Better Safe than Sorry

On 11 March 2020, the World Health Organization (WHO) declared the current global COVID-19 outbreak a pandemic. A pandemic is defined as an outbreak of a disease (quite often viral) that occurs over a wide geographic area and affects an exceptionally high proportion of the population. This is the first pandemic to be caused by a coronavirus (in this case, a novel coronavirus named SARS-CoV-2).

The word ‘pandemic’ is loaded. Pandemics have historically affected millions of people across the globe. The last pandemic was also caused by a respiratory virus—the 2009 pH1N1 Influenza. It demonstrated how fast and how wide-spread infections can occur. The main difference between the last pandemic and the current one is that the already available drug against influenza (Oseltamivir) also worked against the novel strain that caused the pandemic. What makes the COVID-19 pandemic an even bigger challenge for the entire world is not only the speed and scale of transmission of the virus but the fact that there are no drugs or vaccines currently available to cure the disease.

I was part of the virology team in Mumbai that carried out molecular diagnosis of the suspected H1N1 Influenza samples in 2009–10. While testing was important for Influenza, after a certain time, patients were prescribed the medication without waiting for the test result. In the case of COVID-19 however, testing is all the more important to know the magnitude of infections worldwide and to further prevent its transmission.

According to the Director-General of the WHO, this is a controllable pandemic. The key to controlling this pandemic is preventing further infections and breaking the chain of transmission. Without panic!

 How does COVID-19 spread and how can we prevent getting infected?

SARS-CoV-2 is a respiratory virus and spreads through air-borne droplets when infected people cough or sneeze around others. These droplets can also remain on surfaces or other objects such as clothes/utensils/furniture and when other people touch these ‘fomites’ and then touch their faces, noses, mouths, or eyes, they can get infected.

The best way to prevent illness is by avoiding exposure to the virus. Handwashing and ‘Social Distancing’ are effective approaches towards preventing infection. Handwashing is the simplest way to prevent any infection, not just COVID-19. It is one of the most important steps in infection control practices in the medical field. It is essential though that handwashing is done correctly with soap and clean water for at least 20 seconds. This ensures that bacteria or viruses get deactivated. Using alcohol-based hand sanitizers is an alternative, especially when traveling.

Another way to avoid infection is to distance ourselves from others who might be sick. This is called ‘Social Distancing’. It means staying at least 1–2 meters away from other people (who might be infected). As a virologist, I consider this one of the most effective ways to prevent infections. If enough people stay away from each other, viruses will not have new hosts to infect. This way the rate of transmission will slow down. This also prevents high-risk populations from getting infected. If less people get infected, less people will need medical support at the same time and the burden on the public health system will reduce. Experts call this ‘flattening the curve’ which refers to the potential success of precautionary measures such as washing hands effectively or social distancing which helps prevent rapid spikes in numbers of infected people that could overwhelm health care systems.

Simulations done by other experts also show how extensive social distancing (as against attempted quarantine or moderate distancing) can help slow the spread of COVID-19.

Most cases of COVID-19 are not severe enough to require hospitalisation; however, we need to make sure that infected people do not transmit the virus to others. Even if you’re sick, it may not necessarily be COVID-19. It is still important to make sure that you stay away from others. Self-quarantining or isolating at home for at least 14 days (or more until fully recovered) is one way that will prevent community transmission of the virus. While waiting out the 14-day self-quarantine, we must ensure that our care-givers take appropriate precautions, and other people or ‘well-wishers’ are strictly not allowed to visit. We must remember that the virus can only spread through close contact with others and we must do everything we can to prevent that from happening.

Testing is important, but not everyone needs a test

The Government of India has set up a 24×7 central helpline number (toll-free number 1075 or +91-11-23978046) and email (ncov2019@gmail.com) for reporting and testing cases. You should call the helpline numbers only if:

– You suspect you have a severe infection (fever, cough, and difficulty in breathing);

– You have travelled to any of the COVID-19 affected countries including China, Italy, Iran, Republic of Korea, France, Spain, Germany, UAE etc.;

– You are a direct contact of a laboratory-confirmed positive case (even if you are asymptomatic).

The helpline service will note down your contact details and contact you with the testing protocols of COVID-19. The National Centre for Disease Control (NCDC)/Indian Council for Medical Research (ICMR) laboratory network has set up 111 testing centres across India to identify positive cases. The government has also decided that private laboratories with COVID-19 testing kits approved by the US Food and Drug Administration (US-FDA) can start testing suspected cases. If you qualify as a case for testing as per the protocol, you will be tested at one of these government-approved laboratories. The Ministry of Health and Family Welfare (MoHFW), has also set up several resources on information, awareness, and control of the disease. These include routine phone SMSs, caller ringtone information on COVID-19 and other resources available online (www.mohfw.gov.in).

What is India doing?

It might seem like the Government of India has put in some drastic measures. This has been done to prevent the further spread of the virus. Suspension of all visas and travel bans for all non-essential travel to India will prevent infected persons from other countries coming into India. Many State Governments have even invoked the Epidemic Act. This enables them to take ‘extreme’ steps such as shutting down educational institutions, movie theatres, bars and pubs, and banning all big events, gatherings, conferences, and sporting events. Many states have even advised offices to allow their employees to work from home. The health authorities have been screening at airports and quarantining suspected patients. Massive efforts into ‘contact tracing’ of people who may have been in close contact with patients positive for COVID-19 are also being undertaken by the health authorities. The health authorities have also instructed all hospitals and provided guidelines on the best ways to manage outpatients and to set up isolation wards. This way, when people who are sick go to hospitals, they don’t end up infecting others.

All these are excellent measures taken by the Government. But we probably need to go beyond these measures ‘imposed’ on us. In our battle against the virus, each one of us must take all precautions possible to prevent further spread, especially at a community level. The responsibility for curbing the transmission lies with each one of us and not only the authorities.

 How can we stop the spread? Must we cancel everything?

From a virological and epidemiological perspective, the most effective way to control the pandemic is to prevent or minimise transmission. While staying at or working from home might not be an option for everyone, it is easily possible to avoid crowds. We must prevent over-crowding in public transport and on the streets, stop going to parks, and other ‘tourist’ destinations. Events that need a large gathering of people, such as weddings (or funerals) or parties should be avoided as much as possible. Going to shopping malls or crowded open markets should be pushed off to only when absolutely necessary. Perhaps, we could even post-pone visiting elderly relatives, especially since they are more vulnerable. All these steps may seem radical and extremist but are in the interest of preventing further transmission. We must ‘cancel everything’!

This needs to be a collective and community approach though. If enough people stay away from each other or at home, avoid crowds, and cancel everything, the absolute numbers of people getting infected will drastically reduce. We won’t just be flattening the curve, but will be collectively ‘stopping the spread’!

Self-quarantining and social distancing might not be as easy as it sounds. Does it mean that we shouldn’t meet anyone? Will it be alright fine to meet our friends and family that don’t live with us as long as they aren’t sick or show any symptoms of being infected? Perhaps it’s safer to stay away for now. The ‘Janata Curfew’ carried out last Sunday (22 March) is one such initiative we all can self-impose. If most people stay indoors as much as they can, the spread of the virus can slow down. We should get into the habit of greeting people with a wave or a nod or a ‘namaste’ rather than shaking their hands. We can have ‘virtual’ parties with our friends on WhatsApp, Google Hangouts or Zoom. Should we stop going to religious institutions like temples, mosques, or churches? Maybe we can go, as long as they’re not crowded, or perhaps it might just be better to follow our faith at home. With our children being at home from schools and probably getting more screen time than they should, perhaps for the time-being, it should be alright to let them play with our immediate neighbours’ children. On the other hand, we could just try and engage our children at home. Read books, play board games, or even just chat.

All this is for now: while our country still has very limited demonstrable community transmission. Looking at the trends of virus transmission in other countries, it might just be a matter of time before that happens in India too. What we should be doing is making sure that the virus does not spread in the community. Our aim is to avoid that at all costs. Especially since many of the cities and towns in India are far denser and populated than other countries. As a virologist, I re-iterate, slowing the transmission in the community is only way to eliminate the pandemic.

Still, there is no need for anyone to panic. The current disease statistics show that most people recover. While we follow social distancing or self-quarantining, we should be aware that other people are also probably doing that. We shouldn’t over-stock resources especially essentials such as food or toiletries. We shouldn’t make a bee-line to, and start over-crowding outside, the testing/sample collection centres. And we definitely should not be acquiring massive supplies of hand-sanitizers or masks. Masks (especially N-95 masks) should only be worn by people who are actually infected, and by people who are care-givers such as family, medical personnel, or health authorities. Other people do not need to wear masks. That way there will be enough masks available to people who really need them. In fact, when people wear masks, they tend to touch their faces more often while adjusting the mask (to talk or eat) and makes them more likely to get infected.

With news going ‘viral’ faster than viral infections, social media has a much larger role in the spread of misinformation and often, the spread of fake news, half-truths, and agendas to find fault with health authorities. WhatsApp forwards that claim cures, Twitter feeds that blame the Government and Facebook posts that provide ‘advisory’ misinformation are all examples of how social media is responsible for creating anxiety. We must ensure that our friends, neighbours, and other people especially from rural or poorer backgrounds are informed and educated about handwashing and sneezing/coughing etiquettes. We should educate ourselves and others that medications from different medical systems including Ayurveda, Homeopathy, Unani, or various ‘medications’ including miscellaneous cow products are not effective against COVID-19. We must be cautious of this and cross-check and validate information before passing it on to others.

Other countries have demonstrated that the so-called ‘lockdown’ protocols can effectively slow down the spread of the virus. India has been ahead of the curve in implementing these and we should ensure that we comply with the Government/health authorities. We need to understand that there is a balance between protecting health and the impact on our social activities or even the economy. We must not panic but still stay safe.

About The Author

Dr Ritwik Dahake