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How to protect yourself from COVID-19

By VAIHAYASI PANDE DANIEL
September 07, 2020 10:29 IST
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'The social distancing vaccine.'
'And the mask vaccine.'
'If you adhere to these two vaccines and go and meet people in a well-ventilated room -- not in an enclosed, non-ventilated, room -- you are probably going to be okay.'

IMAGE: A woman buys fruit at a market in Mumbai, August 20, 2020. Photograph: Hemanshi Kamani/Reuters
 

Dr Rahul Pandit, who serves on the Maharashtra state medical task force and is the director of critical care at Fortis Hospital, Mulund, north east Mumbai, has suffered from COVID-19.

Since his recovery in April, and as the knowledge of the disease has steadily expanded, Dr Pandit has made certain the team that runs the COVID-19 ICUs at his hospital stringently follow the disease protocols and strictly stick to the correct treatment regimen.

In the second part of his interview to Vaihayasi Pande Daniel/Rediff.com, Dr Pandit speaks about the precautions one must take and the after-effects of COVID-19.

It's very hard to understand what the new normal is going to be.
How safe am I wearing a mask and going out to do some task of work?

If you are going to go out in an open space or into a well-ventilated room, you are probably going to be as safe as you can be anywhere else, as long as you adhere to the two vaccines we have currently.

The social distancing vaccine.

And the mask vaccine.

And not bother about the real vaccine right now, because it is nowhere near being around the corner.

If you adhere to these two vaccines and go and meet people in a well-ventilated room -- not in an enclosed, non-ventilated, room -- you are probably going to be okay.

As long as you:
  • Keep your mask up on your nose and don't allowed it to slip down.
  • And don't touch your hands to your nose or eyes or mouth.
  • Sanitise your hands and wash them as frequently as you can with soap and water.

How can I actually explain it the best?

Fear is natural, and I can understand it comes.

But so does commonsense.

It should be a natural.

We should work with some commonsense up our sleeves.

And have a little bit of an understanding of cleanliness.

It is nothing but cleanliness.

IMAGE: Health workers congratulate the 1,000th patient who recovered from COVID-19 at the Kaushalya Hospital in Thane, August 20, 2020. Photograph: Anil Shinde/ANI Photo

I read a report on how some people who suffered COVID-19 are already returning to hospitals, showing signs of pulmonary fibrosis in the lungs (thickened stiff tissue in the lungs that causes shortness of breath).
Is that possible?

Of course.

It is possible.

It is real.

I have seen a few patients as well.

We have launched the first post-COVID-19 OPD in the country.

It has been functioning for the last two weeks now.

A lot of patients have come to us with variety of problems, of which we have picked up a few early fibrosis as well.

Fibrosis can set in that soon after an attack of COVID-19?

Well, at least on a CT scan, it looks like that.

And their pulmonary function test are actually showing the disease.

So, fibrosis can set in that soon is what it looks like.

And you cannot prevent it?
It's not a function of how you take care of yourself after COVID-19?

No, I think it's about how big was your viral load, how critical was your disease, how much of your lungs was involved and what was the timely treatment that you received.

All those things probably matter.

And, of course, how you continue to look after yourself post your COVID-19 discharge -- have you kept up your lung exercises and did the right things (in relation to) food, clean air?

Apart from fibrosis, what are the other complications you are seeing in patients post-COVID-19?

The most common post COVID-19 complication is a fatigue and this fatigue seems to be bothering them the most.

They are not able to do their daily activities, what they were doing pre-COVID-19.

And they easily get tired and after a few hours of work they feel they need to rest a little.

Almost 80 to 90 per cent of our patients are saying this.

IMAGE: Health worker interact with a COVID-19 patient at the Commonwealth Games Village sports complex in New Delhi, which has been converted into a COVID care centre, September 2, 2020. Photograph: Rahul Singh/ANI Photo

How long after recovering from COVID-19 do they feel this?

That's varied, but most of them have had it for the first two to three weeks since their illness, at least.

Some of them going up to six weeks post illness.

Loss of appetite.

Sleep cycle being disturbed.

Some of them complain they don't seem to have the same exercise tolerance that they did before.

That's all interlinked I think with fibrosis and fatigue.

Certainly, they are saying they are stopping after climbing two flights of stairs, which they could do easily before.

And how does one get rid of this fatigue?

Most fatigue, fortunately -- what I have seen -- slowly resolves itself.

It's a gradual process.

It is just building up your metabolism again.

When they go back to their normal routines, it improves, the sleep cycle improves.

There are some patients who do complain about fear and depression, as well.

They do say they are not very interested in things and 'Why is it me who got infected?' and whether this will still be a problem going forward.

So, there's a psychological side as well.

Are you seeing any neurological symptoms related to COVID-19?

In 25 per cent of the stroke patients coming to the hospital.

Supposing I get 10 stroke patients, then, at least, two or three of them are because of COVID-19.

It's not a coincidence.

They have got COVID-19 and hence they have got a stroke.

What about the efficacy of remdesivir which is the drug that is finding a lot of usage?

Remdesivir is not actually the drug for this illness and some doctors say that it's not that effective.

As I said, the protocols which we have are written up as a live document.

Let's put it this way: For now, the best bet we have is remdesivir.

The next step is plasma therapy probably.

But I would not be surprised if the data changes completely, the other way, or it becomes stronger. Either is possible.

We just got to wait and see for the results of larger trials to come back....

Trials are being done and proof of concept seems to be there.

Whether that is a level of an indication or not, it's very difficult to say in a pandemic.

It's not that easy to estimate?

It's not very easy at all.

But there is this crazy belief right now that come what may if we need to get better from this (COVID-19) and if people are using remdesivir and getting better, let's go ahead and use it

We are the handful of doctors who are actually saying that everybody doesn't need remdesivir.

Only those who are moderately sick or severely sick need remdesivir.

In a mild illness it is not required.

IMAGE: A community health volunteer checks the temperature in Mumbai, August 17, 2020. Photograph: Francis Mascarenhas/Reuters

In Mumbai, COVID-19 has people are on edge.
They are reasonably careful, as far as they are able to be.
But in rural parts of Maharashtra -- an example I have witnessed is Raigad -- that is less so.
It's very worrisome.
Testing is limited.
If cases rise in rural areas it will bring it back to the cities?

Yes. In the country as a whole -- even if we just take Maharashtra -- each city and each region is actually going to have a different peak and a different plateau.

So, while Mumbai is peaked up and plateaued already, Pune is just about peaking up with 1,500 cases a day.

Rural India or rural Maharashtra is not going to be any different.

We need: Education, education, education. Awareness, awareness, awareness.

I don't use the word mask anymore.

I say mask vaccine. Social vaccine.

That makes it like a bullet in the head that this is actually equivalent to a vaccine and the only thing which we have for protection right now.

Social distancing and the mask.

Unless we get it straight in our head, people aren't going to be protecting themselves.

So, it's very important -- very, very important -- to actually bring out the concept of mask vaccine and social vaccine.

That really has to percolate much more, for example, in the rural areas near Mumbai, to keep say a city like Mumbai safe too?

Agreed, agreed.

It needs to go to every nook and corner of the country. Not just Maharashtra.

Because every state has got a city which absorbs population from the surrounding areas, whether it is Delhi, Chennai, Bengaluru, wherever.

And to keep every metropolitan area safe, we need to have every region safe and to keep every region safe you need to keep every metropolitan area safe because people are going to travel to and fro, from the rural areas to the cities and back.

It is an inter-dependent economy, inter-dependent population,

It is not just for Mumbai to remain safe, the rural regions have to remain safe, it is vice versa as well -- if Mumbai remains safe, the rural regions remain safe.

They have to go hand in hand.

What about the issue of domestic help?
What is your stance on domestic help coming back to work?

As I said, for smart unlocking, you need smart ways of bringing back domestic help.

That is the population which is completely dependent on their daily earnings and they have every right to earn their livelihood, as well.

They have to get their livelihoods back

With domestic help, it's a symbiotic relationship between the people who employ them and the people who get employed.

I see no reason why you cannot download the Arogya Setu and see if they are coming from a red zone or a green zone.

If they are coming from a green zone, then the chances that they are infected is extremely low.

But if they are coming from a red zone it is not reasonable to ask them to move to some safe zone, but you need to see if there is some place for them to get quarantined for a few days, test them and then get back to work.

We have the domestic help coming in to my house.

We have a clean pair of clothes for them to wear as soon as they come in.

We give them masks and we give them gloves and we ask them to work.

There is no reason why you cannot be a little more innovative and do it.

You are saying that with some amount of testing and some amount of distancing ie a combination, it is possible?

You have to maintain the social distancing at home as well.

Allow them to work in a room.

That much trust factor has to be there.

Give them a pair of clothes.

They cannot afford that and it is you who has to basically help them out.

Teach them the importance of mask and social distancing.

Help them with sanitisers at home.

These are some of the things which will have to be done.

They are dependent on us.

If we keep doing these jobs (domestic chores) -- which is fine in the Western world, where these jobs are done by themselves -- but here there is a whole eco-system around it and if you disrupt the eco-system somebody will not earn.

We need to make sure they come back to their jobs.

The population will have to come out and help each other.

IMAGE: A security guard at a Delhi Metro station ahead of the restart of its operations, September 3, 2020. Photograph: Adnan Abidi/Reuters

What are the lessons you have learned fighting COVID-19?
As a medical professional and from having suffered the illness?

The two important lessons learned is, firstly, keep an open mind and don't overdo any particularly therapy or any particular drug.

Just basically keep an open mind that this (treatment method) may be a short-lived magic, and, and it may all disappear in a few weeks' time, which is what happened with many of our drugs now, for example, hydroxychloroquine, ivermectin, doxycycline, azithromycin.

All these have gone out of practice now almost.

On the other antivirals coming up, as I said, in another two weeks's time, who knows how the data pans out.

And the second lesson learnt is that don't be complacent.

If numbers start going down, you actually need to tighten things further.

When you become complacent, that's when the second wave hits, if you go by the history of pandemics in the world, whatever has been recorded for the 1900s pandemic. The second wave is always bigger than the first wave.

You need to be actually tightening the social distancing and masks further. And have your smart unlocking.

See now there are so many innovative ways.

These kids are not losing on their schooling, it's all online.

Even the simple people have got a mobile connection and can have some internet activity on it.

Everybody has had some amount of education re-started for the kids.

For offices the work from home is something which has become a norm.

I think we are much better off than what we were hundred years ago to face a pandemic now.

If we can be a little bit more conscious about it, maybe we'll be able to crush it better than what we could do as a population 100 years ago.

Feature Presentation: Ashish Narsale/ Rediff.com

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