Virus Isn’t Going Away, Prevention Is Our Best Bet

Coronavirus has turned our lives upside down in more ways than one and even after a year of the pandemic being officially announced, the world is not in the green. As a community medicine practitioner in Epidemiology, I have been studying the behaviour of the novel Coronavirus and its host, us, the humans. Yet, no matter how much I study things in detail, I always come to the same conclusion about the Coronavirus: This virus can change forms (mutate) and come up with new strains faster than we can figure out its cure or vaccine. So, our best bet right now is to avoid the virus! The prevention is easy; the cure may not be.

Our best preventive tools – masks, hand-wash and sanitisers are now easily available. What is not easily available is the will in most people to co-operate and use these tools both for individual safety as well as public health. Even as the number of infected cases and resultant fatalities rise, there is a certain nonchalance in public behaviour regarding the risks. On March 27, more than 62,000 new cases were registered across the country, with over 300 deaths. The first time that the number of people infected in a single day went above 50,000 was July 27, 2020. The last time that the number of new cases went above 50,000 was November 6, 2020.

Even though the number of new infected cases is going up, the ratio of the number of people losing their lives to the infection, is so far less in 2021, than it was in 2020. However, those suffering with manifestations are showing somewhat severe symptoms than before. Though panic is never a way forward, but we should not definitely let our guards down yet as well.

We are seeing a renewed, fresh wave of the virus because the virus has mutated (changed its basic genetic structure and developed newer, more dangerous strains) to survive in its human hosts. We have learnt some strategies to cope with them and the virus too has gained new skills to dodge the human immune system! The influenza virus mutates almost every year and develops new strains. We will have to see which way the wind blows for the novel coronavirus. It definitely has mutated within a year.

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With newer mutations coming up globally we are faced with the threat of the new strains, the UK strain, the South African strain, and the Brazilian strain. It is the antigens that are responsible for stimulating the production of antibodies by the immune system. Even minor mutations depending on the area of the virus they have occurred in, can play in a big way with our immune systems, and are known as ‘variants of concern’. These new variants are identified using a process known as genome sequencing, which reads and then interprets the genetic information found in the RNA- Ribonucleic acid (in this case) of the virus. We need to study the virus to be able to fight it better.

India, through genome sequencing has also detected what is known as a new “double mutant” COVID-19 variant. This means that two important changes are coming together in the same virus. The mutations are basically affecting key areas in the spike protein (the crown-like area which helps the virus to latch on to human cells) of the coronavirus and thus helping them skip or escape the resistance offered by our immune system. This is mostly affecting states like Maharashtra and Delhi the most. Other states closer to these two are also reporting increased number of cases. This is probably because these two states have the maximum international travel (both inward and outward) and thus the maximum exposure to the virus, both by way of the original strain (from Wuhan, China) and the 3 newer strains. At least 18 states and Union Territories in India now have different strains of coronavirus running amok: the UK strain, the South African strain and the Indian strain, so to speak. The threat of infection is high.

What all this means is we are taking one step forward and two steps back in terms of handling the pan-world health crisis. We were all thinking that with the vaccine we would now be saved, but the virus is changing in ways that render the vaccines weak. We cannot say that a person who has been infected once and has received the vaccine as well, won’t be re-infected, though it depends upon an individual’s immune strength as to how his/her body will react and to what level they would be affected.

However, the scientists suggest that the severity of the disease will be bit lesser among the vaccinated individuals – a ray of hope, but still the battle against spread of infection, is on. During the first wave of coronavirus in March 2020 what saved us was the lockdown; it helped in more ways than one to trace and isolate and further treat infected people. However, for all purposes, a second nationwide lockdown doesn’t look feasible, because it affects the people financially when they are not able to earn their livelihood.

What we need right now to handle the second wave is a really strong execution of the plan we already have in place. Public health awareness was already achieved during the first wave; almost the whole population is aware of the crisis as well as the solution, but what is missing is a respect for solutions and the motivation to enact those simple behaviours.

We need strong public health advocacy. Everyday we need to educate, organize and mobilise to change the reluctant and seemingly over-confident attitude among the mass as a whole.  We need people at the grassroots level to reinforce for good the safety measures. So many people have let their guards down after one year of the pandemic. The various state elections, the many political rallies, the many religious festivals (we have the upcoming Kumbh Mela) have all contributed to the pandemic still holding fort really strong. We need strong community level leadership at every possible level. Anyone with a voice that is heard and respected should advocate for the use of masks, regular handwashing and social distancing. I wish some religious leaders across faiths weren’t so dismissive of the severity of the pandemic; since many people listen to them.

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We need to reach out to these leaders so that they can influence their followers. Faith must meet science if we want to overcome the pandemic. Political leaders at centre and state levels need to reach out to every kind of leaders possible, to bring about behaviour changes among the people to eliminate the virus from amidst us. To use a sociological concept, we need to the diffuse ideas of public well-being and precautions so that they become culturally acceptable and thus practiced among large parts of the population. The media plays an important role here.

The onus this second time around is truly on the public. We will keep losing the race to the virus until we follow the basic measures stringently. Lockdowns can only stop inter-cluster exchange or two areas with infection from interacting with each other and thus ceasing a larger spillage, but it may not stop intra-location infections. Nowadays, we have a huge number of people living in societies and apartments. Even if they go out only to buy essential items, but don’t follow basic precautionary measures like masks etc. they can still infect or be infected.

All of us depend on each of us this time. It’s kind of “One for all, all for one” idea! As a Community Medicine expert, I once again want to emphasise that it is the community spirit which will keep us safe and alive. Each one for another! The virus alone is not the real enemy, but our relaxed approach to the virus certainly is! We can weaken it in some time if we strictly follow the rules. The so called herd immunity has not shown promising results in this case, so individual immunity is all we have to turn our communities healthy. If we don’t want another lockdown, let’s bring out masks, sanitisers and the will to keep fighting the contagion – by respecting the social distancing norms. Let us put all efforts to develop a “behavioural herd immunity” this time.

The writer is an epidemiologist at College of Medicine & Sagor Dutta Hospital in Kolkata)

‘In Initial Days Of Covid-19, Doctors Lost Sense Of Time’

Dr Arista Lahiri, 31, Sr Resident (Epidemiology) at College Of Medicine & Sagor Dutta Hospital in Kolkata, recounts how healthcare professionals battled the unknown virus and why we can’t let the guard down even now

I was fresh out of medical school when the pandemic struck. Even though my field of study was community medicine and thus I was well-versed with the incidence, spread and possible control of diseases during an epidemic/pandemic, yet nothing had prepared us for a crisis of such epic proportions that affected the whole world.

I was posted at the District Hospital in 24 Parganas (North) and had gone to another city to attend a medical conference in January 2020 when coronavirus began to be discussed seriously. Wuhan was already reeling under its impact and slowly the medical fraternity across the world had begun to realise that the virus was soon going to spread much, much farther than China.

In March-end, when the pandemic was officially declared in India, I dedicated myself completely to fighting the unknown virus. We were a four-member team doing 24×7 surveillance of both active as well as potential cases to target and isolate. We were doing everything from data entry to helping Covid patients get admission in hospitals to occasionally going out in the fields to see how the situation was panning out.

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For two-three months we had no sense of time, putting in every hour of work that we could and going home only to sleep. We had no life outside work for those several months and no outlet to unwind. We just kept each other motivated and in good spirits.

Dr Lahiri says battling the virus is not the job of healthcare professionals alone

I was myself scared of the contagion; there were so many people suffering around us. Each day, I pulled myself up and marched on stronger. My parents were extremely supportive and understood my duty as a medical professional.

While the rest of the country was facing only Covid, nature dealt a double blow to West Bengal: cyclone Amphan. I am quite happy with the way our state government handled the crisis. The entire state machinery from the primary to district to state-level worked in tandem. Post-Amphan, there was a shifting of roles and responsibilities and I was asked to be a member of the Covid State Cell in Kolkata in June end.

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We had all learnt better by then and were able to streamline our work better. The workload eased off just a tiny bit, though we were still checking in hundreds and hundreds of patients each day. One thing I was happy about was that I was now living with my parents in Kolkata.

Since then I have been working in Kolkata itself doing 12 hour shifts every day. Between my work as faculty at the College of Medicine and my work at the Sagordutta Hospital, I have to travel nearly 40 kms each day. We cannot afford to slack off even now, though we can relax a bit.

Battling the pandemic isn’t the job of frontline healthcare workers alone. Community medicine is all about a community’s adherence to rules. Even though vaccines have been developed, we need to understand that new strains of the virus might still take over. So masks, sanitizing and social distancing are still our best bets against the virus! I got both my vaccine shots, but I still take all the precautions.

‘Vaccine’s Only Side-Effect Was Mild Fever Overnight’

Saroj Kumar, 49, a family welfare counsellor and frontline worker amid Covid-19 in Uttar Pradesh, is feeling relieved after receiving the vaccine on the first day of the immunisation drive

I work as family welfare counsellor at a Community Health Centre in Moradabad (Uttar Pradesh) and I can proudly say that healthcare sector workers like us have been the backbone of India’s fight against coronavirus. We faced the virus day in and day out without fear, hours on end.

It was therefore a big relief when the government announced that health professionals and other frontline workers would be vaccinated on priority. As a healthcare professional I was among the people to be vaccinated on January 16, the first day of the immunisation drive.

We had been asked to register ourselves a day prior to the vaccination and post-registration, I was told to reach the designated health centre for the serum shot. I reached the centre at 12:30 pm where my temperature and oxygen levels were checked the first thing at the gate. Next, I was given hand sanitisers and waited for my turn.

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Once I was administered the vaccine jab, which hardly took a minute, I was kept under observation for around half an hour at the centre. Two girls who were making a note of the entry and exit timings of the vaccine beneficiaries, also checked if any of the vaccinated person showed any discomfort or adverse reaction. We had been told that there could be mild side-effects.

Saroj Kumar (wearing a facemask and inset) took a selfie while waiting for the vaccine

My workplace (the very centre I was vaccinated at) is nearly 60 km from home. On the vaccination day, I took the regular bus and faced no discomfort per se on the way. However, I ran mild fever after reaching home around evening. The fever lasted overnight and in the morning my body temperature returned to normal. I am feeling fit as a fiddle now.

During the pandemic when public transport wasn’t available, reaching my workplace was tough. So I had requested to be temporarily allowed to work at a health centre nearer home. The authorities were considerate and I was assigned work at the Chief Medical Office’s office closer home.

My new role was to take calls at the Help Centre. Since it was the beginning of the pandemic, we had to field hundreds of calls each day. So, I can tell you there was much anxiety among people and patients about both the pandemic and its prospective treatment or vaccine.

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Now, I have been working with Covid-positive patients who are isolating at home. Every morning, a doctor, I visit these patients in our district and administer medicine to them as well as monitor their condition. Covid is contagious, but for most people, not deadly. Yet, people are scared as it has caused so many deaths.

I am glad that people like us will now feel completely free and safe after the twin vaccination shots, since we meet many Covid positive patients every day. I am not scared of the virus, but I do have a family of four to take care of. The vaccination process has brought me a lot of mental relief. Given how successful our polio vaccination programme was in the past, across the length and breadth of our country, I am sure we will win the fight against Covid too.

As Told To Yogmaya Singh

‘Proud To Be A Part Of Vaccination Programme’

Savita Paliwal, 52, a senior vaccinator in Moradabad (UP), is happy to see India among the first few countries to launch vaccination programme early. She explains how the monumental process will unfold

I have been in the medical profession for nearly three decades now and have been involved with quite a few vaccination and immunisation programmes. As a government employee at the Community Health Centre at Thakurdwara, Moradabad, I have been actively involved in building a healthy society. However, this time it is quite different.

Dealing with the Covid-19 is something that we have never seen before in our entire career. Healthcare professionals have been on their toes for nearly a year now. And with new strains coming up at different parts of the world, the challenge is only getting tougher.

It was therefore both a moment of relief and pride when we were informed that India is one of the first few countries to start vaccination programme. We have compiled the beneficiary list in our zone and have had two dry runs, on January 5 and 8.

We have been divided into two teams of three members each. Both teams have one vaccinator, one helper and a data expert (someone who keeps track of the beneficiaries who get vaccination). Healthcare professionals, especially the pharmacists and paramedical staff will be given the vaccine on priority basis.

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The phase 1 of the programme begins on January 16. Each team is supposed to vaccinate 25 people in a day, so in our locality you can say that the Community Health Centre employees will be vaccinating around 50 people daily. The process will be spread across five rooms with standard operating procedure in place like regular sanitization, temperature screening etc.

Savita Paliwal (middle) with her colleagues at Moradabad community health centre

The DM (district magistrate) was very involved in how the dry runs were conducted and there was total cooperation from the Chief Minster’s office as well. I feel happy that we are all functioning as one smooth machinery.

Of course, many people are scared of taking vaccines but as someone with an extensive experience in this field I know how to soothe people. Asha workers are also involved in the vaccination programme, and spreading awareness about it.

Moradabad was declared a hotspot last year and I would say we expect most people to be co-operative. No query of the beneficiaries will be considered insignificant and we will take care to also inform them of the minor side-effects they might encounter after the vaccination.

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I feel lucky to be a part of this monumental process. I have been keeping myself updated with all the news about vaccines developed in India as well as other countries and I would say so far we have handled the Covid-19 situation really well. But it is not over yet and the pandemic needs the cooperation of every single citizen of the country. I make it a point to carry extra masks in my bag and hand them free to anyone I see not wearing a mask.

I feel proud that India developed and mass-produce a vaccine in good time and now we aren’t dependent on any foreign country for the immunity programme. I wonder how the scientists who developed the vaccines must have raced against time to save as many lives as possible. I hope the process goes smoothly. We have managed and eradicated polio and now we are confident we shall put corona virus behind us too.

‘Docs Are Giving Their Best, But Public Support Is Vital’

Dr Neeta Shrivastava, 37, a microbiologist in Mumbai, reveals how health workers keep tough schedule at work and then also manage household chores in the absence of house helps

I am a clinical microbiologist. Which means I handle the team that interprets the details of swab samples from the testing lab to determine whether a person has been infected by Coronavirus or not. A team from the authorised testing labs is present in various hospitals and collects the swab samples of suspect cases.

Our team has been divided into two batches and we have been asked to report to work only on alternate days. This is to ensure that if even a single staff member gets affected, it doesn’t spread to the entire team. These are crucial times and we cannot take any chances.

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Currently, there are only two government and six private labs in Mumbai doing the testing. Every day many people come but not everyone can be tested. It is only recently that Coronavirus test kits became available but as the cases spike we are on the verge of facing a shortage of test kits again.

We collect nearly 20 samples everyday, which are then sent to a lab. It is a time-consuming and a delicate process. Plus, a dangerous one too. We have to be very careful while handling samples. We have to wear PPEs (Personal Protection Equipment) all the time. Our team collects samples through nasopharyngeal swab that goes up the nose far back into the throat and collects mucous, saliva, and bits of cells.

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The number of Coronavirus cases in Maharashtra has crossed 300-mark (as on April 1) and Mumbai units are handling a major portion of those cases. The doctors here have been giving their best, just like in any part of the world. Dr Rajesh Tope is leading the charge in Mumbai and we have been able to hold fort pretty well in the metropolis. However, it would be helpful if the citizens started listening to an acting upon the guidelines too.

We as frontline workers are scared for ourselves and our families because here is a disease that even the medical fraternity has little clue about. But doctors know how to keep ourselves calm under pressure situations. And the public on its party must understand the urgency and cooperate.

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I have two kids, aged 1 and 7. It is difficult to manage work and home. Plus with the changing guidelines everyday that come from ICMR, WHO etc, means we get very little time to adapt to new situations. People with travel histories to foreign countries should be proactive in getting tested or at least letting the authorities know. Many doctors do back-breaking work at hospitals and then go back home for daily chores too, because the house helps have stopped coming. The medical staff needs to be well-protected and well-supported.

Many heart-breaking videos of doctors not being able to hug their children have been doing the rounds, but I find it difficult to keep away from my one year old girl. She needs me. I make sure I take a thorough bath after I return from the hospital, then I wash everything that I took to work with hot water, and it is only then that I touch my daughter. It is difficult but we will see through this.  My 7-year old understands what is going on and cooperates better than many grown-ups.