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Monday, May 17, 2021

How to defeat the virus and build a COVID-free India

We need to be strong and resilient. Fatigue can't be an excuse.

Written by Shashank R Joshi |
Updated: April 10, 2021 8:56:00 am
A health workers takes a swab sample for Covid-19 testing (File Photo)

One of the smallest accidental wildlife viruses has spiralled and disrupted the planet and India is no exception. Unfortunately, after our first wave with multiple peaks, which varied according to time, mobility, population density and migration, argumentative Indians still want to rebel against the virus. It’s time we all came together to fight the sinister ravages of this tricky ever-changing RNA virus, which is slow mutating compared to its flu counterparts, but leaves a bad aftermath.

Once our first wave abated, everyone thought COVID-19 had departed and we faltered by letting down our guard in terms of masking and adherence to COVID-appropriate behaviour. This was boosted by a false confidence due to lower number of cases and fatalities. Large gatherings suddenly sprang up, and with the vaccine coming in, people got carried away. The COVID-19 virus battle is much more in the mind than in the body. A strong and resilient, strict and firm mindset is needed, not a rebellious, revengeful, reckless and careless one. Fatigue can’t be an excuse either, neither can self-confidence. India has enough masks, which is still the strongest vaccine, independent of the variants that may emerge.

The second surge started very subtly from small, less exposed population clusters in some districts from where it has rapidly spread to the rest of India. Clearly, in the second wave, we are seeing a more transmissible strain, possibly less virulent. It is a work in progress for genomic scientists and public health experts to delineate if it’s an imported strain from the UK, South Africa or Brazil or a home-grown mutant. Public health policing will still be the same but due to its rapid spread, possible evasion of RT-PCR testing or immune escape, it can have serious implications in the long run and we need to generate some high quality science data to understand this.

The current second wave pattern shows large clusters of invisible or asymptomatic COVID-19 cases which are in the community and which need to be contained. The symptoms of fever, dry cough, breathlessness are still very much around but lack of smell or taste, diarrhoea and others have crept up. COVID-19’s changing colours and unpredictable nature makes it difficult to recognise red flags for determining deterioration. The simplest and easiest test is to measure the oxygen saturation on a simple pulse oximeter and after a 6-minute walk record the reading — if it is below 94 per cent or shows a fall of 3 per cent you need to contact a health care facility and provider to seek oxygen, steroid and supervised care. Most asymptomatic cases or mild cases need to be vigilant, especially in the second week, as they suddenly get the “happy” hypoxia and worsen.

Clearly, we need to focus on saving lives and, without panic, organising digitally or physically supervised medical health care. Our health care facilities need to triage the most deserving cases and avoid asymptomatic or mild symptomatic cases in hospitals so we can keep beds for the most deserving cases. COVID-19 care is about close monitoring, right timing of the right medicine, prone position with breathing exercises including pranayama, oxygen and steroids in the moderate to severe cases under supervision. Most treatments like plasma, Remdesivir or others either don’t work or at best improve recovery by a day or two but don’t save lives. Every COVID-19 case should remember it’s a two-week time-table and be rested for at least two to three weeks based on medical advice.

We have unfortunately an overload of information that is not peer reviewed and misleading. Simple life-style measures like eating on time, eating slowly, eating right with exercises, adequate sleep and positive thinking contribute immensely to COVID-19 recovery. In pandemic times, we need to use our resources judiciously as our labs and radiology systems are overwhelmed just like our hospitals and staff. So test under appropriate advice and don’t panic on reports, but take prudent action under advice. Timing is crucial so that there is no delay in red flagging the serious cases.

The vaccine is the new mantra after COVID-appropriate behaviour of mask, distancing and sanitising. The vaccine’s primary goal is to protect the most vulnerable from death and severe diseases. These are all first generation rapidly developed vaccines which are all in research mode. All vaccines are safe, except a few contra-indications which your doctor will identify, like anaphylaxis. India is the vaccine pharmacy of the world and has developed some high-quality vaccines which are homegrown, some that are yet to become available. India led the world in polio and small pox and will do so in COVID-19 too. We should be proud of Indian science and the teams which have made this possible. India is part of the global alliance for vaccines and deserves congratulations for rising above vaccine nationalism by exporting them and fulfilling its global obligations.

We need to vaccinate all vulnerable groups which can succumb to COVID-19 independent of age, but we must also follow vaccine discipline. Our vaccine approach is calibrated, but soon will become more open and inclusive. The current focus is on saving the lives of the most vulnerable. We may need to innovate strategies to vaccinate, like using family doctors or paediatricians’ clinics or mobile vans or vaccine camps as well as avoid wastage by including exceptions in a mindful way.

Vaccines confer protection from disease but not necessarily infection. So post vaccine, even after full doses, we need to mask, avoid crowds and poorly ventilated spaces, distance and sanitise. We shouldn’t unmask while speaking, try to avoid crowds when eating. We need to use safer masking strategies like doubling up, using mask braces, ensuring that it is tight and well fitting. There has to be zero tolerance for violators of COVID norms, behaviour and protocols and we need to have a single-minded determination to conquer this nasty virus. We need to clear the virus from our environment using mind and body strategies and build a strong COVID-free India.

This column first appeared in the print edition on April 10, 2021 under the title ‘Outflanking the virus’. The writer is consultant endocrinologist, Lilavati Hospital, and member Covid-19 Task Force, Maharashtra. He was awarded the Padma Shri in 2014.

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