I got infected with a serious life-threatening virus while working in the present Covid ICU ward of KEM Hospital in Mumbai. This was long ago in 1984. It was then the male surgical ward no. 5. During this pandemic, the same ward has been converted into the Covid ICU. The potentially fatal virus that infected me then was Hepatitis B.
Again, in 1995, I was exposed to another serious and dangerous virus while working as a junior surgeon in Sion Hospital, another major public hospital in Mumbai. Did I become HIV positive?
A few days ago, I performed a major surgery on an infant which lasted more than 10 hours. It was an operation to create an oesophagus for an infant, who was born without one. A couple of days later, my assistant surgeon, who had worked in Covid ward a week earlier, developed fever and sore throat. He was at high risk for contracting Covid and as we had come in close contact for a prolonged period during the surgery, I got swabbed too. Thankfully, the result was negative.
This piece is a relook at my viral encounters with these potentially fatal viruses, the health issues they raised, how society and authorities reacted, the current status of these viruses on this planet and what inferences we can draw from the past for the future of Covid.
In 1984, when I came down with Hepatitis B, quite like the Covid virus, most of us, were blissfully ignorant about the microbe. This may seem surprising because the Hepatitis B virus had been detected years earlier. But back then, communication happened at a snail’s pace. No internet, no social media, no email, no mobiles and no 24×7 international TV. Currently, there is an infodemic running parallel with the Covid pandemic. But when I got infected with Hep B, I had to go to the College Medical library and browse through latest journals to understand more about this virus and the symptoms it causes. Unlike the Covid virus, which is an RNA virus, the Hepatitis B is a DNA virus and is transmitted via contact with infected body fluids.
I was then, a young, overworked resident doctor (as resident doctors in public hospitals still are) and we had to operate day and night on surgical conditions and emergencies of all kinds. Accidental needle or cautery pricks and the occasional cut while performing surgeries were not uncommon. In the emergency ward, when a gasping trauma patient would be wheeled in, I remember taking an IV line or intubating him without wearing gloves (often because the right size was unavailable). During one such life-saving procedure, the potentially fatal Hepatitis B virus carried by the patient had entered my body via a small cut on palm. I had remained fully healthy and unaware of this for six weeks (the incubation period) and then developed severe Hepatitis and jaundice. For the first week, my jaundice was dismissed as the commoner Hepatitis A, but someone suggested that we should test for this new virus. My HBsAg antigen test came positive. I was feeling sick and tired and had lost my appetite. My library reading informed me that there was no cure or medication for this virus and that it could be fatal. If you survived, you had a much higher risk of developing liver cancer. It was also called the ‘surgeon’s jaundice’. I was down for two months and had lost a lot of weight. The authorities refused my sick leave as they had no such disease in their list of occupational hazards. It was only after I wrote a couple of articles in the newspapers about this new virus that my leave was sanctioned.
Today, 30 years later, Hepatitis B is the most common serious liver infection in the world. Two billion people (or 1 in 3) have been infected and more than 292 million people are living with a chronic Hepatitis B infection. Like Covid, there is a simple test to diagnose a hepatitis B infection. Most importantly there is a safe vaccine to prevent hepatitis B. The vaccine gives adequate immunity in 90-95% of cases. Yet, each year up to 1 million people die from Hepatitis B. As of today there is no definite cure. I hope the Covid scenario after a few decades is not the same as Hepatitis B. Vaccines may become available, but will they reach everyone? Will they be as effective as the Hepatitis B one. Generally, the efficacy of the respiratory virus vaccines is not as good. Influenza vaccines prevent the illness in 40-60% cases only.
Ten years after my encounter with the Hepatitis B virus, another serious viral danger came my way – the HIV. The world HIV pandemic raged in the 1990s. By then, I was a junior consultant surgeon and India had entered the era of desktops, internet and email. So this time around, when the virus threatened me, many of us were adequately aware of not just its existence but also its mode of spread. One novelty about this virus, unlike those in the past and Covid, was the amount of stigma attached to it. AIDS, the disease caused by HIV, was known to be associated with promiscuity, homosexuality, drug use and prostitutes.
I had operated on a middle aged man, who later turned out to be HIV positive. All of us who participated in the operation were at risk. I was tense and got my blood test done. I knew that there was no cure for HIV, and in those days if you got AIDS, death was certain within one year. It was a huge relief when my test came negative.
During this evolving HIV pandemic, I recall attending a meeting in the Sion Hospital auditorium to discuss the situation. The auditorium was packed with hospital doctors. Among the various issues discussed, an important ethical question arose – should we do the HIV test on all patients before they are taken up for surgery? The test was expensive. Should the hospital pay for all these tests or should the patients be charged? It did not take much time to reach a consensus that the test be mandatory for all surgical patients. Doctors’ lives were at risk and must be protected. Just as the meeting was about to end, I remember standing up and posing a corollary tricky question – going by the same yardstick, I asked, shouldn’t all doctors operating or doing procedures on patients, also be required to get their HIV testing done ? There was pandemonium and loud disagreement. And as I recall, this particular matter was deferred for further discussion. There is still no consensus on it.
As regards AIDS, till today, we do not have a vaccine against the virus, nor do we have a cure. Only life-prolonging medications are available which have essentially made HIV into a chronic disease. Although new infections have decreased, 1.7m people were newly infected in 2018, and worldwide 32m people have died of AIDS.
The examples show that scientific cures and effective vaccines can take a long time. The stories of these two viruses also tell us that we have to live with viruses for many years. Viruses will come and stay. And humanity will have to learn to live and adapt to their peculiar ways. As health care workers, we have to learn and adapt even faster.
In our hospital we have commenced doing routine surgeries, albeit with enhanced precautions and protection. Although it is still not the time to lower one’s guard, the fear about the virus is decreasing. The other day, I was pleasantly surprised to gather that the staff nurse assisting me in the operating room had been admitted with Covid in May and had now resumed full duties. The casual banter in the OT lounge during tea and lunch breaks is about Covid antibody levels. One staff nurse was lamenting that though she was antibody positive (meaning she has some immunity against the virus) her levels were not as high as her colleagues!
And as we come to terms with this pandemic, we cannot forget the lessons the past viruses have taught us. Ultimately, the pandemic may subside, but it will not end. If Hepatitis B and HIV taught us to change our behaviours as individuals, the Covid pandemic has emphasized the need to change our behaviour as a society. We cannot afford to neglect public health any longer.
(Dr Santosh Karmarkar is a consultant pediatric surgeon and pediatric urologist, Lilavati Hospital & Research Centre)