New Delhi: Most people in the world have not seen a pandemic of this nature in their lifetime. What started more than six months ago rages on with no end in sight. The SARS-Cov2 virus that causes the COIVD-19 disease is believed to have originated in Wuhan, China. On January 3 there were 44 cases only in China, today the outbreak has spread to 213 countries and territories around the world and infected over 9 million people according to the data by John Hopkins University and the world also registered the largest single-day jump on June 21 by adding another 183,000 COVID-19 cases, as per WHO. So far 500,000 people (as on June 23) have died due to the coronavirus infection, according to Johns Hopkins University. So, compared to when it started six months ago, what are the things we have learnt about this new disease.
It is a Zoonotic disease, one which normally spreads from animals to humans. Zoonoses can spread through direct contact between animals and humans from food, water or the environment. While this pandemic is caused by a virus, Zoonotic disease could also be caused by bacteria, parasites, and fungi. According to the US-based Centre for Disease Control And Prevention (CDC), more than 60 per cent of known infectious diseases in people can be spread from animals, and 3 out of every 4 new or emerging infectious diseases in people come from animals. Most of the outbreaks in recent past have been in this category of diseases be it SARS (Severe acute respiratory syndrome), MERS (Middle East respiratory syndrome ), Swine Flu or (SIV), Ebola, ZIKA Virus, NIPAH Virus or COVID-19 now. So, how is the world coping with this pandemic.
Hand Washing And Maintaining Proper Hygiene Remains The Key Precaution Against COVID-19
Explaining the one constant thing that we have always known about fighting coronavirus since its emergence, AIIMS Director Dr Randeep Guleria said,
Till date and from the start of this pandemic, one thing we knew was that if we need to keep this virus at a bay, we need to take a few precautionary measures. The measures include washing of hands regularly with soap and water, secondly, maintaining good hygiene which includes few rules like if we are coughing, we need to cover the cough, if while coughing, we are using a tissue, we need to make sure we dispose it off properly and if using a handkerchief then we need to make sure it gets washed properly. Coronavirus is a droplet infection, so by coughing one can spread the infection.
According to the World Health Organisation as well, precautionary measures like washing hands regularly with soap and water and keeping hands clean with an alcohol-based sanitiser is a must to fight COVID-19.
Social Distancing Can Slow Down The Spread Of The Virus, Hot Temperature Cannot
In India, the novel coronavirus made its entry on January 30 when a student who had returned from Wuhan, tested positive for the infection in Kerala’s Thrissur district. And by March, the virus started to spread steadily. By the end of March, India crossed the 500-mark in terms of infected cases and 10 people had lost their lives to this disease, according to the data by Ministry of Health and Family Welfare. The same month, in the wake of the increasing cases of coronavirus, Prime Minister Narendra Modi announced a 21-day complete lockdown in India from March 25 in bid to break the chain of the infection and lower the rate of the spread.
On March 25, India started to stay at home, day-to-day activities like going to offices, travel, malls, colleges, schools, gyms and other facilities shut down so that the country can stay safe and practice social distancing.
Dr Ashish Jha, Director of Harvard Global Health Institute in Cambridge, Massachusetts said,
All of the western democracies like Italy, United Kingdom, the USA or Sweden, to name a few, have really made a mess-up by waiting too long for the lockdown. Moreover, these countries also didn’t have a very progressive testing strategy. On the other hand, India’s lockdown model which was adopted early was very smart, though I believe that the country needs to scale up the testing much more than it already has.
Apart from fighting the pandemic, the other battle that has been waged is the infodemic or the overdose of claims, myths and misinformation. like the unverified claims that with the onset of summer and rising temperatures in the months of April and May, may slow down the spread of coronavirus in the country.
Negating such claims, Dr Ashish Jha said,
Summers cannot be counted as a major source of benefit since there is no medical research or proof on this fact as of now. What will work is three important things – social distancing, getting hospitals ready and testing aggressively. As everything else is just hope and hope is not a good strategy.
Even the WHO made it clear that from the “evidence so far, the COVID19 virus can be transmitted in all areas, including hot and humid weathers.” Indian Council For Medical Research (ICMR) director-general Balram Bhargava has also stressed that at present, there is no relationship between temperature and the spread of COVID-19.
Masks Become Compulsory To Fight The Coronavirus Outbreak
Apart from social distancing, in the month of April, Ministry of Health and Family Welfare made it compulsory for people stepping outside their homes to cover their faces with homemade, reusable masks to stem the spread of coronavirus in the country. The guidelines said that people who are not suffering from medical conditions or having breathing difficulties may use the handmade reusable face cover, particularly when they step out of their house. This will help in protecting the community at large. It however, also said that the handmade masks, are not meant for patients, health workers or those in direct contact with COVID -19 patients as they are required to wear specified protective gear in order to protect themselves from the virus.
Dr Surender Purohit, Ophthalmologist, Michigan adds,
We are living in the time of coronavirus, we need to think that a person himself and others as the carriers, once we start to see everyone around us as the possible threat, we will automatically take necessary precautions. In past few months, one thing which we all have learned about COVID-19 disease is that most of the patients are asymptomatic, meaning they don’t show symptoms for the infections at all, which means at some point they will be doing activities like a healthy person like stepping out in public, but the fact is they are still the carrier of the infection and can infect many around them. In this scenario what works best is that people should come out wearing masks – homemade masks and if they have cough or cold-like symptoms then a medically approved mask.
Dealing With The Challenge Of Asymptomatic Cases
When India’s death count crossed 500-mark and the cases count was on a continuous increase in the month of April, experts raised a red flag saying that in India many COVID-19 cases are asymptomatic and it is a cause of worry as there may be many asymptomatic people who are yet to be detected in the country and yet carrying the virus around. Dr Raman R Gangakhedkar, a senior scientist at the Indian Council of Medical Research (ICMR) said,
Based on our studies, 80 per cent of the cases are asymptomatic in India. Our biggest worry is on their detection. There is no other way than contact-tracing. It is difficult to detect asymptomatic cases and they can be found out only after tracing the contacts of people who have been tested positive and testing everyone is almost impossible.
However, a month later, in June, WHO said that infection from asymptomatic people is very rare and is not a cause of concern. Maria Van Kerkhove, the World Health Organization’s COVID-19 technical lead clarified her statement from before and said that on the basis of studies carried out in several countries, the transmission of the virus by an asymptomatic person seemed to be “very rare”.
WHO also said comprehensive studies on transmission from asymptomatic patients are difficult to conduct, as they require testing of large population cohorts and more data are needed to better understand and quantified the transmissibility of SARS-CoV-2. Currently, the organisation is working with countries around the world and global researchers, to gain an evidence-based understanding of the disease as a whole, including the role of asymptomatic patients in the transmission of the virus.
Home Isolation For Bulk Patients Who Are Either Asymptomatic Or Have Mild Symptoms
Towards the end of April, when India had reported 28,000 of coronavirus cases according to the data by Health Ministry, new guidelines were issued for coronavirus pandemic stating that COVID-19 patients who have very mild symptoms of the infection or are “pre-symptomatic” can opt for home isolation. The guidelines further stated that the patients should self-isolate themselves completely so that they avoid contact with other family members. Experts and doctors gave a thumbs up to the new guidelines. Explaining how the new guidelines can help India in the fight against coronavirus, Dr Naresh Trehan, Chairman and MD, Medanta said,
Earlier, the COVID-19 infected patients were immediately isolated and admitted in hospitals, makeshift hospitals or wards dedicated to coronavirus patients in order to break the chain of transmission of the highly contagious virus. Now, we have to think above this and we have to get ready for life with the virus. From our past cases and experience what we know is that the maximum number of people, nearly 80 per cent infected with COVID-19 are asymptomatic or have mild symptoms. Now, if we put all of them in hospitals, they occupy beds which are needed for treating sick patients. As a result, there is a lot more burden on our healthcare system. Now, with new guidelines in place which gives such patients an option of self-isolation at home, it eases the burden from our healthcare systems.
Dr Ashok Seth, Chairman, Fortis Escort adds,
The guidelines are well defined and it is definitely a great idea because we all need to start living normal life with the virus, the cases of coronavirus will pace up, as we are slowly opening up. We have seen in Europe and the United States how their healthcare system is overburdened, this is also being practiced by them in a way. Our ministry of health has defined it very clearly, only asymptomatic and very mild symptoms patients are allowed to opt-in for home isolation. The ministry has kept mild, moderate and severe symptoms patients separately, in the west, even patients with mild symptoms are being treated at home. We have these guidelines only for patients who have very mild symptoms.
Surface Transmission For Coronavirus Remains “Unpredictable”
Since the outbreak of coronavirus pandemic, one debate which has always remain in the news is that ‘If coronavirus Airborne?’ Or ‘Can coronavirus live on different surfaces?’
Dr. Maria Van Kerkhove, Technical Lead for COVID-19 from WHO says, “The virus is not airborne.” She explains,
The virus can be transmitted through fomites, which means that the virus can remain on surfaces, but that doesn’t mean that you can get the disease simply by touching an infected surface. The chances of people getting infected via surface transmission are very bleak. Following some of the precautionary measures like washing hands with soap and water or using hand sanitiser and other basic hygiene protocols will surely help in reducing your chances of getting infected.
Recently, the Department of Science and Technology (DST) also said the spread of COVID-19 through surface contamination remains an “unpredictable” risk and, therefore, maintaining proper hygiene and washing hands play a key role in containing the spread of the infection.
Experts also suggest that transmission of coronavirus through surfaces is not known fully as it is a very new virus. Dr Rajesh Parikh, Director of Medical Research, Neuropsychiatrist and author of the book (The Coronavirus: What you Need to Know about the Global Pandemic) adds,
Any object that transmits a virus is a called a fomite. It is important to emphasise that we are still in the early stages of understanding this new virus. The studies being done are new, these might change with time. Besides all viruses are capable of mutations so that their survival time on fomites can itself change with time. The best precaution at this crucial stage is frequent handwashing with soap or sanitiser for at least 30 seconds. Moreover, taking precautions like cleaning surfaces regularly at this stage is important.
The Uncertain Road Ahead
Till now, the world has not found a cure for COVID-19. Scientists around the globe are working and hoping for a breakthrough on both drug and vaccine development fronts. In terms of vaccine, WHO says that currently there are about 100 active projects on, to develop a vaccine for the virus. many existing drugs are also being looked into for possible quick-fix solution to stall the spread of the infection. So an existing antimalarial drug hydroxychloroquine was being pushed as a possibility from certain quarters, but WHO’s the last release on the use hydroxychloroquine (HCQ) On 17 June 2020, WHO announced that the recently announced results from the UK’s Recovery trial showed that hydroxychloroquine does not result in the reduction of mortality of hospitalised COVID-19 patients when compared with standard of care.
Recently, the Oxford University researchers announced the results of ‘Recovery Trial’ for the dexamethasone, a low-cost widely used steroid, in treating COVID-19 patients. As per the researchers, giving low doses of the dexamethasone drug to patients, reduced death rates by around a third among those with the most severe cases of infection. Senior Pulmonologist from Delhi’s Sir Gangaram Hospital, Dr Arvind Kumar highlighting this as the breakthrough in the fight against coronavirus said,
In the gloomy background of last 4-5 months of fighting the virus, it is the first drug which has been shown to have a significant impact on mortality in the groups which saw the highest deaths.
In the past few days, Mumbai-based Glenmark Pharmaceuticals has also become the first Indian company to launch an antiviral drug-Favipiravir under brand name FabiFlu, to treat mild to moderate COVID-19 patients. The drug will be sold at retail chemist outlets as well as in hospitals across India after the company secured drug regulator Drug Controller General of India’s (DCGI) approval to manufacture and market Favipiravir in India. The drug is priced at Rs 103 per tablet Rs 3,500 for a pack of 34 tablets.
Last week, Hyderabad-based Hetero Labs also announced that it had received regulatory approval from DCGI to manufacture and market the generic version of antiviral drug Remedesivir for treating COVID-19 patients. Hetero’s generic version of Remdesivir will be marketed under the brand name ‘Covifor’ in India. The company has already sent 20,000 vials to five states including Maharashtra and Delhi – the two worst-affected states in the country., followed by Gujarat, Tamil Nadu and Telangana. Hetero said a 100-milligram vial of the drug will cost Rs 5,400. The recommended dose for adults and pediatric patients is 200 mg on Day 1 followed by once-daily maintenance doses of 100 mg for five days.
According to the company’s statement, the next batch of the drug will be shipped to Kolkata, Indore, Bhopal, Lucknow, Patna, Bhubaneshwar, Ranchi, Vijayawada, Kochi, Trivandrum and Goa. The company has set a target to produce one lakh vials of the drug in three-four weeks.
Apart from the medicines, another method of treatment of severe coronavirus cases has been Plasma Therapy, which involves transfusion of antibodies from a convalescent coronavirus patient to a critical patient. The therapy is based on the principle that the blood of a patient who has recovered from the COVID-19 is rich in antibodies – proteins produced by a human body, which is then used to build a sick person’s immunity. The therapy has also got a stamp of approval from the Food and Drug Administration (FDA) of United States in the fight against COVID-19.
States like Delhi and Maharashtra are already trying the convalescent plasma therapy to treat critically ill patients of COVID-19 for some time now and the results are seeming to be encouraging as patients show signs of recovery.
Dr Randeep Guleria, Director, AIIMS says that the treatment should not be looked as a ‘magic bullets’. Speaking to the news agency ANI, he said,
Plasma therapy is not the only treatment strategy and it is not that it will be effective in all patients because there are a number of other things happening in people affected with coronavirus. Also, patients willing to give blood after 14 days of recovery must contain a good amount of antibodies. We need to look at it with a research type of treatment modality rather than something which can be done for all patients suffering from COVID-19.
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