:New Delhi/Mumbai, June 7, 2020

While cases are on the rise, life has to go on. Hence, all of us have to adopt a new normal. We have to live our life and also start our works in the presence of COVID-19. In other words, we have to live with COVID-19. But, under the prevailing situation, every individual’s responsibility is also increasing. Social distancing, wearing a mask and hand washing becomes all the more important.

In this context, Dr. Randeep Guleria, Director, AIIMS, New Delhi opines – “Whether we are going to a market or a restaurant and even while going to office and using lifts or staircases, we have to inculcate a lifestyle change. Every individual must understand that we have to live with a new normal now. Then only we will be successful in arresting COVID-19 cases and break the chain of transmission”. Every person needs to understand that COVID-19 spreads through human to human contact. COVID-19 can only survive in humans and virus requires close contact amongst humans for its survival. If we don’t adopt the stated precautions, then we will be giving the COVID-19 virus more chances to grow which will lead to a further rise in cases, which in turn will lead to a rise in hospital admissions and mortality, cautioned the senior doctor. Hence, the responsibility of adopting precautions lies with every individual. Our collective responsibility is to ensure that we and our family members don’t catch the infection and spread it further.

When the COVID-19 infection first surfaced in India, a panic situation happened, even amongst the doctors, because not much was known about treatment of this new disease and there was also a limited supply of essential commodities like PPE kits, N-95 masks etc, says Dr. Madan Lal Brahma Bhatt, VC, King George’s Medical University, Lucknow. But, with the passage of time, we saw that the disease has spread less in India in comparison to western countries. Slowly, the medical fraternity also became prepared to treat COVID-19, further opined Dr. Bhatt and said, it has been found that approximately 97-98% of patients get mild symptoms and can recover from the disease and only 1-2% of patients who have co-morbidities are at risk. Thus, the doctors have overcome the panic. But now in the unlock 1.0 phase, the people who are thoughtlessly being casual about social distancing and not being mindful of personal safety and hygiene are a reason for concern, he cautions and says, “Though lockdown has reduced the rate of transmission of the virus, the cases will rise as long as society, as a whole, does not become fully aware of its responsibilities and adopt all the precautionary measures”.

The patients with mild symptoms or who are asymptomatic have been advised home-isolation. But, in some cases it has been seen that suddenly their health condition becomes serious. In a word of advice to this category of patients and their caregivers, Dr. Guleria says, their health should be continuously monitored for warning signs and they should remain in regular touch with doctor. Also, it is very important to follow all norms of isolation at home, so that the disease is not transmitted to any other family member, cautioned Dr. Guleria while he informed about some of the symptoms which can red-flagged in case of home isolation. Those are – breathing problem, chest pain, high fever on 5^th or 6^th day, nails or lips turning blue or any other health problem creating uneasiness. If any of these symptoms occur, patients/caregivers should immediately contact their doctors and go to a hospital, advises the senior doctor.

Stating the medical community’s observation, Dr. Guleria informed that 98-99% patients remaining in home isolation are seen to recovered fully. They do not require much care also and warning signs hardly appear for them. The doctor further informs that patients in home-isolation who do not show any symptom till 10^th day of being tested as COVID-19 positive will recover fully. The Director, AIIMS New Delhi also states that recent studies in India and some other countries have shown that COVID-19 virus becomes inactive by 8^th day of infection and loses power of transmission. In this connection, he mentions that RT-PCR test may come positive even on the 10^th day as it is a test to only detect the presence of the virus, whether it is active or is non-viral. Hence, symptoms must be monitored and if a patient does not develop fever or any other symptom for the last 3 days of the 10-day period, then the person becomes non-infectious.

But what about the immuno-compromised patients having comorbidities, including cancer patients, have increased risk from COVID-19? Dr. Bhatt says, the patients facing fatality, as seen in India at least, are mostly aged and comorbid people like those suffering from diabetes, renal problems, cancer, cardiac problems, thyroid, hypertension, obesity and so on. On that count, we need to be extra careful about the elderly population to protect them from the infection. They should be strictly kept in isolation and adhere to distancing. Family members who have to step outside home for work or fetching essentials should stay away from the aged people in family, advised Dr. Bhatt.

In the monsoon season, COVID-19 may further increase, also cautions Dr. Bhatt. He called for the medical community to remain fully prepared to deal with COVID as well as Non-COVID diseases which comes with monsoon. Swine flu, dengue along with diarrhea, flu, ILIs typically increase in monsoon, he said in a word of advice.

Speaking on the prevailing situation of COVID-19 in India, Dr. Guleria says, we need to understand that the count of infected persons in India will be high as our population is much higher than many other countries. But more important is the death rate of a country. Our mortality rate is still lower. On a positive note, more than 90-95% patients have mild illness or are asymptomatic and they have the power to recover. Even our ventilator cases are lower than western countries. 

Speaking about the controversies on Hydroxychloroquine (HCQ), Dr. Guleria says, small studies conducted in China and France and laboratory observations have shown that HCQ is useful in decreasing viral replications in the early stage. However, it is not much useful in arresting viral replications in advanced stages, added the doctor. This drug is being used for the last 20-30 years in India. ICMR and National Task Force in India evaluated these observations along with the side-effects of the drug.  “Looking at its safety, we felt that there is benefit in giving it to people”, said Dr. Guleria. Further, ICMR and AIIMS analyzed data collected from doctors who have taken HCQ in AIIMS and other hospitals of the country over the last few weeks. It has been found that COVID-19 infection occurred less in those who took the drug in comparison to those who didn’t take it. On this basis, it has been recommended as prophylaxis for all COVID Warriors, including paramedical staff; to be taken under strict medical supervision. Also, the dose of HCQ prescribed in India is much lower and hence safer, whereas in WHO trails a much higher dose is being given.

On a query about medicines that can be taken at home to keep away the virus, Dr. Guleria informed that that patients and high-risk individuals under home isolation are generally prescribed to take paracetamol and keep a check on fever. Ayurvedic remedies can also be adopted by them, said the doctor. He stressed on the fact that no anti-viral drug to treat COVID-19 is yet known to the medical community.

On a query about a perception that wearing masks continuously may cause harm, Dr. Guleria said, wearing a cotton mask does not lead to carbon dioxide retention even for those suffering from chronic lung diseases, as far as lung capacity is concerned. It is also possible to exercise wearing these masks. There may be a slight discomfort in the beginning because breathing happens through a filter, but soon people get adjusted to it. Even pre-symptomatic persons may be saved from spreading the infection by wearing a mask, he further added.

Many people are suffering from panic about COVID-19 and hence going to hospitals in case of mild symptoms or non-serious illnesses. In this context, Dr. Guleria stated that people may opt for tele-consultation with doctors and opt for home-isolation and only serious patients should think about going to hospitals.

It is seen that the COVID-19 hotspots that have emerged in the country have a high density of population and hence, the medical infrastructure in those cities remain under strain. In such cities, cases have occurred where serious patients with deteoriating health conditions had to visit from one hospital to another in search of a bed. It is important to tide over this crisis by creating a central pool that reflects availability of hospital beds, ICU beds and ventilator beds, said Dr. Guleria. A system like an app to show which hospitals and care centres are available will be useful because then the patients will know for sure in which hospital he or she may get a bed for sure. It would be even better if the hospital gets to know by means of that app that a COVID-19 positive patient is arriving so that they may remain prepared from the first instant, opined Dr. Guleria.

Speaking about the benefits of lockdown, Dr Guleria also said that, the curve did not become steep in the country and this time could be positively utilized to ramp-up the medical infrastructure to deal with COVID-19. As a result, about 1.4 lakh tests are being performed in the country as on date. Efforts are on to increasing the testing capacity to double of this figure by the end of this month. Many medical colleges, besides CSIR, DST and DBT labs and also veterinary colleges have come forward to provide testing facilities for COVID-19. In the last few weeks, hospital beds have also increased. Planning has been done in such a way that there is no dearth of oxygen beds and enough supply of oxygen is being ensured in district level.

In order to boost our immunity and keep away diseases and epidemics, we need to focus on our lifestyle and eating habits, suggested Dr. Bhatt. He advised taking a balanced diet containing nutritious and digestible food with sufficient fruits and vegetables content. Further, regular exercises help to keep one’s immunity intact and weight under control. Enough rest, sound sleep, intake of plenty fluid and water are also very important in this respect, he further informed. In the context of COVID-19, Dr. Bhatt prescribes having warm water more often, along with concoctions and ayurvedic ingredients recommended by Ministry of AYUSH. Also, half an hour of exposure to morning sun helps in Vitamin D formation in the body which further boosts immunity, suggested oncologist expert Dr. Bhatt.

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