Facts Vs Myths: 30 questions & answers on COVID by senior Apollo doctor

Hyderabad: Always remember, the enemy maybe invisible but not invincible! Research is going on and concepts are likely to change. Irrespective, the basic principles of SMS (Social distancing, Mask, Sanitisation) will not change. We will soon have validated treatment and effective vaccines. Humanity will win this war but empathy, common sense, human values, family support, prudence and simplification of the very concepts of life will take us to victory faster.

01 : When to hospitalize home-treated mild Covid-19 patients?

When there is shortness of breath, shallow breathing, chest pain, rapid heart rate, drop in oxygen levels, drop in blood pressure or worsening of existing symptoms.

02. Is there any definite treatment for Covid–19 infection?

At the current stage, there is no definite treatment and most of the treatment is supportive and targeted towards management of complications like using blood thinners and steroids. However, some experimental drugs like Remdesivir, Favipiravir, Tocilizumab, Ivermectin, Doxycycline have shown promise. Usefulness of HCQS is still doubtful but under investigation.

03:Is convalescent plasma therapy helpful?

Yes it is. However, further research is needed to understand safety, efficacy and optimal timing.

04: When will the vaccine be available?

Not before late 2020 or early 2021. Any vaccine needs at least 3 phases of trials. Phase I Trials involve a small number of healthy volunteers. The main focus is on safety. This phase takes at least 2 months. Phase 2 Trials involve a small number of healthy volunteers and the main focus is on efficacy. Since it takes at least 1-2 months to build up antibodies and often booster doses are needed, this phase takes 2- 3 months. Phase 3 Trials involve a large number of healthy volunteers to study both safety and efficacy in a large number of people. This phase takes 2 -3 months. Subsequently, the vaccine will be given first to high risk people like the elderly, those with low immunity and health care workers.

05 : Why is there so much variation in Covid -19 infection rates among countries with similar climate, lifestyle and location?

Possibly due to a combination of poor cooperation by the common people and poor management by the respective governments.

06: Are children good transmitters of Covid-19 infection?

Though children have less symptoms, they are good transmitters of Covid-19 infections. They are known to be good transmitters of most respiratory viruses.

07:Which animals can get Covid -19 infections?

Bats and Malayan pangolins are hosts along with humans. Ferrets, cats and Rhesus Macaques can get infected. Dogs, pigs, chickens, ducks and sheep do not get infected.

08 : Does ethnicity and race influence Covid-19 infections?

Yes. Blacks, Asians and Hispanics are more likely to get severe infections.

09: Is pregnancy a risk in Covid-19 infection?

Yes, pregnant women are at a higher risk of severe infections due to their impaired immunity.

10 What to do if a pregnant woman gets severe Covid-19 infection?

She should be treated like any other person, ignoring the pregnancy. She can have more pregnancies in the future only if she stays alive!

11.Are men at a higher risk of Covid-19 infection than women?

Yes, men are at a high risk due to higher levels of ACE2 receptor protein which is needed by the virus to enter the lungs. They also get more severe infections. Risks are 30% more in men. However, after the age of 60 years of age, the risks are equal in both sexes.

12: Why did Covid-19 infection reach Europe and USA earlier?

Due to more air travel to these places. They had less time to prepare.

13.Will summer decrease the spread of Covid-19 infection?

Theoretically, yes. Dry air and higher temperatures slow down the spread of respiratory viruses. Less crowds in the open due to heat, better home ventilation, no schools, all these impair viral spread. Social distancing must still be practised though because summer on its own cannot stop the virus.

14. Is a second wave of Covid -19 expected to occur?

Yes, because herd immunity will not be achieved very soon. Vaccine is still not available. The consequences may not be so severe though. Those countries that have effectively controlled the pandemic will be at a higher risk of a second wave if the effective controls are relaxed prematurely.

15.What is the risk of contracting Covid-19 infection through different surfaces?

The virus lasts 3 hours in aerosols, 2 days on stainless steel, 3 days on plastic (Another reason to get rid of plastic!). Though the viral load reduces 100-fold after a day or two, it is safer to avoid touching these objects as far as possible. The virus doesn’t last long on copper and cardboard.

16.Can sunlight inactivate the virus?

Yes, sunlight can inactivate 98% of virus within 15 minutes.

17: What are the lifestyle factors that play a role in Covid- 19 infections?

Smoking, stress, dietary indiscretions, alcohol and obesity all increase risk of infections as well as severity. Lifestyle modifications should be made to avoid these factors.

18. If someone is experiencing Covid- like symptoms, is it an absolute must that they should get tested? Can’t they just home isolate?

It is better to get tested otherwise one is forced to isolate totally from everyone for at least 14 days. Imagine you have a simple common cold and you isolate for 14 days unnecessarily, thinking it is Covid- 19. Isolation for 14 days is not easy… it can affect you socially, economically, physically as well as psychologically. Also knowing you have Covid infection would put you on guard because moderate or severe Covid typically worsens after the 8^th or 9^th day.

19 .How to effectively clean vegetables?

There is no need to make any special provisions to clean vegetables. The Covid- 19 virus cannot survive soap and water cleansing nor can it withstand high temperatures. Just ensure the vegetables are washed well and cooked properly. Ensure hands are washed with soap for at least 20 seconds after cleaning the vegetables. Preferably wash the vegetables in warm water.

20. Can Covid infections come a second time after the first infection in an individual? What are the precautions to be taken?

Yes it can. From whatever knowledge we have so far, protection after the first infection does not last longer than 3 -6 months. The usual precautions that are needed to prevent the initial infection should be taken.

21. Is there any impact on the central nervous system if Covid- 19 positive?

Covid infection has the following rare neurological symptoms: Brain strokes, Encephalitis (Brain fever), confusion, paralysis and numbness. Asymptomatic patients have no symptoms either related to nervous system or otherwise. However, they may develop psychological issues like depression, irritation, fear psychosis, etc.

22.What should a kidney transplant patient do if he gets Covid- 19 infection? Home isolation or hospitalization?

The same criteria as described in the earlier questions for home isolation v/s hospitalization should be followed for transplant patients. The kidney specialist will decide if the infection is asymptomatic, mild, moderate or severe. Asymptomatic and mild cases can be managed at home. Moderate and severe cases should be admitted in hospital. The same recommendations apply for CAPD and haemodialysis patients.

23. Is there a natural way of increasing oxygen levels?

No. If the lungs are significantly damaged, no amount of natural methods will help. However, one can increase normal lung capacity and improve normal lung function by breathing exercises, pranayama, cardiovascular training, lying down on the stomach for 2-3 hours in a day and avoiding smoking and air pollution.

24. How effective are Unani and Ayurvedic medicine for increasing immunity?

Ans. Unani and Ayurvedic medicines are not effective for improving immunity. Some of these medicines can cause kidney or liver problems.

25. Any special precautions to be taken for children?

Ans. Children are more likely to get asymptomatic or mild infections. They do not need special precautions. The usual precautions of SMS and good nutrition should be applied. Junk food should be avoided and crowded areas should be avoided.

26. What is the best diet?

Ans. Hygienic diet, freshly prepared. Avoid junk food. Have more protein, less carbohydratyes and less fats. Have plenty of nuts and fruits, especially citrus. Plenty of fluids and minimise salt.

27. If someone has cough/cold/sore throat/fever, is it possible to confirm it is not Covid- 19 infection without doing tests?

No, it is not possible to rule out Covid infection without doing RT-PCR nasal swab.

28. If patient has an underlying disease like kidney, lung or heart disease, etc, what is the percentage of recovery from Covid-19 infection?

It is difficult to estimate percentages of recovery in individual diseases because this depends on a lot of factors like age, ethnicity, general health, medications, stage and control of underlying disease, etc. However, statistically, the most Covid-19 deaths are seen in patients with high blood pressure, followed by diabetes, high cholesterol, heart disease, kidney disease, dementia, lung disease and cancer…in that order. The interesting thing is that most of these are lifestyle diseases.

29. What next after 14 days of home quarantine?

After 14 days of home quarantine, repeat nasal swab for RT –PCR, if negative, get back to routine activity. Follow standard precautions of “SMS”. Continue dietary changes. Vitamin supplements are can be continued. 28 days after RT –PCR is negative, consider donating your plasma for the benefit of fellow human beings. Contact authorised blood banks for guidance on plasma donation.

30 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.

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