The past few months have got everyone talking about the corona virus disease, COVID-19, caused by SARS-COV2 a novel type of corona virus similar to the ones that caused the SARS and MERS outbreaks in 2002 and 2012 respectively. With over 88,900 recorded cases and 2,900 deaths worldwide as of today, it has been placed as an international public health alert and emergency by the WHO. Although most of the cases started in China, the incidence rate in China has been dropping recently while spread to other countries like Iran, Italy, France and more recently , the US have been on the increase. Despite the relatively lower case mortality ratio when compared to other viral diseases like Ebola and Rabies, COVID-19 is a serious problem to the world because of the lack of vaccine or antiviral agent and more importantly, the ease of spread (which is common to many respiratory illnesses). Certainly, nothing is easier than spread via respiratory droplets whether it’s by coughing, wheezing and sneezing. There may also be other means of spread; however, these routes have not been confirmed. In general, not much is known about this nouvelle virus but more information will be unveiled with time. When infected by the virus, the person may be asymptomatic or present with the following unspecific symptoms:

• Fever
• Tiredness
• Dry cough

Others may develop aches, pain, nasal congestion, runny nose, sore throat and diarrhoea which are mild and begin gradually. Most cases resolve without any intervention but some people run the risk of developing very severe respiratory disease like pneumonia and consequently die. The population most vulnerable and with the highest risk of falling sick include:

• Elderly (those above 65 years)
• Those with co-morbid medical problems like hypertension and diabetes
• People with compromised immunity

It is paramount to follow the following tips to stay safe:

• Regular hand washing with soap and water or alcohol based hand sanitizers
• Avoid touching eyes, nose and mouth with hands
• Maintain at least 6-meter distance from anybody especially people who are sick- coughing and sneezing
• Avoid going to overcrowded areas
• Keep yourself up to date with recent COVID-19 news
• Follow new health tips and avoid unnecessary travel especially international travel if possible

Report to health authority if you notice the above symptoms

The increase in Substandard and falsified medical products is a growing public health concern that is not always in the public’s mind. It is always assumed that all health products affect health positively but that is not always true. Just as there are fake gold necklaces and adulterated fruits, there are also substandard and fake medical products. Drugs are by far the most common medical products implicate as well as vaccines and in-vitro diagnostics. Drugs come in either brand or generic forms; the brand forms are made and sold exclusively by the producer while the generic forms can be produced and sold by any manufacturer. Unlike other products that their generic forms are poor, generic drugs actually do very well when compared with their brand counterparts as they contain the same active substances and ingredients. However, brand drugs are far more expensive due to their strict monopoly and exclusivity. It is due to this price difference that insurance companies continue to advocate for the use of generic drugs to help improve drug coverage not only in low and middle income countries but also in developed countries. Furthermore, this price difference also accounts for the safety of brand drugs and is why the vision of improved drug coverage have been sabotaged by substandard and fake drugs.

Substandard drugs are drugs that fail to meet quality standard or specifications due to poor production practices or storage procedures. There are common thoughts that brand drugs are never substandard and that generic drugs are all substandard but that is actually not true. Some brand drugs, no matter how expensive they are sold, can be substandard. The problem with generic drugs is that the manufacturers (particularly those in China and India) tend to send their higher quality generics to developed nations like Canada and the United States while they sell poor quality drugs to developing nations like Nigeria. The ideal is that generics should be as effective as brand drugs. Sometimes, substandard dugs are released by mistake and then subsequently taken out or recalled voluntarily by the pharmaceutical company unlike fake drugs. Fake drugs are not even drugs in the true sense and its production is a pharmaceutical crime. They are drugs and pharmaceutical products that are deliberately and fraudulently falsified products which do not represent their identity, composition or source and are produced for monetary gains. Whether substandard or fake, these drugs pose significant limitations to the realisation of the SDG 3 which aims to achieve universal health coverage, including access to essential medicines and vaccines. This problem is not only faced by developing, low and middle income countries because of their poor drug regulation and poor access to care, but every country and every one is a potential target due to online marketing.

The impacts of accidentally using substandard or fake drugs are glaring. Some of the resulting problems include treatment difficulties, non-responsiveness to health care, adverse reactions, dissatisfaction with drugs and death. In countries where these drugs are very common, many patients have died of treatable infections due to poor activity of these drugs since antibiotics are mostly involved. This can be really frustrating for doctors who sometimes question their diagnosis or drug recommendation and may even increase doses to over 10 times what is considered normal with no perceived effect. In addition, the poor activity of these drugs ends up worsening the problem of antimicrobial resistance since not all organisms are wiped out. More so, some of these products can contain substances that can harm an individual; there have many cases of drugs contamination with toxic substances.

The availability and sale of substandard and fake drugs is a life-threatening problem and must be tackled as a priority. This must be taken seriously by all governments and followed with proper legislative actions including clear and hefty punishments on offenders. There should increase in drug surveillance and these bad drugs should not just be seized but traced back to the source and disciplinary action carried out by responsible regulatory agencies. Currently, there are already very efficient means of detecting these drugs such as scanning of codes or product labels but they are mostly in developed countries. Improved and effective communication between clinics, local and national regulatory agencies and pharmaceutical companies would also help increase surveillance. Finally, we must learn to be careful ourselves and know that these medicines are capable of causing severe harm… always remember to:

• Check if the production and expiry dates of the inside and outside packaging match
• Examine the packaging for spelling mistakes and errors
• Make sure the medicine is not disclosed and doesn’t smell unusual
• Report adverse reaction to your doctor
• Report suspicious products to regulatory agency

If you asked a random person the tips to healthy living, you’re probably going to hear things like being physically active, not smoking, having a balanced diet, going for regular health checks and so on… of course, these are what we are constantly fed by the media. Healthy living as it turns out is more complicated than only these lifestyle modifications. It is easy to understand why we often talk about lifestyle modifications- it’s proactive, cost-friendly and the human mind naturally thinks of prevention. Using a sports case example: Why is a certain sports player so good? Probably because he practices a lot- however, there are other circumstances surrounding the individual such as having a good coach. So, just as having a good coach and other important advantages surround such an individual, there are other factors that surround and consequently influence healthy living- some of these are even more important than lifestyle modifications. Health is not just affected by what we do or don’t do; it is also influenced into our environment. For instance, no matter how many times you wash your hands, you are still more likely to suffer from COVID19 infection if you’re living in China because of the prevalence of the infection in that location. This is not to undermine the benefits of proper hand washing, staying physically active or practicing safer sex, but it’s high time we brought the other factors that influence health into limelight and address them:

• Aboriginal status
• Disability
• Early life
• Education
• Employment and working conditions
• Food insecurity
• Health services
• Gender and gender identity
• Housing
• Income and income distribution
• Race
• Sexual orientation
• Social exclusion
• Social safety net
• Unemployment and job security

These factors are worthy to be addressed because of the health inequalities associated with them. Health is a universal human right and should not be treated like luxury or a mere commodity. Research has documented that people with disabilities are likely to be refused  care, blacks have shorter lifespan in countries like America and even Canada despite universal health coverage. These differences in health outcome are clearly due to differences in realities of daily life such as poor employment which leads to low income and poor housing.

Considering the preceding paragraphs, tackling poverty should definitely be a health priority! This is however very difficult because health inequality is rooted in the fundamental problem of different forms of inequality in human life. It is then left for world leaders and governments to determine what should be a right or privilege and what should be bought as a commodity. Given the importance of health, most developed nations are pushing for universal health care. Income is a better predictor of good health than any lifestyle modification; therefore, it makes sense that income redistribution policies would be a bold step in the right direction for any country that has the health of her citizens at heart. Additionally, education should be made accessible and available to all as it correlates with better income and also contributes to knowledge about ways of staying healthy.

Hospitals and health care facilities are generally seen as one stop solutions to most health problems. However, these places have the potential to increase or add to our health problems when we visit them while seeking treatment. There is always a small risk of something going wrong during health visits or interventions and this; unfortunately, happens quite a number of times as patients often suffer one complication or the other when they go to the hospital or healthcare facility.  Examples of such complications include:

• Developing a VVF from an obstetric surgery
• Developing a nosocomial infection
• Losing a child due to injection of a wrong drug
• Overdosing

Patient safety is a serious and common situation- The World health Organization reports that 4 in 10 patients (40%) are harmed in primary and ambulatory care settings. This is of course worse in low and middle income countries which have substandard health care facilities with 134 million adverse events (over 2/3 of the world burden) occurring annually. A patient in the United States has a 1 in 4 chance of experiencing injury, harm or death when admitted to the hospital, and this situation is quite similar in Canada as well as many developed countries. This bothersome statistics begs the question: Are health facilities doing more harm than good? I mean, should we decline doctors’ appointments and develop cold feet towards hospitals visits- the very place we need to go to get help? Well, the answer remains YES. However, we need to recognize the importance of patient safety and endeavour to make it a top priority. WHO defines Patient safety as the absence of preventable harm to a patient during the process of health care, and reduction of unnecessary harm associated with health care to an acceptable minimum. This harm can come in form of infections, injuries, errors and poor care.

Hospital infections, also known as nosocomial infections are caused mostly by antibiotic resistant bacteria which can affect any part of the body like the skin, lungs and can lead to sepsis and can quickly progress to organ damage and ultimately, death. Invasive procedures like surgeries have increased risk of complications and contaminations due to additional problems with anaesthesia while higher risk procedures like pancreatic surgeries are even worse. This risk is further increased by poor training and expertise. Errors in drug prescriptions also account for many hospital problems which errors cost about 42 billion dollars annually and can easily result in death especially in children. Poor patient management cause problems like bed sores and thromboembolism due to prolonged hospital stay. Patient safety is a serious issue, a matter of life and death actually. Health providers must endeavour to do no harm consciously and unconsciously because it violates the ethics of healthcare. Furthermore, lawsuits to health workers for making a mistake may be cultivating unsafe blame culture which focuses on the ‘WHO’ (who made the mistake), instead of the ‘WHY’ (why the mistake was made in the first place). Focussing on the person that made the error also prevents identification of errors within the system itself.

Errors arise as a result of poor system organisation and usually result from workers being extremely tired, probably experiencing fatigue or burnout. Since human errors are inevitable, a good system- which develops only when there is good safety culture of transparency and no blame games should sufficiently reduce errors. For example, if a nurse gives propranolol to a patient with heart failure that is coincidentally asthmatic (this would sadly cause an asthmatic attack), a good safety culture should seek to find out how the error moved past the entire system, and not just focus on the nurse. Additionally, effective communication, which involves active listening, showing empathy and patient involvement in care, is important and necessary to reduce errors. It would help for patients to be more involved in their care and clarified if need be as this emphasizes the importance of individual care as well as the gradual shift from patient to client. Patients who have questions about their care or feel uncomfortable about a procedure should be able to:

• Talk to someone immediately- preferably someone involved in their care
• Discuss the issue in a polite way and let the person know they want feedback if the issue warrants investigation  OR
• Report to the hospital through the customer service, suggestion box, hotline, patient advocacy or patient and family relations department.

Finally, it is important to have a national hospital rating system like the leapfrog hospital grade system in the US for the public to make choices about which hospital to visit depending on the safety and quality of care; this should also help foster better safety culture for health facilities.