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This article is written for the benefit of my fellow Naga followers and well-wishers. Despite sufferings endured by people because of lockdown, till now, the lockdown period has contributed to containing the spread of the pandemic in India. The lockdown 1.0 – 3.0 in effect created an invisible barrier that has shielded people from the virus. Though we continue to see alarming spikes in the rise of Covid-19 cases, it could have been worse without the lockdown. For Nagaland in particular, lockdown period has practically given us time for preparedness. The government, the medical department and the other frontline workers are now better prepared to face the eventuality than they were two months back. So now the remaining question is, are we as individuals, families, friend circles and community prepared to live with Covid-19? What sort of scenario are we going to face in the days to come?
Corona virus is a zoonotic virus which by mutation became pathogenic to humans. Coronavirus caused an epidemic of flu-like disease in Wuhan district of China in December 2019 that soon spread to numerous countries. Covid-19 is the name given to this highly contagious disease. It is spread through droplets. Medical science is in the process of learning more details of the disease. A per information available, in the majority of the cases, the infection is characterised by manifestation with minor symptoms. However, in 20-30 % of the case, a moderate to severe kind of immune response called ‘cytokine storm’ is seen where there is an over release of immune cells which instead of protecting the body begins to destroy the organs particularly the lungs. The resultant complication kills anywhere between 3 – 7 % of infected people. People with concomitant illnesses referred to as comorbidities like lung diseases, diabetes, heart diseases, hypertension etc. are more severely affected. Children below 10 years and the older people above 60 years are more at risk.
Currently 215 out of 251 countries and territories have been affected by corona virus with global cases mounting to 46,79,511 and 3,15,005 people succumbing to the pandemic (as of 18th May 2020). WHO declared Covid-19 as a public health emergency of international concern on 30th January 2020 and belatedly on 11th March; it declared Covid-19 as a pandemic of global health concern. India reported its first case in Kerala on 30th January 2020 and within a short span of a little more than 3½ months the figure has crossed 1 lakh landmark. Worldwide, the pandemic has caused an unprecedented dip in the economy. This is the gravity of the situation! All stakeholders must, therefore, share responsibility in rebuilding our economy.
For Nagaland, samples sent so far have returned negative but we have to be realistic, Covid-19 is here to stay for a long time and unless we are shielded by continued God’s grace, eventually Covid-19 will also come to Nagaland by import. When, even the well-developed countries with state of the art medical facilities can suffer unprecedented toll, what can happen to us with rudimentary healthcare services and high agrarian population? Therefore, all of us must make an effort in protecting ourselves from Covid-19. Let us keep in mind that, till such times a significant community immunity develops or vaccine against Covid-19 comes by, the people at large will still be in danger of acquiring infection. The only weapon we have at hand is to protect ourselves by adopting safe practices.
Thanks to the advances in information technology & communication and also the availability of cheap multimedia mobiles phones, every household must have come to know about preventive aspects of Covid-19 and the various dos and don’ts widely circulated through the numerous Govt. circulars/notices and guidelines. So, here I will dwell only on how to cope with Covid-19 infection and will mostly use narrative words. Though, I am no longer a clinician, my medical education and research here and there will be my source of information for my readers.
These are the two most important tools for prevention of droplet infections. We now know that, Covid-19 is spread through droplets. If you have seen a person speaking during dead winter throwing out fogging air exhaled while speaking, then you will appreciate why social distancing is important. If you can imagine the speed with which droplets can be thrown while coughing or sneezing, you will agree with me that even one-meter social distancing is not enough. Coughing sends out exhaled air at a forced speed of 100 Kmph and sneezing at 150 Kmph. A single cough can generate about 3000 droplets and a sneeze up to 1,00,000 droplets. One may need to increase the social distance from people with flu symptoms and cough. Use of mask though essential, is often a little exaggerated and there seems to be hype for N-95 and surgical masks. Unless you work in the contaminated zones or caring for Covid-19 patient, I would say that is unnecessary, even a simple home woven mask will do for the situation of social contacts primary aim is to prevent inhalation infected droplets. A three-layer mask may be necessary if you are handling a person with contact or travel history or one that is under quarantine. Beware of wearing masks with valves. They are not advisable since they are designed to allow free flow of air out. You will be putting people at risk if you have Covid-19. Use of masks is not advisable during exercise, as your inhalation of air may not be able to meet your increased oxygen associated with your exercise. Fitness centres should maintain a larger distance between clients as the air breath out during exercise covers more distance. Social distancing and use of mask will have to continue even after lockdown. Avoid close contact games and sports for the time being. Unfortunately, even during the lockdown period, significant numbers of people did not observe social distancing and wearing of masks. People will have to be habituated in maintaining social distance and wearing of masks till such time experts give a green signal that we can do away with the habits. Unfortunately for a long period of time, we will have to re-define our social habits.
Proper respiratory and hand hygiene should continue and be followed religiously. Learning proper handwashing technique is important. Remember my mnemonic WASH given below.
•Wash hands with soap and water frequently and properly.
•Avoid touching mouth, nose and eyes.
•Sneeze/cough into a flexed elbow or tissue paper/handkerchief and dispose of properly.
•Habituate not to spit in public areas.
Mass gatherings/religious gatherings will continue to be a big concern for some time. People will have to will themselves to follow the instruction given by the Government from time to time. Even without one also, mass based community leaders and religious leaders will have to keep themselves informed of the nature of medical emergency we are dealing with and act accordingly. The congregation, if allowed, should observe social distancing. Perhaps as a start-up, one follower per household gathering may offer a solution who then can share the message with the households. In any place of human gatherings, objects frequently touched by hands e.g. doorknobs and handle, railings and any other handles must be sanitized with alcohol-based sanitizers. Imagination can be expanded for areas to be covered.
CBOs, RBOs, e.g., Tribal bodies Churches, Unions and Councils will have to continue to be proactive stakeholders forming the essential volunteering and breaching the gap between the authority and the people. A committee on Covid-19 in all such organizations may be called for roping in the advice of medical personnel within their set up if possible. They must see to it that the right information is reached out to the people and that people do not panic and take ill-informed decisions which was seen in certain areas during the lockdown. They must also sensitise the people to appreciate the sacrifices the frontline workers make. They must also help protect the children and older people since they are vulnerable. While advocating necessary precautions, the mass-based organization should also see to it that no stigmatisation of any person occurs. Since Covid-19 is spread through droplets, much of the danger is resolved when the patients cease respiration on death. However, dead bodies will be well sanitized before handing over to their relatives. The mass-based organization must see to it that no Covid-19 dead is humiliated and that they are given dignified burial/cremation. I must leave a personal note here; I am concerned about pre-prepared stack burial system seen in some of our society and whether such system of burial is advisable since at this point of time we don’t have a full understanding of novel coronavirus that causes Covid-19. I would feel that a six feet deep burial with concrete cementing should suffice. For burial in the soil only, deep burial with a depth of 12 feet may be advisable as is done in other countries.
Quarantine is a process of herding people who have exposed to infection into an enclosure until a safe period is reached. Such people should in fact volunteer to be quarantined for the love their near and dear ones knowing that the little inconvenience taken by them will protect them. Persons requiring quarantine should meticulously follow proclaimed standard operating procedure (SOP) or instruction. Inmates will also have to understand that it is for their well-being as their health can be monitored by medical personnel and will be provided early medical care should the need arise. Quarantine process will continue as long as an epidemic danger persists. The social distancing between inmates is critically important and must be stressed. A three-layered mask must be provided. Different batches of quarantined people must not be mixed together.
Stage 1: Imported cases only. No local cases.
Stage 2: Infection of close contacts of positive cases. Source of infection is known.
Stage 3: Community transmission occurs. Source of infection is not traceable.
Stage 4: The infection takes epidemic form and difficult to control.
I would like to add a stage here. Stage Zero. Nagaland can be said to be in stage zero at this point. In the unfortunate event of some of our returnees testing positive for Covid-19, authorities must see to it that the infection is contained at stage 1. As stages 3 & 4 are separated by just hairline fence, we must by any means prevent stage 3 from happening. It will need a united approach from all of us.
Foremost thing is to consult your doctor if you think you have Covid-19 for any reason or you have travel or contact history. It is important that you do not panic; more chances are that you will fare well and recover. Covid-19 is tested by taking throat and nasal swab. All district Hospital in the state has been converted into Covid-19 Hospitals. It must be remembered that people who have contact or travel history from a Covid-19 zone is the one at risk. What may come your way if you are Covid-19 positive may be just simple ailment to nasty flu or life-threatening respiratory complications. Common symptoms may range fever, dry cough and breathlessness of varying degree. Less common symptoms include chills, sore throat, headache, body ache and loss of taste. Chances are that you may only have a simple flu-like ailment and recover in 2 weeks (70-80 % of cases). A lot may depend on your prior health condition. Once you are tested positive have a thorough check-up even if you are not symptomatic. Remember that a Covid-19 positive can be symptomless even up to four weeks and one can be infective to others before appearance of symptoms. Here are some tips when visiting a doctor -
•Get information from official websites and helplines. Take time to properly read health advisory. Ask for one from your healthcare worker if you don’t have one.
•Social distancing, wearing of mask and hand sanitisation is mandatory.
•Your accompanying person may not be allowed inside the consultation chamber.
•Give proper travel history.
•Disclose contact history if you think you have come into contact with a covid-19 suspect or case.
•Do not hide any comorbidity if you have one.
•Give details of the medication you are under if any.
•If symptomatic give clear details of your complaints. Given the account of any increasing severity of any symptoms that you might have noticed.
•Have trust in your attending physician. They are functioning on a similar standard protocol followed throughout the country.
If you are Covid-19 positive and do not yet have complaints, you may be said to be in the pre-symptomatic phase. Your doctor may advise a home treatment plan.
•Remember you can be infective to others before symptoms appear.
•Stay in a well-ventilated single room with attached bathroom.
•Do not associate with family members till you are advised that it’s okay. Wear three-layered masks. Social distancing is mandatory even among family members.
•Deep breathing exercise and meditation will help and non-strenuous exercise is also advised.
•Sleep properly, at least 8 hours. Utilise the waking period with some creative things that you can do inside your room. Read light books and magazines. Keep in touch with the world.
•Maintain hydration by drinking at least 2 litres of fluid. Eat lots of vegetables and fruits.
•Take your meals with spoon and fork, washed and kept inside your room. Wash your hands before you receive your food. Do not touch utensils and cutleries with your hands. Wash your spoon and fork after meals and keep aside for future use. The family may provide food on a platter that needs no touch or opening. Use proper technique and time for hand washing and disinfection of cutleries. Your healthcare worker will guide you on this.
•All linen and clothes must be disinfected before washing. Consult your health care provider how to go about.
•You may have some first aid medication ready. Paracetamol tablets and decongestant Vicks Vaporub may come in handy.
•If you feel depressed, request for a counsellor. He/she can help ease your tension.
As mentioned majority of the cases will have only minor symptoms. If you fall under this class and are mildly symptomatic, your doctor may allow you to get home treatment. Home treatment will include all the advisory given above for pre-symptomatic Covid-19 cases. In addition, your doctor will give you symptomatic treatment. On advice of your doctor you may take paracetamol tablets for your fever and body aches, expectorants for your cough and vitamins to boost you up. Steam inhalation with a dash of Vick Vaporub may help if you have congestion. Do deep breathing exercise time to time and maintain good hydration. You should be on your way to recovery with this simple symptomatic treatment. But, remember that up to 10 days after symptoms appear is the most infective period. Take care also that you do not pass on the infection to others. Some 20 to 30% of Covid-19 positive cases will develop symptoms of varying degree of moderate to severe illness. You may need hospitalisation if you have the following.
• High-grade fever.
• Difficulty in breathing.
• Persistent pain or pressure in the chest.
• Blue lips or face.
• Confusion.
• Excessive drowsiness.
Remember to keep up your good continence. Will yourself to fight and defeatCovid-19 both in flesh and spirit. Tell yourself that you are going to get well, come what may! When you develop these positive attitude, your body will also start releasing healing hormones with in effect will also cause a decrease in hormones causing depression.
It is not yet documented that pregnant women are at increased risk of Covid-19 infection. It is also not proven that there can be a mother to child transmission. According to present understanding, pregnant women are considered to be at equal risks as the general population. However, mother to child transmission can occur after childbirth. Therefore, women intending to impark on pregnancy or are pregnant should take extra care. Take advice from your doctor regarding breast feeding. Children below 10 years and elders above 60 years are vulnerable groups of people. Every effort must be made to protect them. They should desist from socialising and avoid contact with people for the time being.
Dr.ChumbenMurry MLA; 38 Wokha
A/C chumbenmurry@rediffmail.com