The Cell - Issue 001 by TheCell

THE CELL

issue 0001

take a glance into the world of infectious disease in the first ever issue of "the cell" a student lead magazine all about medicine

. . in fec tion

infection can be defines by many ways; from the take over of disease upon a host organism, in this case humans : infection can be defines by many ways; from the take over of disease upon a host organism, in this case humans : people: or the parasitic takeover once a microorganism (usually a pathogen, such as a virus, fungus, protist, or bacteria invades and manages to penetrate the first superficial defensive layer: the skin. Disease results from infection. Disease needs to be treated before death arrives, disease can be immediately identifiable but it is more deadly when symptoms might be mistakes for something else entirely: or the parasitic takeover once a microorganism (usually a pathogen, such as a virus, fungus, protist, or bacteria invades and manages to penetrate the first superficial defensive layer: the skin. over the years humans have managed to completely eradicate some infectious diseases like polio from certain regions, if not lower infection rate rapidly. This was done largely by implementing several organized strategies that constituted for herd immunity

art showcase of the month

Covid through the eyes of a doctor - an interview

should healthcare be free?

brought to you by the students of Repton Dubai

What's inside

this month's issue of The Cell

2-3 This issue's interview with Dr. Javed Shami

4-5 HIV : Explained beyond stigma

6 How the Covid-19 vaccine works the science behind the jab

7-13 This issue's debate Euthanasia

14 -- 24 Art showcase The art of infection

15-19 Global healthcare Skin deep

20-23 a look inside epidemiology Doctor you? 1

Covid from the eyes of a doctor

With Dr. Javed Shami

Dr Shami, a specialist in colorectal surgery, has worked in acute and elective surgery since his graduation in 1985. Since the pandemic hit the world in late 2019, Dr. Shami had a resurgence in his interest in community medicine and infectious diseases. As every country scraped to understand and cope with the overwhelming pressure this novel virus brought, many doctors such as Dr. Shami found themselves entering a new field of healthcare in order to cope with the shortage of much needed specialists. Within a few months, Dr Shami took up managing a hospital unit and community in Tengiz, rural Kazakhstan, dealing with a whole new world of healthcare. I decided to interview him to see what his reality of that was and what challenges he faced, but to also understand how novel a situation like Covid-19 really is.

What did your role as a senior doctor in Kazakhstan actually involve? Initially, I was employed as surgeon to upgrade a rural hospital, but as Covid spread throughout Kazakhstan I was deployed in a team in charge of looking after a workforce of 62,000 people. They were short of doctors, so I was posted there to treat Covid patients but also to prevent the spread of disease. No one really understood Covid adequately enough until later in 2020. Every single country was in a state of unpreparedness and panic.

How did you have to adapt the existing healthcare system in the area you worked at to accommodate the stress of Covid-19? We needed a qualified and trained workforce to understand prevention, care, pathology, and physiological consequences of Covid-19. That was largely why I was there: to train medical staff. Now, we were far away from any big city, it was not safe for us to keep such a large workforce when we did not have the equipment to support them, the first thing we called for was a demobilization of those who could work from home, urgently. We sent back anyone who was not essential to the physical running of the company back to their individual towns and cities, and in this way, we reduced the population dependent on us from 62,000 to under 20,000.

this actually had a great knock-on effect. Sending back expats and nonessential workers to operate from home freed up accommodation which we used to keep Covid patients with mild to moderate symptoms isolated from the rest of the workforce. This was one of our main strategies for containing the spread of the virus. We also made everyone working in that unit, barrack to barrack, take a PCR test daily. Routine testing helped detect infection early on so we could get the Covid-positive isolated as soon as possible Like the rest of the world, we also needed beds, respirators, and personal protective equipment, and we needed them fast. When it was no longer possible to transfer sick patients, we had to confront the challenge of securing what was necessaryespecially PPE. I mean, if the healthcare staff is infected, who’s going to treat the sick patients?

a surgical team; Tengiz; Kazakhstan

How does your experience with managing Covid compare to the rest of your career? I never had this problem before. Never to this severity. I specialize in surgery, and in my experience, as a doctor working over 30 years in England and Wales, never have I seen such a thing like this before. Everyone, all healthcare staff- be it a pathologist or circulating nurse, was terrified for their own lives, let alone transmitting the disease. Lack of protection caused so much death, we had to improvise everything. I mean, we were using plumber goggles and surgical caps and wearing double masks instead of the proper N-95 ones, nothing was available. This was partially due, I think, to companies prioritizing the highest bidder. It should have been handled all differently. There needed to be an equity to the distribution of ventilators, PPE, vital drugs across the globe, rather than it all being concentrated in certain countries. This could have happened, it happened in America, when New York was hit quite badly they received assistance from other states. There was also an element of greed in the way industrial providers reacted. I mean, ventilators usually costing 10,000 dollars were now being sold at over double the price. I believe that this was not prioritizing the patient, this is not what healthcare should be. When this sort of situation happens, the question is not who is most prepared, but who is most efficient.

In what ways do you feel healthcare needs to change post Covid19? Accountability is key. Regulation should be commonplace; the human impact and the suffering of these patients has highlighted a great many things. The wealth divide in healthcare needs to go, there are so many examples: when it came to respirators, only rich countries could afford them to an effective extent. When it came to vital drugs, like vaccines, very few made its way to poorer countries initially. I saw this in Kazakhstan, the availability of vaccines came much delayed compared to other places. People died because of a lack of respirators. Look at India. They were using industrial oxygen tanks to try meet the demands of what the patients needed, then so many more people died from preventable fungal infections because the tanks were not fit for medical use. There is so much that should change. He world needs to learn that there needs to be some form of preparation. A similar pandemic could happen at any time in the future, an emergency health crisis response needs to be developed in every country. The WHO forecast system should also continue to update, there needs to be a change from the source. The biggest change, however, needs to be that your chances of surviving a preventable disease is no longer tied to your income bracket. Written by Reem Shami

HIV: explained Like most other diseases, public knowledge about what HIV actually is, it’s symptoms, and pathology, is well, limited. This article aims to shed light on this virus, and how if left untreated, it could lead to AIDS. Human Immunodeficiency Virus (HIV) is thought to have originated in central Africa. Chimpanzees, often hunted for their meat, are believed to have carried SIV in their blood, a “simian” version of HIV. The first recorded case is dated all the way back to the 1800’s, however, in America the first ever recorded case dates back only to the 1970’s. The virus itself is 60 times smaller than a red blood cell, which are generally smaller than the average cell due to the absence of a nucleus. When in the body, the virus spreads “cell free.” This means it reproduces inside a cell then bursts free from it before encountering another CD4 cell and repeating the process. Transmitted though bodily fluids, such as blood, there are several ways a person can contract HIV. Commonly, HIV is passed through shared needles, meat containing HIV, and in the same way other STDs are passed on.

HIV occurs in three distinct stages, the last of them being AIDS, however, HIV does not always have to lead to AIDS. If treatment begins early, HIV can be stopped from progressing, even if the person infected can’t be rid of it completely. Stage one, or the “acute HIV infection” stage occurs when a person is newly infected. The body’s natural way to respond to this virus is to present flu-like symptoms. Symptoms may include fever, muscle aches, fatigue, and possibly a rash and ulcers. In this stage, there is high levels of HIV in the blood, which therefore means that the person infected is quite contagious. The next stage is referred to as “asymptomatic HIV infection.” Compared to stage one, HIV in the blood has decreased; however, at the end of this stage, viral load (amount of virus in blood) will rise again. Drug therapy should begin in stage one or two in order to prevent from entering stage three, AIDS.

T- helper cell

Patients with HIV may also be susceptible to developing some cancers

Acquired immunodeficiency syndrome is the last stage of HIV. AS the disease effects the immune system, people with AIDS and to some extent HIV will be more susceptible to suffering from other infections, and as the immune system cannot defend the body against them, they are more likely to kill, or at least have detrimental effects to the patient. HIV invades immune cells, specifically CD4+ T cells. AIDS is usually officially diagnosed when CD4 cells fall under 200 cells per cubic millimetre of blood. In a healthy person without HIV, CD4 cells can reach up to 1600. If the number of CD4 cells is too low, the body cannot effectively combat against other diseases, which is why the life expectancy for people with untreated AIDS is said to be around 3 years. There are two types of HIV, type 1, and type 2. Type 1 is more contagious and common that type 2 and is what most people who have HIV have contracted. As HIV type 2 is less contagious, it can usually be found concentrated in specific parts of the world, like west Africa. While there is currently no cure for HIV, if caught early HIV can be controlled using various drug therapies such as antiretroviral therapy. Understanding of HIV and AIDS, both in medical and public spheres is limited compared to other infectious diseases. Although people who have contracted HIV can live a long and happy life on the appropriate medication, in this case prevention is the best course of action. Stay safe!

Written by Reem Shami

How does it work?

The Covid-19 Vaccine By Mariam Alogaily

Assisted Death

Defiance of Ethics, or Dignity?

with Siddhant Mehrotra and Jamila Mohamudbucus

EUTH ANASIA. advised for readers over sixteen

The argument for

written by Siddhant Mehrotra

Every few years one comes across news articles describing the ‘Epidemic of Suicide’, describing at length how a great many young people around the world feel forced into suicide due to lack of employment, poor mental health, depression, and feelings of loneliness and rejection. Yet there is another kind of suicide happening, not an epidemic, but a growing movement, not amid the youth, but in the homes of the elderly, not with a knife or noose, but with an injection, under care of a physician. This is not a wave of lives being stolen, but an easing of pain, to those that have already lived countless times. This is the movement in favor of physician assisted suicide, a form of medical euthanasia. The history of medial euthanasia dates to Antiquity, where humans in great pain or suffering, whether due to physical injury or disease, would be dealt a merciful blow by their fellow tribe members, and ease their passing. One of the earliest direct references to PAS, however, is found in the famous Hippocratic Oath in the line ‘I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect’ as part of the general motto of ‘do no harm’ encapsulated by the oath. Indeed, this was the motto of the larger field of medicine for the ensuing two and a half thousand years, that no matter what, the physician exists to nurture life, and that alone. Sporadic incidents of physicians administering to their patients lethal doses of a drug upon their request, or to leave them dying and not assist them did indeed occur, but these were the exception and not the rule, and strongly depended on a strong personal relation between patient and doctor. A famous example of this was Sigmund Freud, who had his doctor administer two lethal doses of morphine to him, as he was suffering from an inoperable and painful jaw tumor that rendered him incapacitated and near speechless. It was only in 1942 that Switzerland formally legalized physician assisted suicide ‘as long as the motives are not selfish’ and was followed by the Netherlands and many others in 2001.

We live our lives with dignity, should we thus not maintain the right to die with dignity too?

Now it is important to note here that it is not technically suicide itself that many movements argue in favour of, but a form of euthanasia for people who are already dying, to spare them suffering. Does this not seem fair? Around the world, large numbers of elderly patients with terminal diseases, languish their waning years in Hospices and Nursing Homes. They are forced to endure months or even years of suffering under their condition due to belief that life is sacred, and should not be impeded, and this is where one must ask, is life worth living at all, if there is nothing in it that makes it life? Is knowing that death awaits, and that the road ahead is lonely and painful truly living? Is being forced to struggle under painkillers that could kill animals, in cold and dark hospice, living? Is watching yourself lose your memory, your personality, your movement and even your mind slowly by slowly living? Many people indeed argue that while it may be hard on the patient, it is harder still for the patient’s family, being forced to watch their loved one have assistance in dying, but is it not harder to watch the one you love to become a pain-stricken shadow, knowing that you have prolonged their suffering, out of ultimately selfish cause? We love, because we care, and what is more compassionate, and kind, than letting someone release their misery, and make their own choice, to ease their pain, and live life to its fullest before it ceases to life. Should it be a crime, for a dying person, to end their own life, after making an informed decision?

Another prominent point of discussion is if it is morally right for doctors, who swore an oath to heal, to end someone’s life? Well to this one argues that a doctor’s ultimate job is to ease the life of their patient. Cure their maladies and mend their injuries. Nourish their bodies, and clear their minds, so that they can live freely, so thus, is it not right for the same doctor to ease them of pain, at the end of their lives, just as they have throughout their lives? When healing is no longer possible, and death imminent and suffering unbearable, then the physician’s role should shift to relieving that pain, in accord with the patient’s wishes. Our lives center around the promise of free choice, the choice to live somewhere, to raise a family, to buy something, to where we work. We chose what we wish to enjoy and how to enjoy it, and in doing so, live our lives to their fullest, knowing that we maintain control over them, and face no burdens apart from the ones we set on ourselves. Is it thus not fair, to chose to ease ourselves of prolonged suffering, if we know that we are to die anyways? We live our lives with dignity, should we thus not maintain the right to die with dignity too?

The argument against

written by Jamila Mohamudbucus

Life’s a ticking time bomb. We’re all waiting for the timer to stop counting down. Make every second count, you’ll hear people say, live every day to its fullest, seize every opportunity. We’ll never know when it’ll be our last. Except if someone has made that decision for you. If someone has made that choice to make it your last. If that someone was your doctor. They’ve made that decision to never give you a chance to live life again, to smell a fresh bouquet of flower, to laugh until you can’t breathe with your friends, to experience the sun on your face again. You’ve been condemned to an eternal death by the very person who swore an oath to rehabilitate you back to good health. The Hippocratic Oath – perhaps the most important, foundational documents in the field of medical ethics says Professor Ronald Pies MD – states ‘do no harm to the patient’. Yet, the practice of euthanasia in all shapes and forms disputes this. The American Medical Society covers this in their code of ethics – ‘Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer’. It is a physician main target to nurse a patient back to health not to end their life. Why should a doctor have the right to end a life? It is a betrayal of agreement, trust and respect towards the patient for them to deprive them of the chance to get better. If the patient is incapacitated to make their own decisions about their own futures, what give a doctor the right to make that for them? How is it just without the patients consent? Even if a patient feels as if their life is out of their hands and life is no longer worth living, is it not in a doctor’s duty to heal the patient mentally through proving comprehensive counselling rather than succumbing to assisting in suicide.

It is close to impossible not to bring up the topic of religion while discussing such a controversial topic like suicide. All faiths have their own explanations for death, the afterlife and the creation of life. Yet, there are overlapping agreements in why a multitude of religions are against euthanasia. The first being that human life is sacred. Judaism is one example of this sentiment as life is “created in the image of God.” By tampering with the length of a person’s life, you are effectively opposing God’s plan. The general Christian viewpoint is antiEuthanasia on the basis of life being a gift from God and so humans themselves have no legitimate reason to take the life of a person no matter their intentions. Catholicism teaching condemns euthanasia as a "crime against life" and a "crime against God" as it is drawn from the principle of ethics including the sanctity of life. The Roman Catholic Church official position remain clear and adamant: the killing of a human being, even by an act of omission to eliminate suffering, violates divine law and offends the dignity of the human person. Islam is another religion that stands firmly against physician-assisted dying. It is believed that Allah is the giver and life and therefore Allah should be the only one to take it away. Therefore, ending your own life prematurely is a sin - The Quran (the Holy Book) states: “Take not life which Allah made sacred otherwise than in the course of justice”.

The final point is one human to human, person to person about thinking about what euthanasia is really doing and how it is unethical. Do we not have a duty to our loved ones, our elderly, our ones suffering to not let them die by the hands of their own doctors? Why are we killing people when other alternatives such as palliative care exists? How is it right for us to sit back and watch our friends and family ask to die? Euthanasia is a direct violation of the Hippocratic Oath where it is on a list of things that a physician should never participate in. A physician can be defined as someone ‘a person who cures moral or spiritual ills; a healer’ so how is it morally right that people made to heal are the people to bring death on a human being? The answer to the question of whether euthanasia is ethical is as clear as this black and white text: no.

Artwork by Vasilisa Konovalova

PAN(DEM)IC The pandemic has no doubt resulted in mass abnormal behavior, from increase in fake news to the unintended psychological impact the pandemic will have on humanity later on, Covid-19 was arguably unprecedented in more ways than one. One aspect of the peculiar behaviors exhibited by a large population was the bulk buying of goods, in particular, toilet paper. Obviously, these "store and stock" attitudes were aggravated by the alarm of the situation, but I would argue that this, especially regarding the toilet paper example, is a prime example of informational social influence. The unfamiliarity of the situation, combined with the horror stories of Covid-19 that were becoming increasingly common created a situation in which people did not know how to behave. Research argues that in situations where a person does not know how to act, they will look to others to get this information. That could arguably be one of the reasons unusual habits crop up at times like these, because no one really knows what their doing.

SKIN DEEP a look inside global healthcare with Triesha Narwani

Does your chance of living depend on where you live? Around the world, countries provide healthcare differently to one another and overall, all healthcare systems differ widely. Over the decades, most countries have acquired various systems in order to deliver the best possible healthcare to their citizens. Not only does healthcare apply to the physical aspects like illness, injury, or disease but, includes mental impairments such as occupational therapy. The right to healthcare is a vital part of our human rights and, regardless of our ethnic and socioeconomic background as well as our age or gender, our health is our most fundamental asset to us. There are many different countries that follow dissimilar healthcare systems, and this piece will briefly glance at some of the distinguished examples.

US HEALTHCARE SYSTEM When talking about of one the most highly ranked healthcare systems in the world, it is hard to overlook the absence of the United states in these lists. In the US healthcare system, most of the hospitals and clinics are privately owned with approximately 60% being non-profits. Amongst some high-income countries, the US healthcare system is actually known and proven to be one of the most expensive ones, with around 17% of the GDP being spent on healthcare in 2018. However, the American healthcare is arguably seen as one of the less accessible, efficient, and impartial. Many ethnic and underprivileged unfortunately, suffer a significant amount of inequity and inequality amongst the US healthcare system. Despite the exorbitant spending on healthcare in the US, the United states has poorer outcomes than its international peers. Some examples of this is life expectancy in the US was 78.6 years in 2017, which is more than 2 years below than the OECD average and 5 years lower than Switzerland. Obesity is an important risk factor when coming to numerous cardiovascular diseases and, the US had one of the highest obesity rates amongst countries studied like New Zealand, UK, and Canada. Their rate was 2 times higher than the OECD average and 4 times higher then the rates in Norway.

SOUTH KOREA’S HEALTHCARE SYSTEM Healthcare in south Korea is universal

and well-funded mainly by outside

contributors and government subsidies. Hospitals and clinics in south Korea are known to be modern, accessible, and systematic. Their public healthcare system is referred to as the NHI (national health insurance) where it is mandatory for all residents living in south Korea (for a period longer than 6 months), to register. With the NHI, citizens have the freedom to choose their healthcare provision. The public healthcare in south Korea is not free but, is not as expensive as the US for example. Korean public healthcare covers around 50-80% of medical costs, depending on the treatment and intensity, this means that residents are only, on average, expected to pay 20-30% of their medical bills. However, the cost of medical insurance in south and Korea is relatively higher than some developed countries in the world. The life expectancy within south Korea was 82.7 years in 2018, according to the OECD in 2018, this was almost 6 years more than the US life expectancy.

UK HEALTHCARE SYSTEM It is commonly known that the United Kingdom has a government-subsidized, universal healthcare system, referred to as the NHS (national health service). In a 2013 survey, visitors and residents praised the fact that the NHS was a ‘beloved public institute’, it was ranked number one on a list of qualities that made people be proud and embrace being British. The NHS was founded shortly after WWII and at the time of economic desperation, the government still prioritized healthcare of its citizens. The NHS is mainly funded through taxation, 18% of people’s income tax goes towards the funding and maintenance of the national health service. On a country’s perspective, 8.4% of the UK’s GDP (gross domestic product) is spent on the healthcare system. All the medical services part of the NHS are free of charge including emergency room visits, ambulance rides, operative procedures, and treatments like chemotherapy. As far as prescriptions and the actual medicine, they are quite inexpensive compared to the rates around the world, where in the UK, they only cost a couple of pounds.

Most countries around the world have acquired the skills and the correct knowledge to serve their citizens and residents with the best healthcare system possible. It has taken centuries for governments to decide on a beneficial and efficient system to put in place, and most countries have developed this effectively and, the quality of the systems have been challenged during the COVID-19 pandemic, and has been progressing ever since.

Doctor You ?

Written by

Simran Gill

Epidemiology: Epidemiology is a branch of medicine that studies how frequently a disease occurs in a population to better understand how we can develop better treatments that will reduce these threats. What is so cool about this career in medicine is that there is so much variety in what you will do and all the different skills you will use so read all the information below to see if you are interested in this amazing and exciting job!

Qualifications needed: - Postgraduate degree such as a PhD or Masters (2-3 years typically of studying) (usually in a quantitative science such as in epidemiology or a similar subject such as biological/statistical science or public health) - Bachelor’s degree in Medicine (4-year to 6 years, depending on University) Skills needed: Science (making observations, measuring, predicting, classifying) Reading Comprehension (be able to understand and apply what you have read to questions) Critical Thinking (analysis) Speaking (voice opinions and be able to present information) Active Learning (engage in discussions, problem solving) Leadership (teamwork and coordination tasks)

Day to Day: An epidemiologist works regular hours a week with a team however, they still have a lot of responsibilities to carry out as an individual. They communicate on what they have found in their research and educate other healthcare workers including patients and the general public on disease transmission and prevention. They investigate and plan studies on diseases and different protocols that can be used to improve public health. Furthermore, an epidemiologist has to monitor reports of diseases and standardize methods and procedures to control infection rates. What do you need at school to enter University for Medicine? Whilst requirements differ from Universities, in general you will need: a High School Diploma in Biology and Chemistry achieving at least 2 C grade equivalents in these subjects. IBDP= must take Biology and Chemistry HL and pass all of their subjects with at least 36 points overall Passing interviews for the Universities and providing reference letters from teachers UCAT (for universities in the UK) or MCAT (for US universities), IMAT (for most European international exams) What can help you enter a University for Medicine: work experience or volunteering for medicine, letters of recommendation from esteemed doctors in the field, a personal statement (letter of motivation) and CV, medicine related ECAs!

Whilst there are quite a few different types of epidemiologists, we are going to focus on Infection Control and Infectious Disease Epidemiologists: Infection Control or Hospital epidemiologists implement policies to improve public health in health care settings. The risk of infection in hospitals is quite high as 1 in 25 patients are infected due to hospital care thus, limiting the spread and controlling these conditions will really improve everyone’s treatment! This is why Epidemiologists have to educate other public health care workers in order to keep both employees and patients safe, enforce proper hygiene and report infection data so more methods can be developed to reduce this omnipresent risk. Infectious Disease epidemiologists work to understand the effects a disease can have on a population. They may work where an outbreak first occurred in order to find why it happened and prevent similar events happening in addition to working in a lab. They use data and mathematical models to track diseases and solve public health issues at a population level which can include anything from a pandemic to the common flu. Right now, epidemiologists are studying diseases such as Covid-19 and are still finding treatments to diseases such as HIV and AIDS.

What I try to tell young people is that if you come together with a mission, and its grounded with love and a sense of community, you can make the impossible possible – John Lewis Epidemiologists work together to find the best treatments possible for all of us to stay healthy and safe so let’s take a minute, to thank all the public health workers and epidemiologists who have helped us during the Covid-19 Pandemic!

Is our world infected in more ways than one?

Artwork by Vasilisa Konovalova