Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) the new virus which has caused a pandemic has infected millions of people and led to over more than 100,000 deaths, and the numbers are drastically increasing. Currently, the infection rate in India is significantly much lower as compared to worst-affected countries. Several measures have been adopted by the government to stop the spread of COVID-19. This article addresses the common questions raised by the public in terms of COVID-19 and its effect in India. Scientific evidence has been taken from published literature and inspired by Indian Chest Society.
COVID-19 is spreading widely all across the globe. Sources of infection cannot be effectively identified due to a lack of symptoms. Broadly speaking, in a population like India, it’s tough to manage the situation where dealing with symptomatic patients itself a big challenge. Studies so far do not show promising results. While there are a few papers suggesting that pre-symptomatic or asymptomatic carriers may cause COVID-19 transmission, there has been no evidence as such. We need to understand the degree to which pre-symptomatic or asymptomatic infections can transmit to the general population. However to screen such infected carriers in larger close contacts or in the general population, and assess their risk for transmission, especially in the Indian scenario is tough as priority lies more with positive or suspected cases with symptoms.
We may think that once tested positive for COVID-19 and treated, we may not encounter the virus again, but shocking reports from China and Japan suggest otherwise. China-based media in February said that 14% recovered COVID-19 patients in Guangdong tested positive again. According to an NHK-World Japan report, even in Japan 70 people got infected again after being discharged from the hospital.
So, Indians who have been discharged from the hospital after COVID-19 treatment should not roam out and should take precautionary measures. In terms of science, we can say this is a novel virus which your immune system has not encountered before so there is no partial immunity against the virus. We need conscientiousness while dealing with this. It might be the complex orchestra of different cells. A study in 2007, published in Emerging Infectious Disease conducted on 176 SARS patients showed antibodies remain at the same level for about two years in a patient’s blood on an average. During the third year, antibody level dropped steeply, which suggests that reinfection is possible after three years but it may differ in case of the Indian population and depend on a person’s immunity.
According to the definition: Herd immunity is indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination thereby providing a measure of protection for individuals who are not immune. The virus will continue to spread until an effective vaccine exists or sufficient members of our global population have been infected. As far as a vaccine is concerned for COVID-19, we require safety evaluation for immunopotentiation that increases eosinophilia infiltration or increase the infectivity. We should primarily consider who are suffering significantly – front-line healthcare workers, elders above 60, patients with a history of hypertension and diabetes – they must be prioritized for clinical trials of a vaccine.
The COVID-19 RT-PCR test is a realtime reverse transcription polymerase chain reaction for the qualitative detection of SARS- CoV-2 collected from nasopharyngeal or oropharyngeal swab, even bronchoalveolar lavage or nasal aspirate can be used from individuals suspected of COVID-19. Reports are generated within 24hrs after samples are collected under trained personnel. In a recent study on sensitivity of Chest CT in comparison to RT-PCR it was (98%vs71%) RT- PCR is highly reliable; it might be low patient viremia or improper clinical sampling suggesting that in patient with clinical and epidemiologic features showing RT-PCR testing negative it must be confirmed with CT-scan. In India, we cannot have so many confirmatory CT scans done. Researchers are working and will surely come up with affordable and time managed tests like detection of IgM and IgG antibodies which get elevated once you are encountered with virus recently.
Temperature and humidity may help as some viruses cannot resist environments above a certain temperature, but in case of COVID-19 I think it has not played much of a role, talking in context of India, temperature has already risen above 30degree in most part of the country but it has not decreased the mortality rate. But one of the studies done in China titled ‘Effects of temperature variation and humidity on the death of COVID-19 in Wuhan’, China suggests temperature variation and humidity an important factor affecting mortality from COVID-19.
So, far we have not come up with any medication or vaccine but in most of the cases, a combination of old drugs hydroxychloroquine and azithromycin (secondary infection) is used, in severe cases antiviral and anti-rheumatic combination is added. Again, it depends on the patient’s severity, ICMR guidelines are followed regarding the protocol for the treatment. But for general public please don’t take any medication without consulting a doctor, it may cause severe side effect and can even lead to death. Regarding herbal or alternative medicine, some studies are been done in China, Japan and South Korea where they used herbal medicine with vitamin C and other ongoing drugs. Results were not so potent but helped provide some relief to the patient or reduce cough, restlessness in breathing and other respiratory issues.
N-acetyl cysteine which acts as an anti-mucolytic and antioxidant will not be of any harm to give to patients who are in respiratory distress, but very few studies have been done till date.
Viruses transmit by different sources; it can be controlled if we break the chain of transmission. Lockdown is one such method which will help to reduce the transmission, at the same time, we can get the people who are really affected to come out from the home. People who are home quarantined should be isolated for at least 14 days or even more, the extent of isolation will definitely decrease the rate of transmission to other people.
Convalescent plasma therapy for critically ill patients cannot be used as per my knowledge, cells would already be infected when they are given from the recovered person, what other complications it can lead to, we really do not have much idea. It would be prophylactic for health care workers who are in frequent contact as suggested by Casadevall a John Hopkins Immunologist, still it arises many questions – how much antibody needs to be detected in a recovered patient? What is the optimal time for administration? We really need to explore to answer such questions. Several studies are being made that patients are getting recovered from plasma therapy in China but in India it has not yet started. The plasma therapy in case of Ebola virus did not show any promising result, so how far it can be implemented is a big question.
It is hard to say that virus can pass to mother to child but several cases have come in Japan and China where a newborn baby was found to be positive. However, very few studies have been done so far. In India an AIIMS Delhi doctor gave birth to a baby who was found to be negative, so more studies can give a clearer picture because placenta itself has protective mechanism against viruses. So far, protocols are made to treat pregnant women with COVID-19 positive and doctors are implementing that all over the globe.
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