June 7, 2020

Things have taken quite a turn with the start of this year due to the Corona Virus which belongs to the same class of SARS, MERS viruses of the yesteryear. Over the months, many messages had been popping up on social media or speculations based upon personal opinions and those who were and are striving to find answers also did not have much to answer because this was unprecedented.

We are inching towards the end of another year… what should have been a time for travel, outdoor picnics or for many to reflect on how the year passed, whether they met their targets set for the new year and what resolutions were to be planned for the coming year, have all been thrown to the winds with the havoc this tiny organism called CoVid brought about. Despite the many negative things that befell the socioeconomic aspect there were so many things that we must be grateful to the virus which none could so effectively bring about such as reduction in pollution, reduction in junk food consumption and helping a healthier lifestyle, building up healthier family ties, spending more time with family, learning to be content with what one has, learning to unearth hidden talents and open up creativity, realizing the importance of the Almighty and most importantly, caring and thinking of others.

 

A lock down had helped in maintaining physical distancing around the world and this meant prevention of travel across borders. This was ridiculed by many as it was unpleasant and led to difficulties. The viral load depends upon certain factors such as: coughing and sneezing has more viral load than when speaking, a closed small space has more viral load than an open space, a large crowd can have more viral load than a small group, a long exposure can be more dangerous than a brief exposure, but I must stress these all can be turned upside down if a person with reduced immunity is at the receiving end. A person with low immunity is one who has undergone transplantation, has very poor kidney or liver function, is having cancer or is undergoing treatment for the same, one who is on immunosuppresants for certain diseases, one who is on long term steroid therapies, one who is diabetic ,pregnant and nursing mothers, asthmatic or having heart related issues. Those who are very obese or who are chronic smokers have less respiratory reserve and hence can get more serious outcomes. Those with diabetes may get the infection as is with any other infection, but the outcome depends upon the presence or absence of associated problems with diabetes.

Now, one can understand the reason and justification behind the lock down. It is cruel to maintain family ties during these difficult times when the families are staying apart and cannot meet, but it is in the best interests. One can always be in touch with through the phone or video calls unlike in the past when this would not have been possible as freely as of today.

The usual course is fever, throat pain, body pain, non productive dry cough, loose stools which may appear altogether or in bits and lasts 7 to 9 days or more. Absence of fever does not mean absence of infection! Many have resorted to purchasing a pulse oximeter which measures the oxygen saturation on the fingertips by a probe which can be applied easily. A normal saturation is from 94% upwards. A drop of 4% when talking or walking is a sign of reducing oxygenation but this must be cross checked by a healthcare provider.

The diagnostics: It is wise to have the blood tests, CBC and CRP done for anyone who has the above mentioned symptoms or who is in contact with anyone already infected or who is unwell for more than 3 days and unresponsive to common measures. The need for a chest X ray or other tests to determine inflammatory markers will be decided upon by the health care provider. There are the classical or rapid swab tests using the RT PCR technique and the point of care tests such as the Quidals Sofia SARS Antigen FIA Kit®, the Talis One Covid-19 test kit by Talis Biomedical® and the Accula SARS Cov-2  kit by Mesa Biotech®. There is a salivary test as well being studied into. There is a paper based tests, E25Bio direct antigen rapid test which is being used in some countries. If positive, the person is advised to isolate him/herself completely for at least 14 days. Upon completion of the self isolation and 3 days of asymptomatic period, most orgnizations insist on a repeat blood testing before allowing them to come to office or they may be allowed to work from home. The molecular test for CoVid detects genetic material ( polymerase Chain reaction test) and the rapid antigen test tests some proteins related to the CoVid. As these are rapid and economical, these are used for mass screening, but may not be very sensitive.

 Self isolation means to be staying apart from other colleagues at place of work or other family members at home . Donning face masks at home when interacting with the affected. Preferably, the aged and young, the sick and nursing mothers must not interact with the affected. The room where one is isolated and the washroom have to be well cleaned as that is a closed space which can become potentially an infectious area for others. Using the air conditioner is not harmful, but it is prudent to have the filter cleaned periodically.

It is important to know how to manage during these times to help contain the virus without affecting the society.

If affected by the virus, the patient must observe the following:

  • Stay at home, away from work and office, whatever the work he/she is doing.
  • Avoid public transport and that includes shared taxis and other modes of transport.
  • Avoid mingling with unaffected family members
  • Isolate yourself to a room with an attached washroom.
  • If on treatment for diseases such as blood pressure, diabetes, high cholesterol, heart disease, please continue using them and monitor the progress. Some may notice high sugar levels which will need the oral medicine to be substituted with insulin. Stressing oneself can worsen the level of control of these diseases.
  • Maintain personal hygiene, use the mask properly.
  • Do ones` own laundry and dry the clothes out in the sunshine, if feasible. Do not mix the clothes with those of the non affected members.
  • Let the food cooked be kept outside the room and the vessels used must be disposable.
  • Disinfect the room daily twice taking care to disinfect the surfaces commonly touched such as the doorknobs, flush handles, electrical switches, chargers of the gadgets, remote devices, table tops, screen of gadgets, keyboard, counter tops and floor of the washroom and tub as they all come into contact with body secretions.
  • One can order in food or even do self cooking which can further reduce the load of other family members. Wash the fruits and vegetables well before using them.
  • Please do simple exercises indoors without straining yourself.
  • Warm saline gargling of the throat is good
  • Infusion of warm water with lemon, ginger and honey is useful and a time tested home remedy.
  • Avoid smoking and alcohol.
  • Get sleep.
  • Avoid listening to CoVid related news or posts on the social media so you do not stress yourself.
  • Listening to music, prayers, Holy recitations can help.
  • Avoid visitors
  • If developing high fever despite treatment, developing chest tightness, shortness of breath or altered behavior such as becoming confused or losing consciousness needs urgent medical help. If one has a good quality pulse oxymeter( a device clipped on to the finger tip to measure oxygenation) a reduction of oxygenation of 4 with talking or walking is ominous and needs help. Normal oxygenation is above 94%.
  • Upon completion of the 14 days self quarantine and 3 days of being asymptomatic, one must undergo a medical check which involves a CBC and CRP blood test and some places insist on an Antibody test before being pronounced as fit to work.

There are many areas in the health care facility which are earmarked for CoVid patients separately and so also the washrooms too. It is inconvenient, but it is best if respected as nobody wishes to get infected just by carelessness. All health care providers may insist on having the Covid test done depending upon the setting however uncomfortable this may be.  All over the world, it reached a position where there were not enough beds to match the influx of patients and many times, many had to be sent home on treatment if they were stable. It is a tricky question to decide who may deteriorate and who may not, because the virus is unpredictable.

Those with diabetes who are infected by the virus may notice fluctuations in sugar levels, mostly higher excursions. This may need change to insulin till the infection gets controlled. The outcomes worsen if the sugar levels are generally uncontrolled before getting infected. Conservative measures such as warm salt water gargling of the throat, taking paracetamol, warm food, avoiding cold fluids including cold milk and juices help.

The Covid times have brought about many good things in the world, with people exhibiting hidden talents, unearthing creative ideas, people resorting to a digital world ( online groceries, food, medicines, education), but this is unthinkable for many in remote areas or those without basic amenities such as electricity or education. The virus has helped Mother Earth to heal herself up, clean up the air, and also to help improve family ties and quality time together.

An antibody test  will help those who want to know if they can rejoin offices for work after the customary 2 weeks of isolation or if they want to travel overseas. This is not a diagnostic test for the infection. This will not replace the other diagnostic tests which are in vogue today. The antibody test if negative can mean the following:

  • The person never got infected,
  • Person maybe in the first ten days of infection,
  • Person may be having poor immunity.
  • The level of antibody may fall in 3 months.
  • Positive antibody does not mean one is immune.

The antibody test can be used to identify convalescent plasma donors and also verification of vaccine response. It was also seen that the SARS- CoV-2 IgG did not cross react with other respiratory viruses.

The restrictions will soon be eased and life may come back to how it was during the pre CoVid times, to an extent. It is the responsibility of each and every one of us to prevent the spread by doing our parts and also thus help the new generation to live in a better place.

Many have asked about taking a Flu shot. It is best to have the Flu vaccine in October or November yearly. This may not prevent all the viruses in the world, but can help in building up the immunity and also reduce the severity. A pneumococcal vaccine is also recommended for those with diabetes and the elderly people above the age of 65 years. If pneumococcal vaccine was taken before the age of 65 years, repeat one at 65 years after which a life long immunity is developed.

God bless us all and a special thanks to those in all walks of life who are striving to help keep the society safe, placing their lives and health at risk.

Skin care during the CoVid times:

  • One uses plenty of sanitizers or soaps to clean. These can cause further dehydration and dryness of the skin. Remaining indoors in an air conditioned room can also aggravate the dryness.
  • One can use cool water or lukewarm water. Using hot water to wash hoping to kill the virus can damage the skin and normal flora on the skin.
  • Avoid antibacterial cleansers on the skin.
  • Use gloves while using disinfectants to clean the surfaces as they may cause problems with direct skin contact.
  • After washing, pat dry and apply hypo allergenic non fragrant and non dyeing moisturizers. A moisturizer containing either urea, hyaluronic acid or glycerin will be most ideal.
  • Oil based creams or petroleum jelly will help trap the moisture, but can cause smudges and so one may need to use gloves to prevent he smudging.
  • Care of the face especially after removing the face mask needs special mention too. Use of soap free cleansers which are non comedogenic are ideal. If one has an oily skin, one can use water soluble moisturizers.
  • One may need to treat acne ( avoid popping them) and comedones by consulting a skin specialist. If there are small blisters use of an antibacterial cream after consulting a doctor will help.