• Sunday, Sep 20, 2020
  • Last Update : 10:18 am

A plan for the pandemic

  • Published at 07:43 pm July 13th, 2020
covid
Photo: United Nations Covid 19 Response

Five months into the global pandemic, we know a lot more than we did when we went in. Our lives, however, have been irrevocably changed. With no clear idea about a real reprieve, and social media rife with fake news and misinformation, here are some clearer answers on the important questions.

When will the pandemic end?

It is hard to predict. We should be mentally prepared for the pandemic to last until mid to end of 2021.

What should we do then?  

We need to learn how to live with it. We have to continue social distancing, hand hygiene and using a mask.

Will a second wave come?

Yes, most likely. Many countries that are on the downslope of the curve now are opening up and at the same time preparing for a second wave.

When are we going to have a vaccine?

Most likely by the end of this year. Work is in progress on more than 140 vaccines and about 20 of them are in the human testing phase.

I had Covid symptoms and have tested positive, what should I do?

Take rest, drink plenty of water, take paracetamol if you have fever. Eat fruits rich in vitamin C or take a vitamin C supplement. 

Isolate yourself from the rest of your family members for 10 days.

You can keep a pulse oximeter at home. If your oxygen saturation drops below 92%, you should seek medical attention.

When should I get admitted to the hospital?

If you develop breathing problems, continuous chest pain, mental confusion, inability to stay awake, bluish discoloration of face and hands, you should go to the hospital.

Can Covid symptoms come and go?

Yes. Patients may have recurring symptoms alternating with periods of feeling better. Varying degrees of fever, fatigue and shortness of breath can persist for days or even weeks.

Does gargling and tea help with fighting Covid?

Gargling with warm water and drinking warm tea may help if you have sore throat or other cold symptoms. If you are completely well, these measures will not prevent you from getting Covid.

I have Covid and am being treated at home, should I take dexamethasone?

Absolutely not. The recovery trial done in University of Oxford, UK showed benefit of dexamethasone only in hospitalized patients with severe respiratory complications. Dexamethasone is a steroid that suppresses immunity, increases blood sugar, impairs wound healing, causes muscle weakness, stomach bleeding and have many other side effects. 

Taking it at home by Covid patients may cause more harm than good.

Should I take Ivermectin to prevent or treat Covid?

No. There is no completed clinical trial to prove that Ivermectin helps in Covid. One study done in Monash University in Australia showed Ivermectincan kill the virus in cell culture in laboratory. This study was not done on human beings.

US FDA clearly advices against using ivermectin. Monash University itself on their website clearly states “Ivermectin cannot be used in humans for Covid-19.”

Ivermectin is used for treating parasitic worm in humans. It may cause liver injury, severe skin rash, sudden drop in blood pressure, dizziness, confusion, seizures, nausea, vomiting, diarrhea and many other problems.

How about doxycycline and other antibiotics?

No antibiotic should be taken to prevent Covid or for mild symptoms of Covid. 

Antibiotics work against bacteria. Covid-19 is caused by a virus, not bacteria.

My friends claim they became Covid negative from positive just a few days after taking doxycycline, ivermectin and other antibiotics. How did that happen?

Your body’s own immune system fights against any virus. More than 80% of Covid patients will get well without any medication at all. If larger number of testing is done, this number could reach well above 95%.

Your friends would recover in the same time period even if they did not take any of these medications.

You are talking from US perspective. In Bangladesh the situation is different and I think we should take antibiotics, right?

Wrong. There is no evidence that these medications work against Covid in any part of the world. Taking unnecessary medications may cause more harm. Medications have side effects and irrational use of antibiotic will increase antibiotic resistance. That means these medications may not work in future when you really need them.

Why are antibiotics then used in the hospital for Covid patients?

Some antibiotics are being used in the hospital for severely ill patients as a last resort. There is no proven benefit. In some cases antibiotics help with a secondary bacterial infection, that is, another infection superimposed on the Covid infection in lungs.

I have developed fever, cough and body ache but am not able to get a Covid test. What should I do?

Treat yourself as a potential Covid patient.  

When can I go out?

If you have no fever for 3 days and other symptoms are improving, and it has been more than 10 days since the first symptoms started, you do not need to be in isolation any longer and may go out. This is the CDC guideline.

I have no symptoms but tested positive, what should I do?

Isolate yourself for 10 days from the rest of your family members. Watch for any symptoms.

You do not need to take any medications.

You may go out 10 days after testing positive.

I have a pulse oximeter at home. What level of oxygen saturation is low enough to get admitted to a hospital?

You should seek medical attention if the oxygen saturation drops below 92%.

I have recovered from Covid symptoms, but repeat test is still positive. What should I do?

Repeat test may be positive because you still may have some remnants of the virus in your body.  It does not mean you still have an active infection. You are unlikely to transmit the disease and may go out.

Patient admitted to hospital with Covid symptoms initially tested negative, but repeat test was positive, how come?

Covid testing can be false negative in up to 30% cases. It could be due to error while taking samples or from laboratory errors. If a patient is admitted with typical Covid symptoms, he should be treated as a Covid patient although the test is negative.

What is the difference between isolation and quarantine?

Isolation is done to separate a Covid positive patient from the rest of her family members.

Quarantine is done when a person is thought to have been exposed to a possible Covid patient without proper protection. Quarantine is typically done for 14 days.

What should I do to reduce stress level?

Stay informed, but do not obsessively check things online. Use trusted sources for information like CDC and WHO. Stay away from social media and news  if you start feeling overwhelmed. Focus on things you can control, like handwashing, social distancing and using facemask. Write down specific worries you may have about Covid-19 and discuss with a trusted health care professional.  Stay connected with friends and families by phone calls and video conferencing.  Maintain a daily routine and regular sleep cycle. Take time out for activities you enjoy like reading a book, watching a movie, trying a new recipe, craft or art. Exercise regularly and get out in nature, if possible. Avoid self-medicating. Try meditation. Reach out to others in need. Helping others will make you feel good.

I am not a health care worker, but work outside. Should I use the coverall suit?

Absolutely not. Improper use of coverall increases the chance  infecting others and yourself. Moreover these coveralls can cause dehydration and discomfort in warm weather.

Should I wear gloves?

No. CDC and WHO do not recommend using gloves for people who are not healthcare workers. If you are using the same gloves all day, you are increasing the chance of contaminating yourself and others.  

Best measure is to wash your hands frequently, 20 seconds each time.

Does Covid spread by shoes?

The chances of spreading this virus from shoes are very small. To be on the safer side, you should keep your shoes used outside at the door and use separate shoes or sandals inside the house.

How to handle letters?

There is no clear evidence that Covid spreads by letter. The chances are very low. You should wash your hands after opening the envelope.

How should we  handle grocery?

Wash the packets with soap and water or wipe them with disinfectant. Wash fruits and vegetables thoroughly with clean water. Wash everything well before putting them in fridge. Wash your hands before and after handling and washing the grocery.

Can Covid-19 spread through coins and back notes?

Currently there is no evidence to prove or disapprove this. However respiratory droplet from an infected person can contaminate the surface of a bank note or coin. Wash your hands after touching any coin or bank note.

How to clean clothes worn outside?

Wash your clothes with soap and water. Soap effectively destroys the virus by breaking its outer layer.

Do I need to disinfect sidewalks?

No. There is no proven benefit of disinfecting sidewalks.

Does AC spread Covid?

It is possible, but we do not know for sure yet. Air borne transmission is thought to be responsible in Covid spread among members of a choir in Washington, USA, an apartment building in Hong Kong and a restaurant in Wuhan, China. In a closed space with many people, windows closed and the air conditioner running without proper filtration, the chances of the infection spreading is higher.

Open the windows whenever you can.

Does warm weather kill the virus?

Some laboratory experiments suggested that temperature and humidity may reduce the viability of SARS-CoV-2, the Covid-19 virus. Even if one assumes that SARS-CoV-2 is sensitive to climate as other seasonal viruses, summer heat still will not be enough to slow its initial rapid spread through human population.

Is fridge food a problem?

A 2010 study showed SARS virus survives longer in colder temperature. We do not have any data on Covid-19. Wash your food before putting it in the fridge. Wash your hands before and after handling the food.

Does it spread from dead body?

Viruses do not replicate in a dead body. A dead person also does not cough or sneeze. However the virus can remain on the surface of a dead body for several hours. No one should touch the dead body without proper protection. People dying from Covid do not need to be buried a separate graveyard.

Can I go the gym?

Risk of spreading infection is higher in a crowded gym with poor air filtration system.

It is safer to exercise outdoors or at home.  

Should I wear a mask during exercise?

No. Masks reduce the ability to breathe comfortably during exercise. It is important to maintain physical distance during exercise.

Does alcohol protect against Covid?

Absolutely not. Alcohol increases risk of other health problems.

How about smoking?

Smokers have higher mortality in severe lung diseases.

If you smoke, this is the time to quit.

Can I get Covid from a swimming pool?

Quite unlikely. The chlorine treatment of a swimming pool should kill the virus. The bigger risk is not from the water itself, it is from how close you are to other people in the water.

Can I use elevators?

A crowded elevator with poor ventilation increases the risk.  

Use your elbow instead of fingers to push the elevator buttons.Take the stairs if you can.

Is antibody test helpful?

Antibody test can only tell that you had Covid infection in the past. This could be infection with severe symptoms, mild symptoms are no symptom.  So far we do not know that having antibodies will prevent you from another Covid infection. You should still continue practicing the preventative measures.

What is the most important take-home message?

Stay positive, stay positive, stay positive.

Even if you get Covid-19, there is more than 95% chance that you will recover.

Anything else?

Like everything else in medical science, study on Covid-19 is evolving.  

What we are saying today, may change tomorrow.

Sources:

www.cdc.gov

www.hopkinsmedicine.org

www.harvard.edu

www.who.int

www.nih.gov

Nasser Khan, MD, FACC, FRCP is interventional cardiologist at The Iowa Clinic and adjunct professor at Carver College of Medicine, University of Iowa, USA


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