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'When lockdown ends, we may see a surge in cases'

By VAIHAYASI PANDE DANIEL
April 17, 2020 14:44 IST
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'We really hope that people are aware that even after the lockdown, we will have to follow a lot of things that we were following during the lockdown.'
'Don't get out for non-essential things.'
'Don't gather together for parties, religious events or at religious places.'
'Ensure social distancing at work and otherwise.'
'You know, in India, it is not uncommon for people with a cough and a cold to go to work.'
'We really want people to understand that if you have a cough, cold, fever, just stay at home.'
'Don't get back to work or don't get back to school.'

IMAGE: People maintain social distance as they wait to receive food, April 16, 2020. Photograph: PTI Photo

"Just because there is going to be a slowing of cases and a decreasing number of deaths and cases across the country in the next two weeks doesn't mean that people should start thinking that: 'Oh, we won this thing, the war over corona and it's gone forever'. We know it's going to be with us for months," Dr Trupti Gilada, infectious diseases specialist at the Prince Aly Khan Hospital and the Unison Medicare and Research Centre in Mumbai, tells Rediff.com's Vaihayasi Pande Daniel in the concluding segment of a two-part interview.

 

When I was speaking to the Kerala infectious diseases specialist, Dr Anup R Warrier, he was telling me that right now, because they have a lull in cases, private hospitals are doing a lot of planning.
He was very worried about the fact that there are no Indian manufacturers making Personal Protective Equipment. That's very critical for Mumbai, which is so densely populated?
Are we already facing a shortage of PPE?

We definitely had a shortage of PPE two weeks back.

But the PPE are coming in, in a much more systematic supply now.

I also think there are several Indian manufacturers making PPE.

Dr Warrier said the PPE were not up to standard. They are making it, but he said they are not up to standard..

We have this group from the Indian manufacturers here. Honestly speaking, maybe it's too early for me to say whether they are protective enough as the international ones that we receive.

But I think it's just better than not having it. You know it has all the components of the PPE -- the face cover, the mask. And the eye shield in front of all of that -- we understand that's like the most important thing, you know.

I'm not saying that the gown and gloves and everything is not important, but we also need to understand that this is a respiratory virus.

So if we really manage to keep the head and the face covered, we should be okay.

The PPE supply is much better than what it was two weeks back. It's still very expensive.

I think a lot of NGOs and other organisations are providing PPEs for free to government hospitals and BMC (BrihanMumbai Municipal Corporation-run) hospitals.

Have you seen a COVID-19 patient?

We did see COVID-19 patients, who tested positive later on, when they were transferred. They were suspected COVID-19.

Both the hospitals I work in are not COVID-19 hospitals. So any suspected COVID-19 (patient) needs to be transferred out.

So, you haven't actually come face to face with a COVID-19 patient?

No, I haven't.

What is something really puzzling about this virus for you that makes it quite different from all other kinds of viruses that have been seen before?

What's different is that it's really infectious.

We know that now.

If we have one patient who test positive, then there are another seven or eight healthcare workers that are already positive if the PPE is not rightly used.

It's definitely very infectious.

The other thing that is puzzling is the symptoms that they (patients) present with.

That is something, that as a healthcare system, we will learn over a period of time: How our patients are presenting.

Like a lot of times we have had patients present with not fever, not cough, but with very different complaints like with cardiac complaints and just plain breathlessness.

We will have to compile the data from all the institutes that are seeing in COVID-19 patients to actually understand what the symptomatology of this disease is, in our set-up.

Like in a lot of other countries, like Italy and the US, they said a lot of the mild COVID-19 patients came in with anosmia, loss of smell. They have seen it to the extent of 40 to 50 per cent.

At this point, I don't think we have seen a lot of (anosmia). We haven't seen anosmia yet in those big numbers.

The symptoms of the disease are so different, there is no fixed pattern of how the patient is going to present to us.

Another thing which is puzzling is that there are a lot of asymptomatic patients.

IMAGE: A health camp in Mumbai. Photograph: Arun Patil

Does asymptomatic mean they were not ill at all, in any way or they just had something really tiny, which they didn't notice?

Even if it was something tiny that they didn't notice it or they don't remember. So like when it comes (for instance) to a healthcare worker and he is asked: 'Did you have a cough or a cold?' and he will say no.

So for all documentary purposes, it becomes completely asymptomatic.

But they definitely are asymptomatic cases in the sense that there are those with no symptoms.

And there have been pre-symptomatic cases where they test positive first and then get the symptoms.

So they have tested positive just before they actually are going to start getting symptoms.

So asymptomatic and pre-symptomatic reacts in a certain way. And that only happens in some individuals.

We may not see that in India because those people would never have survived in any case in India, given the the viral load that we have, anyway, on a day to day basis.

There have been quite a few cases in America where non-smoker young people with no pre-conditions are dying of COVID-19.
I hear from my US-based doctor sister that the young people that die of this in the US do so because of an overwhelming immune response or cytokine storm, when your body launches an unduly harsh immune response to a microbe, which causes the Acute Respiratory Disease Syndrome.
She was mentioning to me that given the number of viruses we are exposed to India -- the viral load -- if you were genetically prone to having such an immune response, you might have been already eliminated by the environment long ago and you would not have survived.
So there may not be so many younger age deaths in India?

I don't know.

I think these are all speculation. It's just too early to comment on any of those things.

So like is the age structure different?

Is our immune system different?

Will the BCG vaccination work in our favour?

Is temperature working in our favour?

It's just too early to comment on any of those things.

I don't know whether we are actually in a great place where we are not seeing a lot of cases and a lot of deaths.

Or it is just a matter of time of when we are going to see them, after the lockdown.

I really don't know where we are at this point.

Dr Trupti Gilada

IMAGE: Dr Trupti Gilada.

What are the worries that you have in connection with this disease?
What are your areas of concern especially relating to Mumbai and Maharashtra?

We are definitely concerned about the period post-lockdown.

It is going be absolutely necessary for each and every person to understand that even though the lockdown gets over, the social distancing remains.

We all know that as soon as the lockdown is over, we might see a surge in cases.

So if people start associating the end of the lockdown with the end of social distancing, it is not going to be good for us.

In the next two weeks, we really hope that people are aware enough that even after the lockdown, we will have to follow a lot of things that we were following during the lockdown.

Don't get out for non-essential things.

Don't gather together for parties, religious events or at religious places.

Ensure social distancing at work and otherwise.

Stay at home when we are ill.

You know in India, it is not uncommon for people with a cough and a cold to go to work. Very common for people to do that.

At this point, we really want people to understand that if you have a cough, cold, fever just stay at home. Don't get back to work or don't get back to school.

For those norms of social distancing to become a pattern of living is going to be slightly tricky for us.

To explain to people -- all people -- in the city?

To explain to people and convince them that they really need to follow this.

Just because there is going to be a slowing of cases and a decreasing number of deaths and cases across the country in the next two weeks doesn't mean that people should start thinking that: 'Oh, we won this thing, the war over corona and it's gone forever'.

You don't want people to think that. We know it's going to be with us for months.

It's just about how we behave and how well we test. And when the healthcare is needed -- how well we can offer that healthcare.

Like I said people are really speculating that, 'Oh the summer is here. Now it's gonna be better'.

We don't know.

So if we start counting on those things, that we don't know anything about, it's going to be dangerous.

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VAIHAYASI PANDE DANIEL / Rediff.com Mumbai
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