30 questions & answers on COVID by senior Apollo doctor who battled the virus

Hyderabad: Humanity is fighting the third World War and it is not between countries, between continents or between geographical regions. But between man and micro-organism. Human species versus Covid-19. The war started officially on March 11, 2020, when the World Health Organisation (WHO) declared Covid -19 a pandemic.

The war is also being fought on the social media front and there is a huge volume of information on social media. Unfortunately, a lot of the information is being dissipated by unqualified people and is inherently false and misleading. In this pandemic situation, this leads to fear and panic among the general public.

As a medical doctor, who has been treating many Covid-19 patients since March, 2020 and who has also been a Covid-19 survivor myself ; here are some of the facts and myths on this dangerous disease:

Q.1. Why is Covid- 19 so dangerous? Isn’t it just another kind of common cold?

Covid -19 is highly infective and 25 infected people can infect another 45 within 5 days. Though the risk of death is only 3%, the large numbers of people infected will lead to a large number of deaths. Covid-19 is already the leading cause of death in 2020 except for diabetes and tuberculosis and it will soon overtake these two. Also, a large number of infected people have no symptoms but can still continue to infect others. It also leaves a lot of residual damage which can persist lifelong. It is similar in structure to the virus that causes common cold but that’s where the similarity ends.

Q.2. For how long is Covid -19 virus shed from the mouth and nose of infected people?

Average 8 days (3 -12 days) from those without symptoms. Average 14 days (10-21 days) from those with mild disease. Average 21 days (14 -30 days) from those with severe disease.

Q.3 Does the antibody response (protective immunity) differ between asymptomatic and symptomatic patients?

More severe cases tend to generate higher-level of protective antibodies. Unfortunately, this phenomenon is not universal and often random. Further, the protective antibodies usually do not last more than 3-6 months.

Q.4 Is Covid-19 similar to HIV? Why are the same drugs used to treat both infections?

No, they are not similar. All viruses are basically of two types, RNA and DNA viruses. The only similarity between Covid-19 and HIV is that they are both RNA viruses, hence anti –RNA virus drugs may work in both.

Q.5 Is it true that children have milder forms of Covid-19? Why?

Children have milder forms due to many reasons. They get frequent viral infections so their general antibody levels are higher than adults. This equips them to fight off all viral infections better. Their organs are younger and healthier so they get less severe infections. The Covid-19 virus needs a receptor protein called ACE-2 to enter the lung cells. This receptor is more numerous in adults as compared to children.

Q.6 Can antibiotics be used for treating Covid- 19?

Antibiotics work only against bacteria, not viruses. Covid- 19 is caused by a virus. It will not respond to antibiotics. Antibiotics in Covid -19 are used only if there is a suspected super-added bacterial infection.

Q.7 Can one recover from Covid- 19 infection?

Most people (upto 98%) recover completely from Covid-19 infection.

Q.8 Can drinking alcohol protect you from Covid-19 infection?

No. It is dangerous. It can damage the liver. Most medications used for Covid-19 infections can cause temporary liver injury, so you want your liver to be as healthy as possible if you get the infection.

Q.9 Can the virus be transmitted by mosquito bites or other insect bites?

No.

Q. 10 Can ultraviolet (UV) rays be used to disinfect your hands and other parts of your body?

No, UV radiation should not be used. They can cause skin irritation and damage your eyes. Cleaning your hands with alcohol-based hand rub or washing your hands with soap and water are the most effective ways to remove the virus.

Q. 10 Which is the best way to clean your hands?

Alcohol –based hand wash (with 60-95% alcohol).

Non-alcohol based hand rubs don’t work. Beverages like whisky, vodka, tequila, etc. have an average of 40% alcohol. They don’t work neither from inside nor outside the body! Alternatively, wash hands with soap and water for a minimum of 20 seconds.

Q.11 Can a single infection with Covid-19 give you lifelong immunity from it?

No. Whatever data we have till now shows that one infection protects a person for 3 – 6 months. Sometimes even less.

Q.12 What is herd immunity?

This is the most misunderstood term of 2020. It does not mean that if a large number of people are infected and protected, this protection will jump over and protect the remaining uninfected, unprotected people. Herd immunity refers to the percentage of people from a community (or herd) who are infected and thus protected. It is mathematical. If more than 50% are infected, the rate of spread of the virus automatically slows down as it has fewer potential victims. Statistically, if the percentage of infected people crosses 65%, the virus is significantly slowed down and ceases to be a pandemic. This is herd immunity and it will take time and a large toll if it is allowed to happen naturally. The best way to accelerate herd immunity is vaccination.

Q.13 What are the grades of severity of Covid-19 infections?

There are 4 grades. Asymptomatic (no symptoms), mild, moderate and severe. Mild if minimal symptoms, oxygen levels above 94% on room air and respiratory rate less than 24 per minute. Moderate if oxygen levels are 90-93% on room air and respiratory rate is more than 24 per minute. Severe if oxygen levels less than 90% on room air, low BP or other organ involvement.

Q.14 What are the symptoms of Covid-19 infections?

Fever, cough, sore throat, body ache, headache, shivering, loss of taste, loss of smell, red eyes, loose motions, nausea, insomnia, breathlessness, chest pain, painful red or purple spots on toes (called Covid toes). All symptoms may not necessarily be present.

Q. 15 How do you treat the different stages?

Ans. Asymptomatic and mild stages can be treated at home by isolation, vitamin C, vitamin D, vitamin B12, zinc and magnesium supplements, Paracetamol, rest, fluids, steam inhalation, yoga pranayama, breathing exercises. As far as possible try and lie on the stomach for an hour or two, at least 2-3 times a day. Moderate and severe stages have to be treated in hospital. DO NOT try and treat at home!

Q. 16 Which group of people are likely to suffer from severe Covid-9 infections?

Q. Older age > 65 years, diabetics, obese, those with high blood pressure, those with high cholesterol, heart patients, lung patients, dialysis patients, pregnancy, male sex, those with low immunity like transplant patients, HIV, etc. Health care workers also tend to suffer from severe infections due to higher levels of exposure.

Q. 17 How is Covid-19 infection transmitted from person to person?

Mainly by droplet inhalation (cough, sneeze or speech from an infected person). Also from infected persons touching surfaces like doorknobs, tables, handles which are touched later by uninfected people. Aerosol spread is also possible. It is extremely rare for Covid-19 infection to spread through blood, stool, urine, breast milk and vertically from mother to child.

Q.18 What does aerosol mean?

Aerosol means virus particles contained in bubbles of air/liquid which persist in the environment and can be carried in the air to distances of more than 1-2 metres. Aerosols can last for up to 3 hours in the atmosphere.

Q. 19 How are aerosols generated?

When people sit in a closed restaurant, pub or hall and talk or sing they generate aerosols. Nebulization machines for asthmatics can generate aerosols. Many surgical procedures generate aerosols.

Q. 20 Can asymptomatic patients transmit the virus?

Yes.

Q. 21 Can patients start transmitting the virus even before getting symptoms?

Yes. Patients can start transmitting the virus up to 1-3 days BEFORE getting symptoms.

Q. 22 What are the preventive measures to be taken?

Follow SMS, Social distancing, Mask and Sanitisation (Hand washing). These are the basic pillars of prevention. Keep at least 1 metre distance form others. Avoid going to crowded places like malls, theatres, restaurants, pubs. Learn cough etiquette...cough into a cloth or your elbow. Avoid touching your face, mouth and nose unnecessarily. Avoid touching inanimate objects used by other people (like door knobs, tables, chairs) with your hands as far as possible.

Q.23 Other than knowing standard risk factors, are there any tests to identify patients who might get severe infections?

The following blood tests can help identify those patients who might get seriously ill: Blood showing high Ferritin-levels, high D-Dimer, high CRP, high LDH levels, high ESR, high Interleukin- 6 levels, high Procalcitonin and Complete Blood Picture showing low lymphocyte levels.

Q. 24 Does BCG vaccine (given in childhood for TB) protect you from Covid-19 infection?

No

Q. 25 Does the annual flu and pneumonia vaccine protect you from Covid-19 infection?

Ans. No.

Q. 26 What is the most reliable method to diagnose Covid-19 infection among RT-PCR, anti-body levels and Rapid Antigen testing?

RT- PCR from nose swab to detect the virus is the most reliable method to diagnose and it comes positive 3 - 5 days after onset of symptoms. Blood Antibody levels are useful to identify past infections, immune protection (after infection or vaccination) and identify plasma donors for convalescent plasma. They come positive 2 - 6 weeks after infection. Rapid Antigen Testing from nose swab detects part of the virus protein within 3 -5 days of symptoms. It is rapid and cheap but inaccurate and often has to be confirmed by RT- PCR.

Q. 27 When can a Covid positive patient stop isolation/quarantine?

Four conditions need to be met: 1) Reduction of fever for at least 3 days without using medications 2) No cough or breathlessness for at least 3 days 3) At least 14 days has passed since onset of symptoms for mild cases and at least 21 days for moderate and severe cases. 4) 2 Negative RT – PCR tests from nasal swab taken 24 hours apart. If PCR testing is unavailable, the first three conditions are enough to stop isolation/quarantine.

Q. 28 What is the difference between isolation and quarantine?

Isolation separates sick people with a contagious disease from people who are not sick. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Q. 29 What is PPE? What does it consist of?

PPE stands for Personal Protective Equipment. It consists of cap, face shield, mask, full body gown, gloves and shoe covers.

Q. 30 Are allergy and asthma patients more at risk of Covid infections? Can they get more severe infections?

Ans. No, allergy and asthma patients are not at more risk. They do not necessarily get more severe infections either. However, all attempts must be made to keep allergy and asthma under control.

Dr Ravi Andrews is a Nephrologist at Apollo Hospital, Hyderabad.