Corona Virus / Covid-19 Quick Facts.

Since WHO has declared it a pandemic, it only makes sense that the media sensationalizes it up to the heavens to make us feel like we've all gone to hell.

There have been many questions, even more answers, more videos, posts, tweets and public awareness messages in the last week than the entire year's health budget expenditure by our precious government.

Allow me to bring some common sense back into the equation and to allay some of the fears you may have. These are not myth busters but simple facts that would put you in a better position to deal with the pandemic should it ever reach your doorstep, heaven forbid!

What is it?

The corona virus or the new strain causing COVID-19 is not a new virus. It is something that was there in the past, only this strain is a new strain that seems to have come from animals. In the past, in humans, several varieties of the virus caused diseases ranging from simple common colds to Severe Acute Respiratory Syndrome (SARS). 

Symptoms?

The same as any flu. Cough, cold, fever, congestion, aches, pains and sometimes diarrhoea. Most people may not even feel the severity of these symptoms. 80% will recover with their own immunity without any treatment. Elderly people, those with lowered immunity and those with chronic diseases are the ones that may progress to severe disease and have breathing problems.

How does it spread?

Like any viral flu, this virus also spread through droplets from the nose and mouth expelled either while coughing or sneezing. Any surface that these droplets rest on can remain infective to other people who touch said surface and then in turn touch their face, specifically their respiratory organs that allows the virus to be inhaled. Eyes too can absorb the virus if touched with an infected hand.

Can it spread through someone with no symptoms?

Yes, but only because the person who may be infected may not be exhibiting symptoms yet. There is an incubation period wherein the person may be infected but exhibit no symptoms during this period. This ranges from 24 hours to 14 days.

How can I prevent getting infected?

BASIC HYGIENE. There is no way to emphasize this enough. Simple measures like 20 sec hand washing has shown to be the most effective way in preventing the transmission of this virus. How do you know how long to wash? Sing the entire song of happy birthday to you. That is the perfect time frame to scrub your hands. Also, this is important before putting anything in your mouth as well.

Be careful of what you touch. Everyday items like your coffee cup, your mouse, keyboard and other computer peripherals, your staircase railing, your lift buttons....any of these could contain droplets of someone infected in the neighbourhood. Sanitize your hands often and wash regularly when in contact with a public surface.

Keep your distance from anyone with symptoms  of the flu. The recommended distance is 1 meter or 3 feet. A simple way to do this without having to measure is to keep your handspan distance from the other person. 

Avoid touching your face. Just in case the virus gets onto your hand and you haven't had the chance to wash or sanitize, just keep the hand away from your face, specifically from the points of entry viz, eyes, nose and mouth. Get to a tap or sanitizer first, then scratch away at the itch

Do not indulge in the international pass time of picking your nose! 

Follow respiratory hygiene. If you have to cough or sneeze, cover your mouth and nose, keep a handkerchief or napkin handy, use tissues if available and dispose them immediately after use. Do not wait for the second sneeze to throw that tissue away

If you are sick, stay home. Be responsible and avoid spreading it to others!

Avoid travel unless absolutely necessary. Break out of the cocoon that nothing can happen to you. That's what everyone who is currently infected thought, including the doctors!

What is the risk of catching it?

If you follow the basic rules above, very very low! If not, remember the virus does spread fast and not only do you risk catching it, but also spreading it forward very quickly. The only risk is close contact with an infected person or his belongings which may contain droplets

How long does the virus stay on surfaces?

There is no clear cut answer to this as it will differ with temperature, the type of surface and the humidity but in general the virus could remain from a few hours to a couple of days. In very hot climates, it would tend to be lower! 

Do I need to worry?

Not really. Be aware but don't be paranoid. Most infections are mild and self limiting. If you can prevent it, that is the best case scenario. If you have people around you that are in the high risk category, it would be wise to take extra precautions. If not, basic hygiene should see you through

Antibiotics?

There is NO ROLE of any antibiotics in the treatment of COVID-19. There are some trials with regards to anti HIV medication but those are reserved for the severe cases. No self treatment or IDIOT (Internet derived information obstructing treatment) behaviour (credit for this to a video I saw with an infectious diseases specialist doctor) and definitely no Doctor Google's self medication please!

Vaccine?

Not yet, but the powers that be are working on it 24/7

What is the deal with masks?

The most common mistake that people are making is to think that wearing a mask will protect you from infection. It doesn't. If you are sick, you need to wear it to prevent spreading the infection. If you are not sick, you are wasting a mask from people that may need it. Also, disposable surgical masks can be used only once! There is no point if you wear it after 24 hours as it probably has become a hotbed for the virus particles itself.

The N95 mask is to be used only by those who are in direct contact with infected persons. Medical personnel, nurses, medics, paramedics are at higher risk to inhale droplets from patients. They need to wear the mask at all times.

Should I give up Non vegetarian food?

There is no evidence that well cooked non vegetarian would increase the chance of spreading the virus. Avoid exotic meats at this point of time though.

Should we stop meeting people and isolate ourselves?

Not at all, unless there is an infected person among the group. Meet up with friends, have a relaxing time, stay positive and be aware.

Do not spread panic, do not spread forwards of doom and despair. Instead share this post to educate more people and help stop the spread of the virus.

Dr. Dheeraj V. Mulchandani

  

Doctors and their charges, should the Government intervene?

The State Government of Karnataka is considering tabling a bill in the Winter Session of the Legislative Assembly which would make the private medical practitioners in the state come under the Karnataka Private Medical Establishment Act (KPMEA), 2017 (Amendment).

The act in question aims to bring down costs of healthcare in the state of Karnataka by enforcing certain caps on the treatment costs incurred at the said private medical establishments. The act also seeks to form a district grievance committee which will perform the role of a civil court. The role of this body would be to respond to complaints at the district level. The complaints received will be reviewed and a recommendation sent to the manager of the establishment with a copy to the Karnataka Medical Council or the Ayush Medical Council. It will also inform the registration authority, comprised of the deputy commissioner, the district health officer, the district AYUSH officer and two members from recognised associations, which can also register a private medical establishment. Any complaints regarding the services offered by a medical professional belonging to a private medical institution can be made to this district grievance committee, which will decide the process further.

The entire state of Karnataka is at this point in time in a state of us vs them. The lines have been drawn and the game is afoot.

The major issue here seems to be the fixing or capping of costs for medical services which the government states, they are trying to do, in order to compile uniform rates for procedures across the state. They claim to have set up a committee to decide fair and just prices for standard services like an OPD consultation, basic surgeries like appendectomy, hernia repair, delivery, cesarian sections etc.

Let's look at this objectively for a moment. On the surface, to the general public, this will sound great ,at first! I get to meet a consultant who used to charge Rs. 5000 for 15 minutes of his time and all I have to pay him now is Rs. 200 (Super specialist Fees). Awesome!! 

Let's get back to reality now. Do you think he charges Rs. 5000 only because he wants the money? The more probable answer is that he is a senior citizen who is now working for a few hours a day, using all his years of experience, giving opinions and second opinions to patients who haven't found answers elsewhere, all while trying to keep the lines down to a minimum because everyone in the city wants to be treated only by the 'best doctor' in the field! The price point is probably a technique to fend off those who may not really need his advice and to make it more manageable for the Doctor to see genuine cases who he might be able to help.

Another Doctor charges a sum of about Rs. 500 to Rs. 1000 depending on his qualifications and specialty as a routine consultation fee. A lot of the general public might find this expensive, a lot of them find it fair. The point is they have a choice. As should he, to decide what his time is worth! This has nothing to do with how much he spent on his education and how much time and money and how many years he's invested in becoming the Doctor he is today. It has to do with his freedom of choice as to how he wants to position himself. If he isn't good at what he does, even if he charges the stipulated Rs. 50 that the Karnataka government wants him to charge, he won't have any patients. Even then, and especially then, the choice is still his, because the last I checked we don't live in North Korea (with 5 haircuts allowed and a dictator with the worst one).

A lot of people in the past few days have tried to defend this saying it's not targeting doctors but private medical establishments. How ridiculous is that? There is a reason private medical establishments are expensive. They have spent money obtaining the land, building that structure you marvel at, keeping the place spic and span so that you are satisfied about the cleanliness of the hospital, not to mention, it ensures that you don't get infections once you're admitted in there, hiring the best staff so that your experience in the hospital is a pleasant one, hiring the best nurses and Doctors so that your care is epitomised. Even then, if you think they charge more than required, remember that open MRI machine you wished they had because you are claustrophobic and can't get into a closed one, that costs some more money now doesn't it. The wonderfully reclining bed so that you can watch your TV post surgery, that non-squeaking cushioned wheelchair, that doesn't hurt your backside when they wheel you to get an x-ray, that non greasy x-ray machine that takes the perfect x-ray so that your tiny kidney stone isn't missed...the list goes on. Unfortunately, these cost money. Money that the government isn't giving to the hospital, neither is it spending on its own public hospitals so that you don't need to go private at all.

That really is the crux of the matter isn't it. Do we really need a cap on the private medical practices or do we need better sustainable public healthcare? As an example of Mumbai, would you mind going to a public hospital if it was made as Kokilaben or HN or Saifee hospital? I would gladly go there if they weren't so badly maintained, ill equipped, badly staffed, unclean, and terribly stocked.

Why only medicine? Could we cap a lawyers fee just because he isn't a public prosecutor? How about a cap on those who build our roads (rather potholes)? A cap on the MLA's allowance....I mean he isn't really providing a service is he? He could do it for free? A cap on architects and interior so they can't charge you to make you house look beautiful? 

As a last point of contention, I've worked in both public and private hospitals. I am a surgeon. Once the patient is admitted under our care, we no longer look at where you've come from or what you own or how much you make in a year. All we are concerned about is how to get you well again and how to send you home in better health than you came in with.

This article appeared in the first post website and I think it's worth a read.