Trying out something new(ish)…COVID-19

It was never a surprise for anyone close to me that writing is my biggest passion. Yet I’ve been finding so little time to scribble down my thoughts, plus being stuck in Patna is driving me crazy. Yes…this Calcuttan is in Patna now. For the last 2.5 years. In January 2019 I got postgraduate residency at AIIMS Patna in the department of Community and Family Medicine. Many people have asked me what this stream means. I had a lot of difficulty explaining it to them, until COVID-19 got unleashed upon the world. Believe me, I never planned to write about my profession or COVID in my blog, but things seldom go according to plan. So here I am.

The count increases…determining Epidemiology of a disease

Community Medicine is the branch of medical science which deals with the health and related problems of the community as a whole rather than an individual’s. Certain problems like maternal health and nutrition, a disease endemic to a region (such as Kala Azar in Bihar or Japanese Encephalitis in North Bengal), environmental protection of water and air, vaccination to control and eliminate preventable diseases from society and plenty others need to be dealt with as a community medicine expert. Sometimes, they are also called Public Health expert. And one of the toughest jobs to do in this stream is to identify outbreaks, determine its geography and trend, tracing spread of the disease and subsequent actions to control the situation. That is what COVID-19 has forced every one of us to do since the start of 2020. Although, now it’s a pandemic, and it will go through its course, mutate and finally settle down in due course of time. That ‘course of time’ is for now uncertain.

COVID-19 virus

As a Community Medicine Resident, it is now imperative that certain measures are taken immediately to mitigate certain common misconceptions and notions. Misinformation pandemic has spread as much as COVID, maybe even more. Sitting in this cool 1 bhk hostel room, within the safe confines of this barren campus, one would think it’s much easier said than done. What about those who have to go out everyday for their daily wage? What about them who have lost their family members, their jobs and homes, those who cannot afford to give the public health problem priority in their lives right now?

But if you want to survive the pandemonium of this pandemic , there are a few precautions you should abide by, for your and your family’s safety. As a community medicine resident, it is my duty to keep the community informed.

1. Wear mask. Whenever you go out.

A N-95 mask works best. Even if you don’t have access to it, doubling up with a surgical and a cloth mask stops the transmission of more than 70% of particles. Because COVID is a disease spread by respiratory droplets, and NOT AIRBORNE, masking up is enough to stop the spread. Without this first and foremost step, you cannot break the chain of transmission of the virus. And there is no telling what COVID will do to you once you contract it through your nose or mouth.

2. Maintain Social Distancing and Cough Etiquette

Always cough or sneeze into your elbow or your handkerchief or tissues and keep in mind to maintain a safe 6 feet distance from others. This are necessary steps in dire times. Respiratory droplets can travel a maximum of 6 feet till it drops down through air and gets deposited on a surface. In a closed environment, this is even more prudent because the droplets might keep on circulating and with them, the virus. Keep a mask on also when in close proximity with other people.

A not recommended situation, being so close to others in pandemic times.

3. Get tested when you have symptoms!

Especially with history of being close to a COVID positive person. Testing is preferred with the RT-PCR test, but if you don’t have such facility near you, go for a Rapid Antigen which gives result in 30 minutes. Although it’s false negative rate is about 55%, meaning you might be falsely declared as COVID negative even if you have the virus multiplying in your nose and throat. So upon being negative, do not think you can go mask free. In fact you cannot think that ever during this pandemic. But if available, always go for RT-PCR. It is the most reliable test with highest diagnostic ability and takes about 6 hours. Most people have a confusion about the significance of the CT value in the RT-PCR report.

4. Follow proper management protocol and go to a doctor.

When you become positive but have no symptoms, there is no need to worry except for the fact that you can spread to others. So isolate yourself and always wear an N95 mask in home also. Keep separate from everyone in your own room and use a separate bathroom if possible.

If you do have mild symptoms, you should only stick to symptomatic treatment and not take Vitamin C, D or E or Zinc. You should also not take any antibiotics or antivirals, as their indiscriminate overuse may bring about new complications which might be not so easily manageable. A burning example nowadays is Mucormycosis or the infamous “Black fungus” which is an opportunistic infection spreading due to irrational use of steroids. In mild disease, oral steroid tablet should be used only when fever with or without cough is worsening over 7 days.

All the while, keep checking your oxygen level with a saturation probe and whether it remains above 90%. If it dips below 90%, then oxygen therapy is definitely needed, even if difficulty in breathing is not there (such a situation is known as Happy Hypoxia). Arrange a oxygen cylinder or rush to the hospital in such a case, because if correct intervention is not provided, the situation might worsen. Another thing to remember is Remdesivir, Tocilizumab, Plasma therapy are not at all magic bullets that could save you in Moderate or severe covid. So do not hoard them or run frantically searching for them if not available.

Management of mild patient
Management of moderate and severe patients of COVID is mainly by oxygen support through appropriate devices, low molecular weight heparin and steroid therapy.
RECOVERY trial results show no significant result in plasma therapy

5. Avoid crowded places, festivals, celebrations and travelling.

I know it is a difficult time for everybody. To be alone at home all the time, sometimes away from family and not able to go to school or work. We crave for social connection, long for face to face communication. But COVID can break bread if you give in to your desires. You will be here two years from now, COVID won’t. So bear with it a bit more. This will pass. No matter how tempting that invitation to the party or wedding is, kindly decline. Do not go out and travel. You never know when you will contract the disease and spread it to others. Bear a little more, let the pandemic end, or at least let the situation be in control till you go out partying with your friends and family. Patience pays.

Try to avoid long drives in convertibles!

Just follow these 5 precautions and I promise you will pass through the pandemic with flying colours. Ache din aane wale hai! I would be remiss if I didn’t mention my friends from Medicine and Anaesthesia who gave me much needed information and understanding on the management part of this post. I appeal to the enlightening part of you all…be safe, be secure, do not be stupid. Stupidity can cost you your life, or worse, someone close to you.

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