Since the pandemic is still looming all over the globe, Basheer Ahmad Dar, assistant editor, Zaanvun Lokchaar, reaches out to Dr Showkat Hussain Tali ( Showkat Shifa) MD pediatrics, DNB neonatology, and assistant professor pediatrics at Government Medical College, Anantnag, who enlightens us with the prognosis of the novel virus in the valley. In this email interview, Dr Showkat, apart from talking about the issues health workers face on daily basis while fighting the pandemic, walks us throw the impact COVID-19 could have on the children, pregnant ladies, and lactating mothers.
Q. Dr Saeb, thank you for taking time for this interview. Please tell us what is COVID-19?
Ans. You are welcome. COVID-19 is an illness caused by novel coronavirus now referred to as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). COVID stands for coronavirus disease and 19 indicated the year in which it was detected first.
Q. How did it start and why is it spreading so quickly?
Ans. It was first identified amid an outbreak of respiratory illness cases in Wuhan city, Hubei Province, China. It was first reported to WHO on 31 December 2019, and on 30 January 2020 WHO declared COVID-19 outbreak a global emergency. And finally on March 11, 2020, WHO declared COVID-19 a global pandemic.
As of 28/3/2020 (6:58 am), total number of cases who tested positive worldwide are 5,97,458. Out of these, 4, 36,715 are active, 27,370 (4.58%) have died and as many as 1,33,733 (22.32%) have recovered from the illness.
Disease is spreading in geometric progressions and each case on an average is infecting two to three healthy individuals. There are the cases (20 percent of total) that spread the infection at a much higher rate. They are known as super spreaders. Possibly, these are the patients with extensive social contacts but the exact reason is still unknown.
Q. How does it spread in humans?
Ans. It spreads through respiratory droplets. When an infected person coughs or sneezes, these droplets can directly get deposited into the mouth, nostrils or eyes of healthy persons. A person can catch the disease by touching a surface that is contaminated with these droplets and then without washing or disinfecting hands touches mouth, nose or eyes. There is a possibility that virus can spread through stools as well. Cleaning hands properly after going to toilet cannot be left unstressed.
Q. Can infection get transmitted from an apparently healthy but infected person to others?
Ans. Infection is generally transmitted from a symptomatic person to healthy ones but transmission even before the onset of symptoms is quite possible, too. When infected, a person becomes symptomatic after 2 to 14 days of contact. And if no symptoms occur within 14 days of contact, person is considered uninfected and non-infective.
Q. What is low and high risk exposure?
Ans. Low risk exposure is:
1. Remaining in a closed environment with an infected person for less than 15 minutes or more at more than two meters distance.
2. Face to face contact with an infected person for less than 15 minutes and at a distance of less than two meters.
3. Travelling together in any convenience.
High risk exposure is:
1. Not meeting the low risk exposure criteria.
2. A household contact of infected person or direct contact with an infected person or direct contact with infected secretions.
3. A contact in an aircraft within two seats in each direction of a COVID-19 patient: travel companions of the patient and crew members serving the section. If severity of the disease or movement of the index case indicate more extensive exposure, all the passengers on the air craft may be considered as close high risk contacts.
Q. Are children vulnerable to it? If yes, to what extent and what are the symptoms?
Ans. Children are not immune to COVID-19 infection but they don’t develop a severe disease. Babies with acquired or congenital diseases have been found to be more susceptible to infection. The good thing, however, about the pediatric COVID-19 is that mortality rate is extremely low as compared to the other age groups. However infected children, especially when symptomatic, are a source of infection to others.
Fever, cough and respiratory difficulty are the symptoms in pediatric age group. However, as many as 40 percent may not develop fever. Besides, respiratory tract infections other than COVID-19, are so common in pediatric age group that the parents often get unnecessarily alarmed. Earlier studies have shown that only 2.5 percent children and adolescents (below19 years of age) are getting affected by the infection, and out of these only 2.5 percent develop any severe disease (termed by WHO as insignificant).
Q. How do we distinguish COVID-19 symptoms from seasonal flu, and when is the right time to go for a screening test?
Ans. It is not that easy. Generally, it is said that when you have a running nose or wet cough, you are not infected with COVID-19. But it is not worth the risk. And the problem is compounded when you have dry cough, fever and dry nose. So best is to follow thoughtfully designed guidelines and a scoring system for the same.
Travel history and contact with a COVID-19 confirmed case gets a score of three each. Fever (or myalgia), dry cough, shortness of breath, history of similar complaints in a family member/friend or working in health care facility are given a score of one each. But it does not mean that clinical acumen has no role. It is the sufficiently trained health care worker who will decide whether to send a person for COVID-19 screening or not. Our duty is to report to the health care facility if score is more than three.
Q. Are saline gargles anyway meaningful in case we experience sore throat?
Ans. Saline gargles are helpful for sore throat. Warm saline gargles may be beneficial in COVID-19 infection confined to oropharynx, theoretically speaking, but the evidence for the same is lacking.
Q. Does the intake of Vitamin C supplements enhance immunity and help us develop resistance against the virus?
Ans. Theoretically Vitamin C intake may be beneficial but not a proven preventive measure. There is no harm in taking it but it is dangerous not to follow the social distancing, which is a proven preventive measure, for want of getting Vitamin C from the market.
Q. Should we encourage children to use hand sanitizers and alcohol-based sprits?
Ans. Like adults, children should also practice all the measures that have proved to prevent COVID-19 virus transmission. Social distancing, regular hand washing, and using hand sanitizers when needed should be encouraged. At home, hand washing may be a better option as far as availability, accessibility, feasibility, affordability and safety issues are concerned.
Q. Does it pose any pregnancy related risks to expecting mothers?
Ans. The evidence at hand does not suggest that pregnant women are at higher risk of contracting COVID-19 infection or a more severe form of disease as compared to general population. However, pregnant women may be given priority during testing and may be monitored more closely.
Q. Does the infection get transmitted to the babies in the womb? Should expecting mothers take extra precautions? Is there any role of cesarean section for delivery?
Ans. There is no evidence till date that suggests the infection is transmitted to the babies in the womb. Expecting mothers should take same precautions as the general population and must report the symptoms to health care workers at the earliest. Cesarean section should be done purely for obstetric indications.
Q. For lactating mothers, what are the precautions?
Ans. Even women with proven COVID-19 can breast-feed their babies while observing respiratory hygiene: Wearing facemasks, washing hands before and after touching the baby, and routinely cleaning and disinfecting the surfaces they touch. They can even share a room with their babies. But if the mother is not able to directly breast-feed the baby because of the level of sickness, she may express her milk and feed it to the baby safely.
Q. Which age group of population is more vulnerable to the infection? Do existing chronic or acute clinical conditions have any bearing on the mortality and morbidity rates?
Ans. It has been seen that people who are more than 60 years of age and with chronic medical conditions have higher mortality and morbidity rates. As per initial reports, the average age of the diseased people in Italy which has highest case fatality rate was 78.5 years. This does not mean younger and healthy people should be careless. Due to COVID-19 infection, anyone can die (though vulnerability may vary) irrespective of age or preexisting clinical conditions. In addition, they can be a source of infection and risk for the vulnerable section of the society.
The best thing that the people more than 60 years of age in general and with chronic medical conditions in particular can do for themselves and for the society is effective self-isolation till the pandemic is over.
Q. Does its incidence have to do anything with the blood group of the patients? I learnt that people with Blood Group A are at higher risk in comparison to others. Is it so?
Ans. This is an important question. Though initial reports suggest that people with blood group A are most susceptible and those with blood group O the least, this does not mean anything beyond the likelihood or probability of getting an infection. It is not a certificate of complete immunity from the disease. All irrespective of their blood group must consider themselves susceptible to infection unless proved otherwise.
Q. Are there any quarantine wards for kids in your hospital? What are the risks that it will spread among the kids at an alarming rate? What is the predictable case scenario?
Ans. At present, we don’t have any but administration is working hard to do everything possible within available resources.
Overcrowding in the hospitals, lack of adequate man power and other stock are surely considerable risk factors for the spread of infection but we cannot afford to make it an excuse for playing our part at this juncture . We must understand that we are living in a developing world; and we need to fight the infection and the fear of getting infected in our own way. What is more concerning matter is that the health care workers who are at the highest risk of contracting the infection don’t have a minimum required protective gear and PPEs. However, we are determined to fight this bug and we are hopeful that with the help of God we will make it through.
Q. Should parents be worried about the coronavirus spreading among kids?
Ans. Good news for the parents is that the new virus is quite friendly virus for the pediatric age group. They rarely suffer from severe diseases and almost always come out stronger.
Q. What is the role of lockdown and how is it going to help in long term?
Ans. Lockdown is a temporary measure and it should not be viewed as a permanent solution. Since our health care system was caught off-guard (because of our own mistakes), it would have been a disaster if some restrictions were not in place. This could give us preparation time to make alternative arrangements so that COVID-19 patient rush does not crash our already ailing health care system and create more chaos.
However, we can’t afford to go for a lockdown for a long period for multiple reasons. Firstly, ninety percent of our work force is associated with unorganized sector. Moddy, the world economy rating agency, has forecasted India’s GDP to fall to 2.5 percent and our region will have its ripple effects. Secondly, we are losing millions of our people to preventable diseases, malnutrition, and accidents every year. If we fail to address these concerns now, it will be a catastrophe for us for decades to come. Thirdly, unemployment and problems associated with it may kill us and we would not be able to address anything appropriately including healthcare and education sectors in future.
So, the best thing would be to use this already announced lockdown period for addressing the short-comings of our ailing health care system on a war footing. It is not wise to kill your own self before the pandemic actually kills you. The best possible thing would be to effectively isolate elderly and people at higher risk till the peak of pandemic is over. Home quarantine the infected and the persons suspected to have the infection, making alternate health care facilities available for COVID-19 patients, and allowing the healthy population to get immunized through natural infection in the absence of vaccine.
Q. “Our own mistakes,what do you mean by that?
Ans. For years, we have been fighting over issues that could have been resolved through dialogue or shelved for time being to address the more important issues of poverty, illiteracy and ailing health care system. Rather than wasting money in creating monuments and ripples of uneasiness in the society, hundreds of world-class healthcare facilities could have been created with lesser amount. On 30 January 2020, COVID-19 was labeled by WHO as outbreak of global concern but we wasted the preparation window period and responded by self-destroying lockdown as we were left with no better option. Past is past, but we must learn a lesson from it and must not repeat the same mistakes in the future.
Q. What is your message to all of us?
Ans. Human beings have been designed by Almighty Allah in such a way that they can win any kind of battle and can defeat any form of evil provided they apply the power of reason and carefulness and magic of faith and fearlessness. I wish you all best of luck. Stay home, stay safe. Thank you very much.
