As the Covid-19 pandemic enters its ninth month, even today, the coronavirus is predictably unpredictable, both in its virology and the human immune system response it evokes. India has rapidly peaked at more than three million cases, though the disease has been asymptomatic or mild in most cases. Most Indians have recovered due to their strong immunity but there is no letting our guard down. In the most vulnerable sections of our population, namely the elderly or those with comorbidities like diabetes or hypertension, strict vigil must be kept. India has lower case fatality and better recovery rates. Independent of all the advances in the medical treatment of Covid, which include access to the latest antivirals, steroids or immunologics, plasma, nasal oxygen in prone position as well as advanced critical care facilities, for the most needy we still need to close the tap at the base of the pandemic, which is to break the chain of transmission.
“In order to break the chain of transmission and close the Covid-19 tap the only way to close it is to have an alert, well-behaved citizen with a hyper-vigilant public health system in each city, town and village of one of the most densely populated countries on Planet Earth. “
In order to close the Covid-19 tap, at the first suspicion of disease, we need to aggressively test, test and test. The test has to preferably be the RT-PCR (which can still be negative in 30 per cent of the cases) but it usually takes a day before results are available. The rapid antigen test is good to detect and diagnose Covid in few hours but unfortunately, a negative test must merit an RT-PCR test or a close follow-up with isolation till we prove that the suspected case will not progress into Covid-19.
Sometimes, fear and panic make people bypass testing, which is irresponsible, and they often get a CT scan of the chest or are not forthcoming about their symptoms. Every human must self-protect and protect all their near and dear ones they are in contact with when they suspect they have symptoms. Self-protection and Covid-appropriate behaviour is the key, so please isolate and contact your medical doctor immediately.
The biggest challenge is posed by asymptomatic carriers -- often, children and the younger generation -- who must ensure that they 'SMS' all the time -- Sanitisation, Masking and Social Distancing. Avoiding crowed clusters and poorly ventilated spaces is the key. At eateries, one tends to unmask while eating and in public places, this poses a risk which everyone must be aware of and be careful with. Toilets, especially in public and office spaces, are another focal point of transmission. So everyone has to take care of themselves in Covid times, as we unlock gradually.
But to close the tap, mere testing and Covid-appropriate behaviour is not enough. We need a hyper-vigilant public health system, which traces each and every contact of the positive case and isolates them. The only way to truly contain the virus is through aggressive tracking and tracing of every single contact and ensuring they are under supervision and testing. Often, this may mandate door-to-door surveillance. Unfortunately, this step needs people’s voluntary cooperation and participation and unless we have a popular movement, we will again fail to contain the pandemic and close the tap.
The third vital cog to close the Covid-19 tap is to isolate, isolate and isolate. Isolation is the next key step, where home or institutional care are the options. Most can home-isolate and self-protect if they are below 55 years and do not have comorbidities and remain in constant connect with their doctor. All asymptomatic Covid cases that home-isolate must be very careful for 14 days as in the second week, often they can suddenly deteriorate due to happy hypoxia. Every home-isolated case should have a separate room with a toilet, 24/7 connectivity with a medical or healthcare provider and a simple pulse oxygen monitor. If twice a day, under medical clearance, a six-minute walk test is done and the oxygen saturation does not drop below three percent or below 94 per cent it’s okay. However, if the person gets breathless or symptomatic or the oxygen saturation drops then you need to rush to an oxygen health care facility or hospital.
This pandemic has told us, our VVIPs are our senior citizens and people living with comorbidities and chronic illnesses, who need maximum care and attention. But at the same time, we cannot lose focus on the youth or children either, as occasionally, they too can contract the disease or become potential spreaders or super-spreaders.
The Covid-19 tap can only be closed by dual participation of both, our population and our public health system working as one team for one India. The key is aggressive testing, tracing with tracking and isolation, apart from prompt treatment and care for those who need it. Equally important is to avoid crowded spaces, poorly ventilated environments and ensure we mask, with strict distancing and hygiene.
Remember, your health is in your own hands. It’s time to protect ourselves and others, with the new mantra -- 'Covid-appropriate behaviour', of masking, with hygiene and distance and avoiding crowds or poorly ventilated spaces.
Dr Shashank R Joshi MD, DM, FICP, FACP(USA), FACE(USA), FRCP (Lon, Glsg & Edin) (Padma Shri Awardee 2014, Chair, International Diabetes Federation Southeast Asia, Dean, Indian College of Physicians, Endocrinologist, Joshi Clinic, Lilavati Hospital, Apollo Sugar Clinic & Bhatia Hospital, President, Association of Physicians of India (API) (2014-15), Emeritus Editor, JAPI President, Indian Academy of Diabetes & Hypertension Society of India, Past-President, Endocrine Society of India(2015-16), Past President, RSSDI (Research Society for the Study of Diabetes in India 2011),Past President,AIAARO (All India Association of Advancement for Research in Obesity),Chapter Chair India AACE. Office:91-22-26402769/93210 24941