CNR 101- The Pandemic and general guide lines
The Corona Pandemic
This is to understand the challenges presented by the Pandemic.
What is COVID-19?
COVID-19: Origin and how it became a Pandemic
COVID-19 is an infection caused by the family of viruses known as Coronaviruses. Coronaviruses are known to cause infections in both humans and animals.Coronavirus infections range from common cold to severe respiratory or lung infection. COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain. SARS-CoV2 was unknown before the outbreak that started in Wuhan, China in December 2019.
On 11/03/2020, the WHO declared COVID-19 a Pandemic. A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.
COVID-19 Infection
COVID-19 infection is most commonly associated with symptoms like fever, dry cough and lethargy/ tiredness. Other symptoms include ache/pain, sore throat, nasal congestion, conjunctivitis, loss of taste or smell, headache , breathing difficulties and diarrhoea in some patients.Anyone can be infected with COVID-19 irrespective of age or sex or religion or nationality.
The elderly and people with underlying health conditions such as diabetes, lung/heart problems, high blood pressure or cancer are at higher risk of developing more symptoms and worsening. These are called co-morbid conditions, the presence of these will make an individual more susceptible to get infected by the virus.
But that does not rule out the possibility of the younger population getting infected. Anyone who develops breathing difficulty/chest pain or loss of speech or movement should be considered as a severe case of infection.
How does COVID-19 infection spread?
The infection usually spreads from an infected person to normal individuals. Droplets or aerosols from the nose and mouth of infected persons generated while coughing, sneezing or speaking are the primary route of spread. These heavy droplets generally tend to sink to the ground quickly but when in close proximity of 1 metre or less, a person can breathe in these droplets and acquire infection.
Similarly touching droplets resting on surfaces of doorknobs, tables, handrails followed by touching or rubbing eyes, nose or mouth can result in acquiring the infection. A visual guide to how the virus works is given in reference for additional reading.
Testing of COVID-19
It is recommended that people with symptoms undergo testing. We have an antigen and RT PCR test currently available in our medical field of expertise. The RT PCR test is a global standard system, it is costly(varies from Rs.500-1500 in various states) and the result is accurate ,but time-consuming (approx. 24 hours). It tests for viral RNA presence and Virus genetic material may be detected.
The Antigen tests (cost varies from Rs.150 to Rs.300) check the presence of protein, the accuracy is lesser as compared to RT PCR. It is an easily accessible test. The virus particle is detected. For checking antibodies present, a blood sample is taken and if the virus enters a person's body, it will take around 7 – 8 days to get this antibody test back positive.
Our future with COVID-19:
Our Immediate future with COVID-19.
In the current scenario, COVID-19 cases are increasing which has raised red flags across general public and government officials. It is also essential for us to understand the possibility of the disease persisting for a longer duration than expected.
Moreover, the COVID infection has long-term health effects which needs to be studied and managed. To know more about the research done on the same.Therefore public has to come forward and partner with the local government bodies to create an efficient system to fight this disease.
Information is the best weapon we have to fight the virus. It is very important that everyone in the public is aware of the best practices to curb the transmission of the virus. Also data relating to the capacity of the healthcare facilities also play a crucial role.
Communicating such real-time accurate data of the healthcare capacity within each district/state will
- Enable the administration to make effective decisions and policies based on real data.
- The awareness that such data creates among the general public will motivate them to comply more strictly with the social distancing norms advocated by the administration.
The million dollar question is 'When will this pandemic end?' but it still remains a question unanswered by all major world bodies or governments across the world, even when multiple vaccines are available and all governments across the globe are engaged in aggressive public vaccination drives.
Keeping this uncertainty in mind, the general public has to make the conscious effort to start living their normal life while fighting this pandemic as just another added task that we face in our daily life.The first step forward is to create a good public awareness regarding COVID-19, safety precautions to be followed, existing facilities that can be utilized and the proposed plan of action for the future.
A community based approach is essential to fight the impacts of this pandemic as its tentacles have gripped various segments of our daily life including healthcare, economy, education, secure employment, supply of essential requirements,etc.Every individual will have a role in rebuilding or reinventing methods to revive various sectors/segments of the community. It is time that the citizen, especially the youth step up and partake more in this fight against the virus.
Major Challenges during a pandemic:
One of the most significant problems that we still face one year into dealing with the pandemic is the limitation faced by the mainstream healthcare facilities of any state or nation due to the uncertainty in the number of patients.
For example, the overall healthcare infrastructure of Kerala has ~100,000 beds for 330 lakh people in Kerala which is very comfortable during regular times but will fall short during pandemics. This ratio for Kerala is among the best in comparison to other states in the country.
Even with Kerala's sincere efforts from the early stages of the pandemic, we are experiencing an unprecedented surge in the number of Covid positive cases.To summarise, the three key challenges that we should be prepared for during a pandemic are:
1.Uncontrolled spread of the infection: The uncontrolled spread of infection in the community due to lack of adequate precautions and awareness in the general population.
2.Large volume of patients: Even the most advanced nations across the world fail due to the sheer volume of patients that a pandemic creates in a short period of time. Therefore it is essential to tackle this by preventing an uncontrolled spread.
3.Augmenting our Healthcare Infrastructure to meet the load: Our existing healthcare infrastructure may be inadequate to cater to those who are affected by the pandemic and for regular patients. The healthcare system of any state should be able to absorb the load created by the increased number of sick people so that the system doesn't collapse due to overload.
For example, augmenting the healthcare system for the Coronavirus in Kerala is done by creating Corona First-Line Treatment Centers where community halls/auditoriums etc. are temporarily converted to clinics. This model is explained in detail in subsequent chapters.
Ensuring Correct and Prompt Treatment for regular patients. It is important that the healthcare facilities should also be available to other people who might need medical attention for regular diseases like cardiac, kidney, diabetic problems or antenatal care, etc.
Even with the introduction of vaccines, the virus persists to spread rapidly in many parts of the world. Our lack of understanding of the nuances of the virus even after 1 years time, and the rapid rate at which the virus is mutating are all great causes of concern.
General Advice:
The highest level of care must be taken in preventing the spread of the infection from one individual to the other.
General Advice
Always wear a mask in public places.
Limit your movement. The lesser people you interact closely with, the less likely you and the people around you are to being sick.
Encourage repeated hand washing. Carry a hand sanitizer and use it wherever soap and water are not available. Wash your hands as soon as you get home. Wash your hands or sanitize before you touch your eye, nose or mouth.
Maintain social distancing. Limit contact even while running errands. For example, at the grocery store, do not touch the items unnecessarily. Maintain 1-meter distance from anyone and avoided touching common surfaces like cash counter etc.
Respiratory hygiene and cough etiquettes must be observed by all.
Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.
Establish a system to ensure proper disposal of masks/tissue papers.
Proper usage and disposal of masks
During the initial phase, WHO warned us that the common populace using masks could potentially lead to danger. But when the virus started to spread, it has become a norm for the society to be trained on how to use a mask. Now, wearing a mask is a necessity. It helps in decreasing the spread of the disease. While we sneeze, we need to cover our mouth and nose. If someone who is a carrier of the virus sneezes, it could act as a vector and go unnoticed as he or she is asymptomatic. We need to wear a mask to prevent the spread of the virus occurring due to our daily activities and it must be worn properly. The major problem we see nowadays is that people tend to forget the importance of wearing masks and pull their masks away from the nose and mouth. Careless touching of the outer side of the mask should also be avoided.
Proper disposal of used masks and PPE kits:-If it is a cloth mask, boiled water can be used to clean the mask. Surgical masks or N95 masks are not recommended because they are to be used by medical personnel, wherein burning the mask is one way of disposing it. N95 is recommended for aerosols or people who are in contact with those tested positive for COVID-19.
We can only ensure proper waste management if everyone does their part. If we touch an area that people frequently use, we need to wash our hands properly since the probability of getting the disease by touching our eyes and mouth increases. If we are wearing gloves, we need to be extremely careful since we need to dispose of it after each use. So the best practice is the use of hand sanitizer.
Hand Hygiene:
Hand Hygiene
One must be extremely careful while washing their hands or while using a hand rub.
The following steps must be followed:-
Home Quarantine:
Asymptomatic patients are advised to stay at home.
Clinical eligibility for home quarantine
- The patient is covid postive by any of the confirmatory tests.
- The patient is asymptomatic.
- The patient does not have any other health conditions.
- Psychologically fit and willing for room isolation.
- If patient is less than 12 years of age, a guardian may accompany the child.
Social eligibility criteria for home quarantine
- The house has adequate road access and communication facility.
- Facility for room isolation with attached bathroom and adequate ventilation.
- The Covid positive patient should not come in contact with another vulnerable individual.
- An adult healthy individual should be willing to act as a caretaker .
- The family should have adequate community and social support.
Self care
- A balanced diet.
- Take warm water and fluids.
- Adequate rest and sleep for 7-8 hours.
- Self monitor for symptoms and red flag signs.
- Maintain a diary of daily symptoms.
- Promptly respond to any communication from health authorities.
- The caretaker and the patient should wear a 3 layer mask while interacting for food or other necessities.
- The patient should not use any other part of the house for any purpose.
- The patient should not share common household objects.
- Wash clothes in the bathroom and disinfect all objects in the room daily. Wash hands frequently.
- Burn general waste. Biodegradable waste should be buried under the soil.
- If any symptoms start developing , the patient must be moved from the house according to severity.
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