The more the questions are answered, the more the number of doubts about Covid-19, in this time of the pandemic. The readers of Lifestyletodaynews.com had a plethora of questions in their minds about COVID-19 ranging from precautions, medication, and the long term impact of the virus. Dr. Mathew Varghese, a Public Health expert and orthopedic surgeon, who was featured as a real-life hero by Bill Gates was kind enough to answer the question in the mind of the readers. He spared time for an in-depth video interview about almost every question that is relevant to a common man in the present scenarios. Read on to find the informative answers which are educative in nature:
According to experts, the pandemic is not going to end in July, will it end?
The experts are basing their information on facts of previous epidemics and the behavior of coronaviruses. You had SARS1; we had Middle Eastern Respiratory Disease. These are the experiences that help to guide us in our understanding of this disease.
Mathematical models have been done. They are modeling to show that possibly by July, or maybe even August, the epidemic will reach a peak, and gradually settle.
A definite time? Difficult to answer
Historically if you look at epidemics, they have all been like this. Including the Spanish flu, which came, lasted for quite some time, and then eventually disappeared. So it is not that these pandemics will be there forever.
They will eventually be overcome by human immunity and resistance to fight against viruses. Therefore it is difficult to answer when this pandemic will end.
How long will it last?
We do not know. But usually, pandemics have a history of infecting a certain number of people and then petering out.
So there is a growth curve, which may be steep or slow, reaches a peak, and goes down.
When a large number of people have herd immunity
That growth curve starts going down, only when a certain proportion of the population is infected which then has the resistance to fight against the virus. This is called herd immunity.
When a large number of people in a community have been immunized by the infection, they have herd immunity.
What is the percentage of people that need to be infected, to get herd immunity?
There are experts that until recently have been saying 60%. But there are some recent reports saying that even up to 20-30% of people been infected gives you sufficient herd immunity for the pandemic to end.
Somewhere between 20-60%
Anybody who says that this is going to end in 10 days or 15 days, it is all guesswork. We do not know, but we hope, once herd immunity of a certain proportion somewhere between 20-60% is reached, we will have overcome the pandemic.
Will the virus be eradicated?
In Coronavirus, we do not have a vaccine as yet. It will take about one, one and a half years at least before a vaccine comes.
Even then, if you look at the few vaccines that are available today, they do not provide you permanent immunity like smallpox or oral polio vaccine does.
They give you a limited period of immunity. Flu vaccines need to be given every year to protect the elderly from the effects of flu-related pneumonia.
We do not know how effective will the vaccine for coronavirus be. We have to wait and see. Until then we cannot answer this question, can we eradicate it or not? But looking at the historical behavior of flu unlikely we can eradicate it forever.
Is there any possibility of home testing for coronaviruses and is that legal?
As yet there is no home testing available, so the question of legality does not come. We do not have such a test.
At this point in time we do not have any home testing
In the future, there may be and it may be useful to test that. But at the same time, at this point in time, we do not have any home testing that is available with us.
Is immunity the biggest weapon against coronavirus?
Yes, the first virus that was identified, you know what it was? It was a plant virus, Tobacco Mosaic Virus (TMV) in 1891. The first human disease-producing virus, you know when it was identified? 1901, it was a yellow fever virus. Remember, till today, 120 years down the line we do not have a drug to cure virus illness.
When somebody says that I am immune, it could be because they had an infection or they have been vaccinated and become immune.
We overcome virus illnesses by the body producing antibodies that fight the viruses, kill the viruses and we win. Those antibodies that the body produces are what give us the immunity.
When somebody says that ‘I am immune’, it could be because they had an infection, or they have been vaccinated and become immune. Either of the two is essential to have immunity.
So is this natural immunity?
No, it is a healthy individual who can raise antibodies in sufficient numbers and strengths to fight the virus. When you say you have good resistance, you are saying you are a healthy person without any malnutrition, without any other illness which may be lifestyle diseases or other diseases that make you vulnerable and immune-compromised, and therefore vulnerable to get the infection.
It is a healthy individual who can raise antibodies in sufficient numbers and strengths to fight the virus.
How to increase immunity?
Your health is based on a balance of things. Balance of what you eat. You have to have a balanced diet, which means a proportion of food has to be carbohydrates, proteins, and fats.
Labourers need to take a large number of carbohydrates. People who are inactive take fewer carbohydrates, less fat, and more protein. And you need to have a balance of physical activities also.
But that’s not sufficient.
You need to have minerals. Minerals like Zinc, like Copper, various other minor elements are required for your enzymes in your body for fighting and producing cells for fighting viruses. So these we get from the natural food that we take like the vegetables, like the nuts, and the pulses.
We need to take a balanced diet; stay healthy and physical activity keeps our body fit. Intellectual activity keeps our mind fit.
Physical health, mental health, well-balanced nutrition are foundations for good immunity.
So we need to have good physical health, good mental health, and good nutrition that are balanced to maintain our body health. That is the baseline foundation for good immunity.
Most people have to venture out for work, essential, medical emergency, so how do we protect ourselves from being infected?
This is basic. Everyone has to remember. First, we have to understand how the virus spreads. The virus spreads from one person’s breath to another person’s breath.
The virus spreads from one person’s breath to another person’s breath.
If you are close to each other and breathing into each other’s nostrils or mouth you are actually infecting each other. If a person is within your breath air distance, you are likely to get infected if the other person is infected.
How do we prevent this?
We can’t stop breathing. You continue to breathe. So we need to wear a mask.
1. The first safety step is a mask, a good mask.
A cloth mask with porous layers in it doesn’t work. It has to be a mask with multiple layers that prevent the virus. Remember viruses are very small particles. It can go through the pores of your cloth mask.
Therefore you need to have a mask which has a filtration capacity to filter the viruses.
Mask to protect you from the other person’s breath.
Remember any mask is better that no mask.
So if you don’t have any masks then use a multilayered cloth mask. At least two or three layers so that the probability of the virus entering your airway is less than normal.
2. The second safety step is to keep a safe distance.
This is debatable, whether you say one meter or two meter or whatever.
By and large minimum 1 meter distance should be kept. That is important to prevent you from getting infected from the other person’s aerosol. It is the droplets that come out of his breathe when he breathes.
Remember if you are shouting, or you are singing you bring out more aerosols. So if you are standing opposite somebody who is singing and it is likely to send the aerosol further down the line, maybe 3 meters also, 4 meters also, be careful. So it is important to have the mask.
Sometimes these aerosols, small droplets, fine droplets, which contain virus particles, land on your hands. And any human being touches their face atleast 20 times in an hour. So from our mouth, from our nose, from our eyes, we get the viruses on to our hands. When we touch an object we transfer the virus from the hand to the object.
When we cough without a mask, we put those aerosols on the objects around us. The objects around us are contaminated, and if somebody comes and touches those objects, we transfer the virus to the hand.
3. The third most important safety step is Hand Washing.
Regular hands washing, especially, if you have touched foreign objects outside your house. Unless you are in your home where somebody is infected and home quarantined, then don’t touch any article that he has touched.
Don’t go to him closer than one meter. Don’t go to him without the mask. You have to be very careful. Any outside object that you have touched, wash your hands.
Any unknown person bringing you an object, wash your hands. Anybody giving you some items through courier, wash your hands soon after you have touched. If you have a doubt, leave the object untouched for 5-6 hours and that is sufficient enough to be sure there are no viruses on the packet.
How to wash our hand?
I say that soap and water is enough to wash hands.
Soap and water is the best.
Why do you say that?
Washing hands with soap and water is the best way. The virus has a coating. That coating is easily washed away by soap because it has got a lipid content.
What are Lipids?
Lipids are fat-related substances. You know oils are washed only very effectively with soap. Therefore soap is more efficient than plain water or even sanitzer.
You are not happy with sanitizers? Why?
- It is expensive.
- It is difficult for poor people to get sanitizers.
- They finish off in no time.
- Because you want to conserve the amount of sanitizer you use a small amount. You put a little bit on your palm and rub. That is not sufficient.
Use it liberally. Back, between your fingers, your thumb all have to be. And that is the same technique for washing also.
Liberal, not thrifty use of sanitizer.
So the steps for cleaning your hands with sanitizer, cleaning your hand with soap and water, remain the same. Every finger, front, back, thumb separately. Palms everything has to be cleaned properly.
Soap and water is the best. But in the absence of that, you can use a sanitizer. Liberal use, not of a thrifty use of sanitizer.
Should we also use soaps for washing vegetables, and fruits and packed grocery?
No, you don’t have to do that. Vegetables are usually cooked and eaten. Washing them in a good amount of running water is sufficient. On top of that, you are cooking it. However, if you have salads that you are consuming, make sure that you have washed it thoroughly with running water.
You don’t have to use soap. I have seen people using Soda bicarb, washing soda, detergents. No. Some of the detergents will soak into these vegetables; some of these may be toxic.
Washing vegetables in good amount of running water is sufficient.
Especially washing soap, you don’t want them to be consumed into your body. So running water is good enough.
If you are very worried, you may use warm water and wash these vegetables that you are going to consume raw. Or the fruits that you are going to consume, wash them thoroughly with water. Running water is good enough for you.
There is a recent report that sunlight will help you fight the virus. How effective is sunlight to fight the virus?
Sunlight has a spectrum of rays, from the very narrow spectrum to the very long spectrum – infrared to ultraviolet. Ultraviolet rays do kill the viruses, but they need to be exposed for a certain period of time.
If you are thinking of getting yourself sunbathed, remember Ultraviolet rays are also bad for your skin. We do not recommend it as a method to protect yourself from the virus.
Drying and keeping objects in the sunlight for 5-6 hours may be good enough.
However, if you are thinking of keeping objects in the sunlight, which have been probably contaminated, you may keep them out in the sun, leave it. Just drying and keeping in the sunlight for 5-6 hours may be good enough.
One important item which you may use the sunlight is for your masks. Any surgical mask, which you buy, can be reused provided you dry it sufficiently.
Any surgical mask can be reused provided you dry it sufficiently.
You take four masks, number them 1,2,3,4.
1st day wear Mask No. 1.
2nd-day mask No. 1 goes on the washing line. Leave it in sunlight and use mask No. 2.
3rd day the second-day mask goes up the washing line and mask No. 3 is used.
4th day, mask No. 3 goes on the washing line, and mask No. 4 is used.
5th day, Mask No. 1 comes back and you recycle it to a maximum of about 28 days.
One set of four masks can be used for 28 days. This has been found to be reasonably sufficient, for the recycling of your mask. And that is the only area where I would use sunlight to sanitize the mask.
Curiously, some of the coronavirus positive cases are those who have never ventured out of their houses, for 6 months, and followed all the precautions at home, how could that happen that they got infected?
It is not possible that they have had no contact and yet they got infected. The virus did not come out of thin air. It came through a source that was infected.
It has to be they handled some object, they handled something, they met somebody, coming to their house, who was infected and therefore they became positive. It is not possible that there was no interaction for the chain of infection to continue.
The virus did not come out of thin air.
There has to be some interaction from some infected person, either directly or indirectly through objects of exchange. Maybe notes, handling notes. Maybe some other package that was given by a courier.
There have been reports of Pizzas delivered by pizza delivery boys who were infected and they infected people.
It could be anything that the virus landed to your body from.
There is a doubt in everyone’s mind that in these three months we might already have been infected and healed from coronavirus?
Yes it is possible. Many of us had mild flu, cold, cough, and no other symptom and we became alright.
It is possible that you are infected and you got cured.
That is exactly what was seen in the aircraft carrier Theodore Roosevelt where it was found that 60% of the young healthy men were infected but asymptomatic. So it is possible that you are infected and you got cured.
In such cases will we be able to find out if we were infected?
Yes there is a way to find out and that is by testing for antibodies.
The problem with this test is that the antibody tests are not as reliable as the antigen test that we call the real-time PCR. Those are far more sensitive and far more specific. Whereas the antibody tests are non-specific and not so reliable. The testing for antibodies will help us identify these cases.
The testing for antibodies will help us identify these cases.
What is an antibody?
The antibody is a body substance created by our cells to fight the virus. So it is something in your blood that is protecting you from infection from the future. So if you have an infection, initially there is no antibody because the virus is a completely new organism that has entered your body.
The antibody is a body substance created by our cells to fight the virus.
As it enters, the body recognizes it as a foreigner and starts fighting it. As it fights, the antibody level goes on increasing till it reaches a peak and the body wins or sometimes the virus wins and the body dies. Usually, the body wins. 99.5% of cases the body wins. And we are able to eliminate the virus. So testing for antibodies will help us identify these cases.
Are there any long term side effects for a coronavirus patient?
The virus, since it has been identified, has been only six months old causing its symptoms and the disease. As yet it is too early for us to say are there any complications that are long term.
Short term we know what is happening. But long term we do not know. Only time will tell. Most viruses do not leave long term effects except for diseases like poliomyelitis, and a few other viruses that leave long term damage to the body.
Most viruses do not leave long term effects
But by and large, coronaviruses do not belong to that category and therefore we do not expect, but time will tell. At this point in time, I can’t answer that question.
When largely the elderly and those with comorbidities have succumbed to coronavirus, some young healthy people with no health issues died due to coronavirus, what could be the reason?
Again difficult to answer. But in my hospital, I have been keeping track. We have a 200-bed corona ward in our hospital. We have been regularly treating coronavirus patients right from the beginning of the epidemic.
We have had many cases coming to us. What we have found is 90% plus of those patients that have died, whether they were young or they were old, were diabetics. We don’t know what happens in them. For some reason, diabetics have been vulnerable.
For some reason, diabetics have been more vulnerable.
And those that have died have shown significant changes in their lungs. And what has been described in the lungs, earlier what was thought to be pneumonia was later on found to be not pneumonia, but clotting in the vessels of the lungs.
What do lungs do in our body? They oxygenate the blood. This oxygenation happens because blood is flowing through the alveoli in the lungs.
Some have been described to have what is known as ‘Cytokine Storm’.
And when the blood vessels are clotted blood flow cannot happen. Oxygenation cannot happen and the patient dies in the absence of oxygen. Because of the tissues not getting oxygen for survival. That is what happens. Some of these patients who are young and dying have been described to have what is known as ‘Cytokine Storm’.
What is a Cytokine Storm?
It is a reaction vomitted by the body to fight the virus, but the reaction is an overwhelming reaction and that actually causes side effects to the patient and the patient dies from it.
The younger people dying are usually ones who had a cytokine storm and usually, these are the ones with diabetics or some other major illness.
What is the precaution to be taken by pregnant women, especially while going to the hospital for checkup?
The precautions remain the same. Mask, distancing, hand wash.
Remember when you are pregnant; a pregnant mother is two lives; the mother and the child. So there is a double reason to be as cautious as possible keeping away from
- Crowded outpatient areas.
- Closed and poorly ventilated areas.
- Poorly ventilated doctor’s chambers.
Make sure that when you go, you should have seen the clinic earlier. It should be well ventilated. The number of air chambers should be good so that your probability of getting the infection is low.
Can we accompany our child along with us?
I would not recommend that. Except in a dire situation, where no one else is at home to protect the child, to be with the child, you may carry the child.
Remember, children may be impulsive. They suddenly go and touch things, they may suddenly interact with people, and they may also pull off their mask.
Take children with you only in a dire situation, where no one else is at home to protect the child.
Therefore because of the impulsiveness and unpredictability of behavior of children, we do not recommend that children should be accompanying pregnant mothers for antenatal care.
ADVICE TO MEDICAL PROFESSIONALS
You have directly handled patients during prime times, be it HIV+ve or Coronavirus patients, what is your advice to the medical service professionals who are directly dealing with Coronavirus patients?
My advice remains the same. If you protect yourself you will be able to take care of your patients better. While I myself have seen so many patients who are coronavirus positive, frankly infected, I have dealt with them without fear.
For the last 31/2 months now I have been dealing with patients every day. But I take my precautions. My job as a physician is primarily a responsibility for patient care.
If you protect yourself you will be able to take care of your patients better.
I have taken the Hippocratic Oath, and I will care for my patients, come what may. And this was what we noticed when the HIV epidemic came up. Huge stigma against those HIV victims Then they started coming up with innocent victims and not so innocent victims of HIV. Those are all judgmental issues.
We should not be judging people for an infection. We should not be stigmatizing people for their infection. Our job as professionals is to take care of these patients. We do it to the best of our ability, without any stigma. However while we do it, we protect the patient and we protect ourselves.
How do you do that?
- Make sure that you wear a surgical mask. If it is close contact it has to an N95 mask that you need to wear.
- If you are going to do an invasive procedure you must wear gloves.
- Or you must wash your hands before and after you touch the patient.
- As far as possible keep away from the breathing area of the patient.
How do you assume that you have not got an infection from somebody? You may be infected without having any symptoms. You need to wash your hands before you touch the patient. And after touching the patient you protect yourself by washing hands again.
If you have to touch the face, the eyes, the nose, and the mouth of the patient, or any other invasive examination is to be done, make sure that you are wearing gloves. Do not do it without gloves.
Maintain distance. Any object that you use, after touching the patient, or any object that you use on the patient, should first be sanitized, used, and then sanitized again. Like the Stethoscope that I used for seeing the last patient with a backache, I sanitized it with sanitizer.
I am an orthopedic surgeon; you will wonder how the corona patients come to me. Yes, they come to me with a backache. Body aches are common in viral infections.
The protocols are the same: Protecting yourself, and protecting the patient.
They came to me with back aches. They didn’t know they had corona. I didn’t know they had corona. I examined them. I suspected on the basis of some of the questions that I asked. I sent them and they were confirmed to be coronavirus patients.
We need to be careful. The protocols are the same: Protecting yourself, and protecting the patient.
Hydroxychloroquine is used to treat lupus, rheumatoid arthritis and malaria, does that mean that those with these conditions can kill two birds with one?
Don’t get wrong impressions. The diseases of Lupus and Rheumatoid, these are autoimmune diseases.
What are autoimmune diseases?
These are diseases that the body’s immune system fights its own cells. Normally our immune system fights foreign cells, viruses, bacteria, allergens. But in this type of condition, Systemic Lupus Erythematosus or Rheumatoid Arthritis, these are Autoimmune diseases where the body fights its own cells and causes disease.
You are not winning two wars at one time.
So the body’s immune system is busy fighting its own cells, therefore when an invader comes, you are vulnerable. So even if you are taking Hydroxychloroquine your invader will have an upper hand. It is just like internal strife is the right moment for an external enemy to fight and win over you.
Similarly, malaria is an external infection because of a parasite. So there is a fight between the body and the malaria parasite. So you are actually fighting one war inside your body. When another invader comes, even if you are taking Hydroxychloroquine that invader has an upper hand. So that kind of cross-protection does not happen. So you are not winning two wars at one time.
Some people still believe that Coronavirus is a myth or a conspiracy? What do you have to say?
As yet, there is no evidence to show that coronavirus has been created as part of bioterrorism. We do not have any reasons for that. There are hypotheses but it has not been proven anywhere. We do not have any reason to say that.
The only proof we have is, Coronaviruses which are ordinarily seen in bats and some of the animals, and most commonly in bats have 500 species of coronaviruses. They are a real storehouse of coronaviruses, without any disease in them.
Bats are a real storehouse of coronaviruses, without any disease in them.
But when it jumps from bats to human beings, you have the disease coming. Had there been an intermediary? We do not know.
But remember, when we tinker with nature too much, when we tinker with the natural habitat of these animals, in the animal kingdom, we are likely to have an interaction between the viruses in the animal kingdom and the human interface. And that is when we have diseases jumping from animal kingdom to humankind.
When we tinker with the natural habitat of these animals that is when we have diseases jumping from animal kingdom to humankind.
So the key message that is there in this pandemic is we should not ruin our environment, we should not ruin our forests, we should not unnecessarily damage our animal kingdom. We are all part of an ecosystem, we are part of that an ecosystem, we have a responsibility to protect the ecosystem to stay safe.
The virus is here, it will have a natural peak, and they die down naturally. The vaccine is the way to protect it for the longer-term. But a vaccine will take a minimum of 11/2 years to come by.
Until then the only way to protect from the virus is by preventing spread of the infection from one human being to the other.
- Wearing a mask
- Keeping a safe distance
- Washing your hands regularly.
And staying away from places that people gather as we do not know who is infected and who is not infected.
Thankyou so much, keep safe, all the best.
Dr Mathew Varghese is a Public Health expert and Orthopaedic Surgeon. He is currently the Head of the Department of Orthopaedics, St Stephen’s Hospital, New Delhi. His work with polio patients caught the attention of Bill Gates, who named him in his blog as a real life hero who inspires him.