In the Times of Corona- Don’t panic, Be Informed!!

Prelude-

As I see the news of a Corona suspect 23- year old man committing suicide by jumping from 7th Floor of Safdarjung hospital in Delhi, I thought this is high time I should serve my part by making the community aware of certain things so as to help them avoid undue panic about this Pandemic. I was associated with Safdarjung hospital in the past, did my MD there, before joining IRS !

          And I can say with conviction that I am still in habit of reading Articles published in Medical Journals, a habit I had to cultivate while in Safdarjung so as to complete my MD Thesis. So whatever I write today, shall be based on quite well researched articles about Corona. In this write up you will get to know about basic information about Corona virus itself which may be little technical in semantics but I will try to keep it as simple as possible. Further I will put some information about its treatment part so as to demystify sensational news regarding this, and about quarantine which is scaring people due to lack of proper information. After reading this you will be able to convince yourself that, isolation and quarantine are 'nothing to get panicked about sort of ' measures to contain transmission and basic droplets precautions and WHO Advisory about  preventing community transmission is all that is required now.

Here comes Corona

COVID-19, now officially called SARS-CoV-2 is a single stranded RNA virus which is close relative of some Bat Coronaviruses like SARS  (severe acute respiratory syndrome)  and distant relative of MERS ( Middle East Respiratory Syndrome virus). So it mainly causes infection in animals specially bats. But in Wuhan city of China from where this Pandemic started in December 2019, a seafood Market which was handling live bats, animal to human infection occurred (anthropo-zoonosis). Reports say that this time, infection travelled from bats to civets and pangolins, and from them to humans. (Journal of Medical Virology, https://doi.org/10.1002/jmv.25726)

How it spreads?

Human-to-human transmission occurs by droplets from infected person to others during coughing, sneezing, and even talking. Droplets usually don’t travel beyond 6 feet / 2 mtrs, so practice maintaining this distance while interacting with people. These droplets when fall on surfaces like door handle, tables, files, keyboards, they can lead to fomite infection. If you touch these surfaces and then touch your face, you may transmit it to you. Note that face has mucosal surfaces like Eyes, mouth, and Nose. Mucosa is thinner than skin, so virus infects mucosa rather than skin. This virus survives for different durations on Different surfaces. Thankfully it there is not much risk of aerosol infection for general public. It only occurs when procedures like Tracheal intubation etc. are done by doctors. So medical staff is at risk for such mode of infection, not others.

How Dangerous is this Corona virus?

Let’s understand this by comparing Coronavirus with SARS and MERS, the two previous similar large scale outbreaks. Corona virus spreads faster than these two, but it’s case fatality rate (i.e. number of deaths it causes among infected patients) is much lower than them. Corona spread from single city of Wuhan to entire China in just 30 days. SARS in 2002-03 infected only around 8000 people before being contained in 2004. MERS which first originated in Saudi Arabia in 2012 took 8 years to infect around 2500 people. According to one study, to infect 1000 people MERS took 2.5 years, SARS took 130 days, Corona takes 48 days !! While SARS killed 10% of infected people,  MERS killed 35% of them, this Corona virus kills just 2.2% on average.

(https://www.weforum.org/agenda/2020/02/comparing-outbreaks-coronavirus-mers-sars-health-epidemic/). 

But then, the number of deaths are much much higher by new Coronavirus, because it spreads rapidly and 80% symptoms mostly remain vague and mild until you feel the need to see a doctor. So, as compared to SARS and MERS, I personally think this new Coronavirus needs us to be more precautionary!!

This virus can present symptoms from 2 to 14 days of getting infection. The median incubation period is 5.1 days. So that means you can develop Fever,  cough, cold, headache, difficulty in breathing within 4-5 days of getting infection. However bad news is that in three cases it has been reported that symptoms occurred 19, 24, and 27 days after infection. So as of now maximum incubation period is 27 days. Further there are still studies going on, to gauge severity of transmission by Silent Covid-19 cases, which never develop symptoms but carry the infection and hence spread it silently.

When you actually need  to raise alarm?

You don’t need to see a Doctor until you have one or more of these---

1) Foreign travel recently, especially in high cases countries like China, Italy, Spain etc.

2) Close contact with infected person or people who have returned from foreign visits.

3) If you are traced by medical authorities retrospectively, because some infected person has come in your contact unintentionally and unknowingly. For example, the case of a person in Noida, who travelled in Metro train, unaware of his infection status, which got confirmed later only. This is called Contact-Tracing. If you are traced to be in contact with some infected person, by any chance, then you will be asked to be in Self-isolation for at least 14 days. Ideally all contacts so traced should be checked for symptoms and tested for virus by RT- PCR. But due to limited capacity and resource crunch, self isolation is requested. But one request- don’t do self medication during self isolation, as some medicines are known to worsen certain epidemics.

For details about symptoms one can read this-https://www.webmd.com/lung/news/20200310/know-the-symptoms-of-covid19

Quarantine and Isolation…..

There were news that people are panicking over news of being quarantined and Isolated. I think it’s time to dispel the misunderstandings. These are not monsters! Nobody gets killed by bullets as shown in Hollywood movie- “Quarantine”. That happens only in movies ( and in …..)

1) Isolation separates sick people with a contagious disease from people who are not sick.

2) Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

So in hospitals there are isolation wards for already infected and diseased patients. While at airports and near other entry points like land-borders , apparently healthy looking, incoming persons are quarantined.

 So quarantine simply means you won’t be able to go freely in public for specific number of days. Usually you will be kept in some designated areas with all facilities needed for normal living like good food, hygienic wash area etc. India has created temporary quarantine areas with hotel-like facilities for persons coming from some high risk countries. So during quarantine you are under observation of a medical team for symptoms of disease and otherwise you live normal life with restrictions on moving out and roaming freely in the Country. It’s nothing like if you develop disease you will be shot! Rather if you develop symptoms and test positive you will be shifted to hospital and if you don’t develop any symptoms and test negative for 14 days in the instant case, you will be released from quarantine and you can have your full freedom!

The Do's and Don’ts……

Self isolation and social distancing is best these days. You can obviously give birthday wishes over phone instead of going to birthday parties these days. One should avoid unnecessary travel and unnecessary social gatherings. Avoid public places, avoid public transport, maintain 6ft distance in public, if possible.

Wear masks if you go out. Masks like the rectangular disposable ones are sufficient for droplet infection. The N-95 respirator is needed for preventing aerosol mode of infection. Respirators are slightly different from masks. Respirators allow you to breath only smaller sized molecules and filter out bigger sized molecules.

Cover your face while coughing and sneezing. Use sanitizer frequently (but don’t get obsessed). After coming back to home, wash hands first, then remove masks and outer Clothing, put them in wash-bin to wash (as clothes may carry droplets and virus particles), wash face and hands again.

I think, I don’t need to tell that, you are not supposed to go on family holiday trip given that schools and colleges are closed and work from home instructions have been given.

There’s no objective relationship with corona infection and eating Non-Veg food, but cook it properly. Take proper sleep. Even Gyms should be avoided. You can obviously go on running with masks in limited space avoiding crowd. The idea is to avoid person to person close contact.

When should you consider yourself at high-risk of getting infection or having higher mortality rate?

1) Persons with lower immunity- Diabetic, Hypertensive patients or other Chronic mental or physical disorders

2) Old age people. Coronavirus mainly infects  persons in the age group 30-79.

3) Pregnant women

4) Persons on medicines which affect the immune systems.

(American Journal of Respiratory and Critical care medicine,  https://doi.org/10.1164/rccm.2014P7)

What tests are done for Corona virus?

Frankly speaking this information is just for those who are curious. You may ignore this part, because it has some technical terminologies. For virus confirmation, real time RT-PCR is done from samples from back of throat (it’s not even a blood test, so no need to panic and that’s confirmatory test) . Currently in India only government labs were allowed to test. But recently ICMR has allowed private labs too. For chest symptoms, since chest X RAY can’t always detect the opacities, so CT Scan is better. ( American journal of Roentgenology,  https://www.ajronline.org/journal/ajr)   

 Further WBCs go down in blood test, called Leukopenia. Liver function test (LFT) may get deranged and elevated.

About treatment of Coronavirus-

As of now no FDA approved medicine or Vaccine is available. Mainly Symptomatic treatment is being offered in hospitals like Saline Drip, Anti-Pyretics, Oxygen etc.

Situation is not that bad. If symptoms are quite severe, doctors are trying some Anti-Viral drugs. There have been reports that doctors used some drugs with success, on corona-infected patients. These are Anti-HIV drugs like Ritonavir, Another drug is Remdesivir, originally developed for Ebola virus. China has approved Favilavir another anti-virus for treating Corona. The Vaccine mRNA 1273 has started human trials but still it will take another 1 year to come in market because there are 5-6 phases of vaccine development. Similarly other antivirual drugs are being tried by hit-and -trial method on serious patients. However, among these dark clouds, many patients are recovering from Corona virus in India, as silver linings!!

After reading extensively the published materials about corona, it can be said that it is too early to predict the period of this on going pandemic, before it can be effectively contained. It may continue to be at the present level in the near future. I will be writing another blog as and when I find something further relevant.

(To be contd..)

Regards,

Dr. Priyanka Singh

MBBS, MD (Dermatology, Safdarjung hospital, Delhi)

IRS IT, 2018 Batch.