'J&K needs a public driven campaign to reduce transmission'

How do I know if it is COVID-19 or just the common flu?

A COVID-19 infection has the same signs and symptoms as the common cold and you can only differentiate them through laboratory testing to determine the virus type. However, nasal discharge has been found less common in COVID 19. A travel history to areas with documented COVID infection or contact with a COVID positive person should arouse the suspicion for COVID. This is also true for healthcare workers working in areas where COVID positive cases and suspects are kept.

What are the symptoms of COVID-19?

The most common symptoms are fever, dry cough and shortness of breath. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhoea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who get infected becomes seriously ill and can develop complications like respiratory and renal failure. Data reported till now have shown that complications are commoner in older people, and those with underlying medical problems like high blood pressure, chronic lung and heart problems or diabetes.

Are patients with heart disease, diabetes or hypertension at increased risk to get coronavirus infection?

No, people with hypertension, diabetes or heart diseases are at no greater risk of getting the infection than anyone else.

Among people with above diseases is there an increased risk of severe illness or complications once infected?

The majority (80%or more) of people diagnosed with COVID-19 will have mild symptoms of a respiratory infection (fever, sore throat, cough) and make full recovery. Some of the people with diabetes, hypertension and heart diseases may develop more severe symptoms and complications. Therefore extra care is advised for these patients.

How does COVID-19 spread?

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or sneezes and a person in vicinity inhales these exhaled droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

These droplets can also land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces and then touching their eyes, nose or mouth.

Is it in air around areas where a positive case is housed?

There are some unconfirmed indications of the virus being transmitted through aerosols. However precautions for airborne infection are recommended only for settings in which aerosol generating procedures are performed. These include healthcare settings like intubations, nebulizations, bronchoscopic procedures, etc. There has been a single study in which virus has been grown from the stool of a single specimen. However, there are no reports of feco-oral transmission of the disease.

Can Corona viruses be spread through street/pet dogs, cats or other animals or mosquito bites?

There is no evidence that mosquito bites spread COVID 19 virus. The exact mode of transmission is unclear as yet. It is believed that the virus is seen in bats and from bats it jumped to some intermediary animal and from them jumped to the humans. This intermediate host has been variably postulated to be snakes, other sea food animals or even pangolins. However these are only conjectural and no definite evidence exists. There has been a single episode of a cat having gotten the infection from her master. There is no need for discarding pets based on current evidence.

What are the important steps you can do to prevent acquiring or spreading infection?

We need to practice social distancing and hand hygiene:

Social distancing is extremely important:

a. Avoid contact with someone who shows symptoms of possible COVID-19 – anyone having a cold or cough or fever.

b. Avoid non-essential travel and use of public transport. Observe the lockdown as strictly as possible.

c. Avoid public places, crowds and large family get togethers. Lockdown should not mean family get togethers or partying. We should keep in touch with friends and relatives using phone, internet, and social media.

d. Avoid routine visits to hospitals / Labs. for minor problems. Contact hospital or healthcare facilities by phone or helpline number if possible. If you are regularly checking like blood sugar, INR, CBC, etc. please contact the doctor over phone if possible and try and avoid a hospital as much as possible.

2. Hand hygiene:

a. Avoid handshakes and touching face with hands

b. Wash your hands with soap and water frequently – do this for at least 20-30 seconds and systematically to clean all parts of the hand, not leaving any area unwashed.There are a number of pictorial or video demonstrations of the correct methods of hand washing which should be adopted/

c. Alcohol based hand-sanitisers are also useful. The use of non-alcohol based sanitizers is not proved and the sanitizers should contain at least 70% alcohol.

d. Avoid touching possibly contaminated areas/objects –toilet doors, door handles etc.

e. Wash hands after touching potentially contaminated surfaces like steering wheels, car handles, key chains, wallets, mobile phones, etc.

f. Health care workers need to practice infection control measures as dictated by their level of exposures and the associated risk. This forum would be inappropriate for detailed discussion of the same.

Everyone out there is looking for a mask and most are wearing one. Is it needed?

According to the WHO, for individuals without respiratory symptoms, a medical mask is not required, as no evidence is available on its usefulness to protect non-sick persons. The mode of transmission is when someone sneezes or coughs on you and if there is none, the mask isn’t necessary. However, masks are being worn in some countries according to local cultural habits, say for prevention of pollution  in China, Hong Kong etc. If masks are used, best practices should be followed on how to wear, remove, and dispose of them and on hand hygiene action after removal.

Masks are not recommended for common people unless they are caring for someone who is a patient. However if the masks are left for healthcare workers, it would certainly be better.

What needs to be kept in mind while wearing a mask?

  • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected COVID 19 infection.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
  • If you wear a mask, then you must know how to use it and dispose of itproperly.
  • Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.
  • Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.
  • Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
  • Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
  • To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.
  • Avoid stockpiling masks if you don’t need one. If you do, someone who needs it like a healthcare worker could be missing out on one. The whole globe is falling short of masks. Iso let us reserve it for those who need it the most.

People are also surgical wearing gloves while out on roads?

No. Latex gloves do not protect you from getting Corona. People concerned about the transmission of infectious diseases should prioritize good personal, respiratory and hand hygiene. People using gloves may paradoxically have a false sense of security and as such may turn that much complacent to hand washing which is paramount.

Can spraying alcohol or chlorine all over your body kill the new coronavirus?

No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes or mucous membranes (i.e. eyes, mouth). Be aware that both alcohol and chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations.

Will taking a bath with very hot water prevent the virus from attacking me?

Taking a hot bath will not prevent anyone from catching COVID-19. Our body temperature remains around 36.5°C to 37°C, regardless of the temperature of our bath or shower. Actually, taking a hot bath with extremely hot water can be harmful, as it can burn you.

Can regularly rinsing your nose with saline help prevent infection with the new coronavirus?

If I do Wudhu 5 times a day, am I protected?

No. There is no evidence that regularly rinsing the nose with saline water has protected people from infection with the new coronavirus. Just rinsing the nose and gargling may not be effective for reducing transmission. While these are useful measures, additional proved measures need to be undertaken to mitigate transmission.

Can eating garlic help prevent infection with the new coronavirus?

Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.

Is it going to go away in 3 weeks as suggested in some reports?

I don’t think so. If we look at the dynamics of the infection in China and Italy, it took nearly 8 weeks for the cases to level off and register a consistent decline. If we follow a similar trend, then we could be in for a longer haul than just the middle of April. There are some estimates that India would peak somewhere in the 3rd or 4th week of April. If those estimates prove right, then we would be looking at more prolonged battle with the disease than just the first or second week of April. I think we are yet to peak and we should peak in another 2-3 weeks from now. While I say that, I hope and pray that I am proved “wrong”.

Are there any specific medicines to prevent or treat the new coronavirus?

There are a number of drugs that have been repurposed for use against COVID 19. These include antivirals against influenza and HIV, antimalarials like hydroxychloroquine, antibiotics like azithromycin and various experimental agents. While there are some claims of success of such agents, the evidence is weak and not supported by robust clinical trials. FDA has recently approved the use of convalescent plasma for patients with COVID on compassionate grounds. We are looking at obtaining regulatory approvals for the same as well.

Are antibiotics effective in preventing and treating the new coronavirus?

No, antibiotics do not work against viruses

I am vaccinated against influenza and pneumonia? Can I still get pneumonia by COVID 19? By when do we expect a vaccine?

Yes. Routine vaccines such as pneumococcal vaccine, Influenza and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus. The COVID 19 virus is a new virus and will need its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV. Some candidate vaccines are available and in fact some human trials have already started. However it will be about a year to year and a half before safety and efficacy data are available before the vaccines can be put to human use. That is a long way away as yet.

Can COVID-19 virus can be transmitted in areas with hot and humid climates or will the activity reduce with ensuing higher temperatures in summer?

From the evidence so far, the COVID-19 virus can be transmitted in ALL AREAS, including areas with hot and humid weather. Areas with warm geographies at present have also reported cases and as such it is not definite if the ensuing warm climate will have an impeding effect on the virus circulation. This emphasizes that regardless of climate, we must adopt protective measures.

How effective are thermal scanners in detecting people infected with the new coronavirus?

Thermal scanners are effective in detecting a febrile person. However, they cannot detect people who are infected but are not yet sick with fever. This is because it takes between 2-14 days before people who are infected become sick and develop a fever.

So many positive cases of COVID19 in Kashmir, did our airport screening fail?

It seems so,  because all of our positive cases have not come from those who were asymptomatic and then quarantined but from those who sneaked out of the airport filter through whatever means and the contacts of those index cases. Even when the quarantine of more than 1700 guests has been undertaken at a huge cost to the exchequer as well as to the exhaustion of the resources, none of them have reported symptoms. You can yourself gauge the success of the exercise. Further there are people who came through other routes like road, trains, etc where screening was more permissive. Guidelines do not mandate quarantine of asymptomatic individuals. Let us just say that this exercise was a “good intention gone wrong”.

Was our quarantine protocol correct?

We have bodies like the WHO, CDC or the MOHFW that draft technical policies based on technical inputs from experts. I would impress upon the authorities to follow these guidelines in letter and spirit so that we do not invent our own guidelines that results in inappropriate use of men and resources. Our quarantine policies have been criticised for being unscientific. If we follow guidelines, then we are not only following a laid out procedure, we are also insulating ourselves from disheartening critique when we are trying our best to follow procedures that we believe are in the best interests of the society.

Numbers are growing, are we prepared?

In one single word, ‘No’. Actually nobody is. I don’t want to create panic but if the evolved health care systems like that of the US and many European countries can get overwhelmed, our systems stand no chance if we get similar kind of numbers. Our manpower, healthcare infrastructure, hospital bed density, etc are no match to theirs and considering our population density, poverty and consequential compromise of hygienic practices, we could face a greater onslaught of the virus and our systems are bound to crumble. Our resources are grossly insufficient despite huge efforts by the administration. There lay the importance of a public driven campaign for reducing transmission rather than an authorities driven initiatives. 

A lot of talk about areas in Kashmir being demarcated as “red zones”, “yellow zones”. Is it right to do so?

It is an administrative decision and best left to the wisdom of the administrators. I am sure they would have gotten enough technical expertise for demarcating these as such. Generally countries are classified and color coded as such:

GREEN ZONES: Countries or localities without confirmed cases or with a few infected travelers arriving from other countries

YELLOW ZONES: Countries or localities with a few cases of local transmission, but without clusters of community transmission (e.g. Germany)

ORANGE ZONES: Countries or localities adjacent to Red Zones or with small clusters (e.g. Japan)

RED ZONES: Countries or localities that have sustained community transmission (e.g. China, USA, Iran, Spain, Italy)

The administrators have probably used the same classification to classify the areas to prioritize appropriate public health response.

If public health response is to be geared up for large areas, you can definitely use some color coding to prioriotize the enhancement of your response based on the disease epidemiology of the smaller sub-areas. China did it.

A lot is being written and circulated about COVID19. How does one know what to believe and what to ignore?

COVID19 infodemic is as big a threat as COVID19 epidemic. We are fighting two wars together.

Please follow credible sites like those from CDC, WHO, ICMR or MOHFW. This info medic can be very dangerous and breeds misperceptions and wrong practices. Don’t follow dictats of Whatsapp universities and twitterati. Medical professionals should follow society guidelines and credible journal sites.