India in stage 4 to 5 of community transmission, says top Kashmir endocrinologist
Photo: KM/Umar Ganie
Srinagar: For the last two weeks, fear has gripped people after COVID-19 cases recorded a sharp increase in Kashmir. The outbreak has claimed over 154 persons so far, an overwhelming majority of them from the Kashmir division.
Doctors predict that the situation in the coming weeks will be dire. More than 50 percent increase has been noticed in the cases of pneumonia – a number unprecedented in the summer months. Moreover, they claim the virus might have mutated, as the younger population is becoming more vulnerable by the day.
The questions that arise are: What have we achieved so far? And where are we heading to? To seek answers to these questions, The Kashmir Monitor spoke to Dr. Mohammad Hayat Bhat, Consultant Endocrinologist at Government Superspeciality Hospital, Government Medical College, Srinagar. Excerpts:
KM: How do you see the recent surge in COVID 19 cases?
Dr. Hayat: Well this was expected given the fact that the causative mutated organism is resistant than other respiratory illnesses causing viruses to heat and hence has increased longevity and infectivity. We had predicted it when COVID19 started in our union territory. During those early days (in April), COVID19 cases were reported from places like Maharashtra, Karnataka, Gujarat, and Tamil Nadu where the temperature already had crossed 35 Celsius. Hence the hope that transmission will be contained as the temperature rises were the only meager as was evident to medical science.
KM: Why has there been an increase in the number of cases despite the extended lockdown imposed by administrative authorities?
Dr. Hayat: Initially lockdown was imposed with the idea that we may be able to contain the virus by preventing human to human transmission. However, the virus continued to spread throughout the country during this phase albeit at a lesser pace. After the lockdown restrictions were eased, the number of cases started to increase exponentially consequent to close interaction between humans. Today the country is already in stage 4 – 5 of community transmission by now. COVID 19 is a cluster source epidemic, which means each infected person can further infect multiple individuals. As the restrictions were eased, the rate of infectivity increased and so did the number of cases and mortality.
KM: How do you see the next few weeks?
Dr. Hayat: It is very difficult to answer. But one thing is for sure that this virus is not going to disappear anywhere soon. It will be around us and will continue to infect many of us. The biggest hurdle in the containment of the virus is the asymptomatic person who keeps on infecting others without knowing that he is infected and a new source of infection in the community. There comes the role of a face mask. Face masks prevent the distance through which the microbe traverse and the number of microbes being disseminated. It may well become from epidemic to endemic disease a few years later which means cases coming all through the year in a limited number of cases. The future depends on many things which include the level of close contact between cases and un-infected persons, the degree of social distancing adopted by the public in general, and other measures like the use of masks and sanitizers.
KM: Has there been any improvement in the treatment of COVID19 cases?
Dr. Hayat: Medical fraternity all over the world is learning to better understand the mechanism and explore more treatment options for the illness. During the start of COVID 19 in India, we only had Hydroxychloroquine as the add on treatment to the illness in addition to usual Viral pneumonia treatment protocols. In the past 12 weeks, many drugs were tried in the course of treatment for these patients. These include Doxycycline, Ivermectin, Remdesivir, Favipiravir, Lopinavir, Ritonavir, Tofocitinib, Aspirin and Dexamethasone. These drugs were tested all across the world at high facility centers and approved by different authorities for the management of the patients. In addition to medicines, a convalescent serum is used in the treatment of these patients.
KM: How can we prevent the number of deaths?
Dr. Hayat: A very important factor in the disease outcome is the viral load at the time of infection. Which means the number of viruses that infect the individual? Viruses are shed in the respiratory droplets at the time of sneezing or cough by an infected patient. Higher the viral load, the more severe is viremia and a higher degree of the illness. Social distancing can limit the number of virions being transmitted from an infected individual to another. If principles of social distancing are followed, a significantly lower number of virus particles can infect a person than when the distance is close. So adhering to proper hygiene like washing hands frequently, use of soap, avoiding direct contact with a suspected or confirmed case, use of hand sanitizers, avoiding mass gatherings, use of face mask and face shields are useful.
KM: What about a relock down given the number of cases are continuously increasing?
Dr. Hayat: There is an administrative lockdown and there is a personal lockdown. As I mentioned earlier this virus is not going to disappear soon. So one should always consider the possibility of being infected whether the administrative restrictions are in place or not. So a personal strategy is very important. An administrative restriction is an option for time being only. Genuinely it cannot be extended for too long. It had to be considered for some time only. Yes, it limits the pace of transmission as long as the restrictions are enforced. However more important is the personal restriction which one imposes for himself and the community.
Community members have to strive for themselves. They should give due support to the health care workers and the administrative authorities. Anyone who had a fever, body aches, Cough, Chest Discomfort, Redness of eyes, Throat discomfort, Diarrhea, should report to the hospital and get tested after the advice of the treating doctor. Hiding such history will only alleviate the scenario as such a person will continue to infect individuals including a fragile subset of persons which include those having diabetes mellitus, Hypertension, Cardiac, lung and liver ailments, those suffering from malignancies, receiving chemotherapy, or immunosuppressants, organ transplant recipients. Gatherings should not be allowed at salons, Bakery shops, Restaurants. Simple measures include fixing a proper time at a saloon telephonically. This will avoid undue gathering at the saloon. The availability of hand sanitizers and soap at all such places is mandatory. Fragile individuals should avoid a crowded place.