t help admiring it. One of them actually ‘checked out’ the style and commended the barber.
The other was more bent on the ‘love matter’ but I was too busy to give her any attention. LOVE!
I was reminded of this when I viewed a premier showing of the latest Sikaman film titled THE POWER OF LOVE. The film kept me thinking. Some of us have long forgotten about what it is like to be head-over-heels in love. When we were students, we had such experiences because there was nothing doing anyway.
We were either learning how stylishly to smoke ‘jot’ or how romantically to fall in love. Anyhow, I was intrigued by this latest movie because of the way love unlimited was portrayed on screen. It took my memory back many years to relive those youthful days when we felt we’d really die if jilted by our lovers.
The storyline of THE POWER OF LOVE is really an exciting one. The combination of love, treachery and intrigue made me feast my eyes intently on the screen, unbelieving the extent the force of love can reach.
Ama and Afua are good friends. But when it comes to matters of the heart, they have different tastes; Ama is content with only her boyfriend (a student) and Afua samples the bigwigs around town. Afua, not satisfied with the shots in town, wants Ama’s boyfriend Joe in addition. She lies to Joe that Ama has often been picked by a man on four-wheels, whereupon Joe dismisses Ama and takes on Afua.
Ama doesn’t realise that it is her best friend Afua who is destroying her relationship with Joe until she catches her having sex with him. She collapses and goes out of her mind from the broken heart. But before then, she had been made pregnant by Joe.
Having escaped from a psychiatric hospital, she roams town murmuring Joe’s name. Heavily pregnant now, she espies Joe boarding a mini bus and runs towards him. Joe, seeing her approaching, quickly disembarks and takes off.
Ama pursues him furiously, and he runs to his home where he finds his bosom friend Frank making love to Afua. He immediately realises the treachery of Afua who instigated him to leave Ama.
He intends leaving the home in disgust and meets mad Ama at the door and embraces her despite her madness. Instantly, she regains her sanity.
Love indeed heals the wounds of the mind and it is the greatest positive force in the world. Incidentally, the greatest negative force is hatred.
Greatest force
Now coming to talk about love, I reiterate it is the greatest force imaginable. That is why a man will butcher his rival to death if he catches him climbing his wife without asking permission; and a woman will go mad if jilted.
It is also for this reason that a young boy who is scared stiff of cemeteries and under normal circumstances would not dare go near one, will this time walk boldly through a cemetery at midnight if that is the only way to his lover’s abode.
The Bible describes love for our neighbours as the surest way to heaven: Love thy neighbour as thyself.
Unfortunately, what Ghanaians are more interested and skilful in is loving the opposite sex. Romance under the cover of darkness is what we understand love to be all about. When it comes to loving our fellow human beings, we are found wanting.
People hate others just because they are of another tribe and do not speak the same native language. Too much grudge-bearing that does not augur well for national development.
War in Liberia, carnage in Rwanda are the results of the absence of love for one’s fellow being. If everybody could express a little bit of love for his fellow being irrespective of tribe, race, politics or religion, Sikaman—and indeed, the world—will be a more habitable place.
This article was first published on Saturday, October 29, 1994
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“Sir,” Ms. Odame said when David Asante answered the call, “my name is Victoria Odame. I’m a teacher at Research School in Koforidua. I would like to come and see you concerning a student called Sarah.”
“Okay, madam. I would be very glad to meet you. How can I make your trip easier?”
“I was going to join a bus to Accra.”
“Here’s what we will do. Take a taxi and ask them to bring you to Accra. I will speak to the driver, give him the directions, and pay him when you get here.”
The taxi stopped in front of the house. The gate opened, and the driver moved to the long driveway and stopped.
“What a beautiful house,” he said.
David and Adoma came out to meet them. Adoma paid the driver as David and Sarah stared at each other.
“Please come in and sit down,” Adoma invited. She served them water.
“You are welcome,” Adoma continued. “We have been waiting anxiously since you called this morning. So please, let’s hear you.”
Before she could open her mouth, Sarah rose, moved to David, hugged him, and sat on his lap. They both broke into tears. Adoma and Ms. Odame also broke into tears.
“Sorry, madam,” David said. “This whole episode has been a very difficult one. But let’s do the proper thing. Let’s hear you first, and I will also speak. I’m sure we need to answer some questions immediately.”
“Okay, sir. I have been taking an interest in Sarah because, although she’s brilliant academically, she seemed to be troubled. Following my discussions with her and some whispers I had been hearing, I went to Aboso Senior High School and spoke to your former colleague, Mr. Hanson. He told me that you were an exemplary teacher who was loved by all, and he also told me about the unfortunate events that caused you to leave for Germany. So I returned to Koforidua with the view to finding the appropriate means of helping to solve this problem.”
“Great. Ms. Odame, I have to thank you for finally helping us to solve this problem. Now, let me state the facts. This is what happened.
“Gladys and I met and got married whilst we were both teachers in the school. Some months into our marriage, she told me that she needed to spend some days with her parents, and I agreed.
“It turned out that she was actually spending time in a hotel with her ex-boyfriend, Simon. This happened again after Sarah was born. I got wind of this and told her that I was no longer interested in the marriage.
“I started preparing to travel to Germany. She pleaded for forgiveness, but I stood my ground. Then she told me that she would punish me for rejecting her.
“She came out later to say that Sarah was not my child, but Simon’s. She went and hid her somewhere, obviously expecting that I would fight to take my child. I was actually going to do that, but my parents advised me that it was almost impossible to win such a fight.
“They advised that, difficult as it sounded, I should leave the child with her because she would come back to me eventually. I have absolutely no problem taking care of you, Sarah. I am taking care of quite a number of kids who are not mine. So that is what happened. My hands were tied. I have been trying to find out how you are doing.
“I kept hearing that you were doing well at school. I also heard that Gladys and her husband were having problems, but I kept hoping that my daughter would at least be okay till it was possible for me to go for her.”
“Sarah, now you have met your dad. You will be free to—”
“I’m not going anywhere!” she declared as she held on to him.
“You don’t have to worry about that, Sarah,” Adoma said. “We have been looking forward to the day you come home. This is your home. Now, you have to meet your siblings.” She called Abrefi and Adaawa.
“Girls, we told you that you have a sister who would join us anytime. Now here she is.”
“Sarah?” Abrefi asked.
“Yes,” Adoma replied. The girls hugged her and took her away.
“Now,” David said, “I think it is time to call Madam Gladys.” He dialed the number.
“My name is David Asante. I’m here in my house with my daughter Sarah. I hear you have told her all sorts of crazy stories about me. I could make life very difficult for you, but I won’t.
“You are your own worst enemy. I don’t think you should be expecting her anytime soon. What do you say?”
Gladys stayed silent for over a minute, then cut the line.
“Food is ready,” Adoma announced. “Everybody, please come to the table.”
Sarah chatted excitedly with her siblings as Adoma and David spoke with Ms. Odame. She kept staring at her father.
“Now, Ms. Odame, after you have brought such joy into our home, should we allow you to go back to Koforidua today, or should we wait till we are ready to release you? I could call your husband and ask permission.
“And please don’t tell me you didn’t bring anything for an overnight stay. There are several supermarkets around here. We can fix that problem quickly.”
“I will beg you to release me. Now that I have been so warmly welcomed here, I already feel part of this home. Koforidua is not that far away, so I will visit often.”
“Well, let’s see what the kids have to say. Ladies, shall I release Ms. Odame to go back to Koforidua?”
“No!” they shouted, and all broke into laughter.
“Ms. Odame, I will have mercy on you. But we are going to do something to make it easy for you to visit us. My wife wants to show you something. Please follow her.”
Adoma led her to the driveway as the others followed. They stopped in front of the car.
“This is a Toyota Corolla 1600. It is very reliable and good on petrol consumption. We are giving this to you in appreciation of your help in getting our daughter back to us.
“And here in this envelope is a little contribution to help you with maintenance. And here in this other envelope is a gift to help with your children’s school fees.”
As she stood, stunned, and stared from the car to the envelopes, David put his hand around his family.
“Let’s leave her to take a look at her car. Ms. Odame, one of my drivers will drive you to Koforidua and leave your car with you. We are waiting inside.”
By Ekow de Heer
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