Addressing webinar hosted by Guwahati’s Royal Global School, world-renowned cardiologist Dr Naresh Trehan answers pressing questions around COVID-19
Guwahati: Guwahati's Royal Global School is conducting webinars from renowned persons from their respective fields to aid children and parents during the nationwide COVID-19 lockdown.
The school recently hosted a session with world-renowned cardiovascular and cardiothoracic surgeon Dr Naresh Trehan. A Padma Bhushan and Padma Shri awardee, Dr Trehan has performed close to a whopping one lakh cardiovascular surgeries.
During the session, Dr Trehan answered the most pressing questions around COVID-19, and also debunked many myths related to it. Here are edited excerpts from the webinar:
What is the basic explanation of what is novel coronavirus or COVID-19 and how is the virus transmitted from one person to another? Also, given the world has previously dealt with deadly viruses like Ebola, SARS, MERS etc, the number of people affected were not as staggering as those infected with COVID-19. What would you attribute the exponential rise in the number of COVID-19 cases to?
Corona is the word that comes from the crown because the crown has spikes and the surface of this virus also has spikes. So, that’s why the name corona was coined. Earlier, we had many corona viruses and this is a variation of the same virus. What we are seeing now is like the cousin of the ones we’ve seen. That’s why we are saying it as COVID-19, and sometimes as SARS-CoV-2. So, we know that these viruses have been around, and the nature of all bacteria and all viruses is that they mutate for their own survival, as they see something working against them.
So when SARS virus came, although deadly, the death rate from it was 10% which is very high for any infection, but it was contained very quickly because the warning signs were sent out early. Same thing happened with Ebola, MERS, etc. There were deaths around the world, but miniscule as compared to this one.
What makes this virus different is: So the answer first starts with China. China did a major disservice to the country and to the world. This is bordering on criminality, that you could see that something was happening and that you hid it from the world. A lot of investigations are being demanded, but now investigations are underway. So far, we say most likely the virus is a mutation in animal from the wet markets, which are like prevalent in China, and other controversy surrounding it. But, the virus was hidden for over four weeks. That actually made it possible for this virus to travel with the people who are traveling in and out of Wuhan. And the Wuhan is a very busy centre of China. There are 30 flights a day out of Wuhan to the Western world only.
So that’s where this whole thing spread very widely. Look at Europe, Italy was the worst. There were two reasons – one in Italy, there was a design show where came from all over the world, and the Chinese were also there. In India too, the first identified case was from someone with a travel history to Italy, then of course, it came from Iran, etc. But point is that it had already spread so far before anybody knew, or was told that this is a dangerous thing that’s happening in Wuhan. So that is the culprit here.
The other part of this virus is that there is what we call an arrow factor. If one person gets it, how many people can the carrier infect? So if for SARS, it was one to one, in this case it is one to four. We can see the mathematical multiplication. This virus will spread very fast unless we break the chain.
Government of India responded quite well, quite early compared to other countries by imposing the lockdown. Lockdown brought into focus on how contagious it is, and what are the ways of breaking the chain. And if knowingly we didn’t imposed the lockdown, say in countries like in Italy, Spain, even Germany, then India doesn’t have the resources to cater to its huge population compared to these countries.
In the first phase of lockdown we were not ready with the infrastructure, then lockdown 2 happened. This had given the medical and health sector some breathing space. It has contained the chain, if not eliminated the chain. It kept the numbers under control, and the surge in the cases which you are witnessing now would have happened maybe three weeks ago. If lockdown didn’t happen then we would have been totally unprepared now.
In the meantime, the exposure from news media made everyone aware of the fact that there is such a thing as Coronavirus, which can which can infect you and make you sick. And also, we don’t know whether people are going to die.
Now, should we be careful, be fearful or be panicking? These are the three responses that come to mind.
One is the public, which is the most important part of any country, the way public will behave with what responsibility we had, that is going to come in. Second, how the government in its wisdom, controls of the situation. So there is the life versus livelihood situation. The whole debate is real and quite complex. Then there is the medical profession and its entirety. Doctors, nurses, technicians, sanitation workers need to work together. It is the army to fight for it right now. These three things must work in tandem. If we don’t, we will have a disaster on our hands.
We all have a responsibility, one to protect ourselves. Second, to protect your own family which may have kids and elderly people. And then those people who are not only elderly but also have some co-morbidities.
We have heard about quite a few cases of people infected with COVID-19 having no symptoms at all. Is the largely asymptomatic nature of the cases, posing the biggest threat towards the containment of the infection? And why is it that some people show mild/no symptoms? Also, how is it that different people are affected in varying degree by the virus?
So, you know, this is a double-edged sword. You’re happy that people contacted the effect, not toxic. So that was so strong that they could fight the disease. That means that they contain the virus. They overcame the virus. So the virus was there and it has a life of support as predicted, and with time, whatever it may be, we can build to overcome that.
Everybody should follow the three dharmas, no matter what religion you are. Your new dharma is threefold -- hand hygiene, masking and distancing. If you follow this, it is the only thing you can do to protect yourself, your family and you do yourself to the country by actually practising what is required of everyone. So everyone, irrespective of being symptomatic or asymptomatic or healthy, must wear a mask.
There was a study done, which says, one person who has the disease is not wearing a mask, and the other person who is within three feet of them and is not wearing a mask and the contact is close to 15 minutes, then the chances of the uninfected person to get infected is very high. Now, the infected person is wearing a mask, and the non-infected person is not wearing a mask, chances become medium, to low medium. If both of them are wearing a mask and within three feet of each other and more than 10-15 minutes exposure, then it becomes very little chance of getting infected. Logic has it if both of you are wearing gear, you are more than three feet apart, we recommend 6 feet apart, and even talking to that person or being in contact with the person for 10 minutes will reduced the chance. If you keep your interaction to one or two minutes, the chances of a non-infected person to catching it would be extremely, extremely low. So no matter which way you look at it, it takes responsibility today is to stop spreading the disease.
As educators, we would be very concerned about the safety of the children if and when they start coming to school. Parents too will have their own worries. Children perhaps would be too naïve to understand the severity of the situation once they meet their friends and start studies. What would be your advice to the educators, children, and parents regarding safety once school begins?
There is no 100% rule you can make, but all students should wear masks, your desks should be far enough from each other, minimum standard of three feet distance is to be maintained. Then there is the problem with the play field for children, so sports should be discouraged till we are in the middle of all this. Ideally non-contact sports should be started with.
Some day children will have to come back to school, it can’t be forever that they can’t come. Today what we are looking at is your holidays would have started anyway. So now, you will extend it in any case, and hopefully, the peak would have come and gone in June. But it will not disappear for several months now, so be prepared for a year. I think that we should we should reassess the situation in mid-June to say where are we, should we open the school or has revoked education being successful. Those are the classes that you’re holding by video conferencing, is it is it okay? So, there will be a new normal for a while and that new normal will exist till we find a vaccine and the vaccine then immunizes people enough to feed the field.
Now, second thing I want to talk to you is that we have reached the stage where there is a lot of economic distress. So, of course we have to start opening. Same thing as we were talking about the school applies to industry also. Slowly, there is the way to start. Everything normalises over the next couple of months. You can’t start suddenly.
There are three partners in this: one was the public on how we can all participate. The second is the government policies, how to open but there’s but at the same time, there’s a lot of demand from the business community for economic packages to come down, which will happen. Hopefully, the government will open its fists and help with fiscal health to get businesses started, again, including healthcare. Then the third limb is the healthcare providers.The healthcare providers are basically deliveries in the hospital. You have nurses, doctors, other paramedics, which goes into taking care of people. Now, the problem is that all the hospitals around the country in the private space are suffering from huge financial losses because we stopped elective work. That’s what the government ordered, thinking that COVID will come and then we’ll need all the hospitals. But fortunately, COVID didn’t come in its full fury and hospitals were empty. My main concern is being the medical army, which is the real army now the enemy is in quit fighting shape. There has been lot of anxiety on their part and we’ve been working to boost their morale.
Now, my point is we should not panic. We should be worried and be careful. If all of us as providers are careful, the community’s careful, we will win this battle. The sunny side to this challenge has given India a great opportunity to create more and innovate more in our country.
Now, in the “new normal” where we all have to learn to co-exist with the coronavirus, what all can we do in our homes to enhance our immunity?
Immunity comes from muscle and fitness. So, if you find yourself in a contained space because you’re not going out, you can do many things. One is, yoga which can be done on a mat. With just a TV there is enough yoga lessons going on every day. And if you already knew yoga, then surya namaskara is a complete exercise of all the muscles. So if you gradually increase the number of surya namaskar to 25-30, then that by itself is a complete exercise. Otherwise, you can do static bicycling, treadmill, or any form of exercise for 40 minutes a day. Also you must have proper nutrition that is protein. So avoid carbohydrates in excess or towards proteins. And that’s the best you can do for your own body and immunity. There are many grandmother recipes like tulsi and amla which builds your immunity. If you believe in it, you should take it.
I would like to add that it has caused a huge amount of mental strain. As a child you might be anxious about where are you going to go back to school, meeting friends, etc, and also anxious about that I shouldn’t get sick. But the adults have a much bigger drop, because they’re their canvas is to provide for everybody, their own business, will they be able to revive it, where is the financing coming, these things are very subjective. So for mental health, there is nothing like yoga. Nothing like the breathing. Also, listening to music, playing games might help. You just have to keep your mental health going and sooner than later, you will see that this will settle down.
But in the beginning, you said that there are messages coming that we have to live with this virus. Now we have lived with viruses forever, and this is not the last virus that’s going to come. But having said that, it does not mean that you throw up your guard and say it’s going to be around. That’s not the state. You have to keep up your guard and be careful. I don’t want people to get depressed or fearful, but careful. That’s the buzzword that you need to put into your head – be careful
Can patients of COVID-19 once treated, get re-infected with the virus?
So there is some confusion about that because from Korea, China, and some of other countries, there is news coming that the people who we thought were cured and now have got a second infection. The confusion here is that is it the same virus lingered on when they thought they were cured, but they will not really cured. That’s also possible because you get relapse of flu. Many people can relapse. The second is that is the virus is mutating. So effectively, that within a period of two to three weeks, it has mutated and re-infected these people. That evidence is not there yet. But possibly viruses do mutate, as you know, there is a vaccine against swine flu. But last year’s swine flu vaccine is not good enough for this year’s swine flu because the virus has changed. So we get it reinvented every year. So same thing will happen for this also. The good thing is that the death rate is lower, much lower than SARS, but the bad thing is it spreads much faster.
Now that lockdown is getting relaxed and people have started coming out of their houses for a few hours, we have seen a rise in the number of cases. This instills fear within us, especially in northeastern part of the country, where the cases weren’t too exaggerating like the other parts of the country. But off late we’ve started seeing that cases are on the rise. So does that mean that the lockdown period is what is going to be the new normal?
Like I have told you, the mantra to be safe is only with the three things you can do. In the meantime, there are medicines coming, which will lower the death rate even further. There are vaccines that are under development right now and but it will take six months to a year at least. The only recommendation today is keep the red zones absolutely locked up. That still will cause a huge amount of disruption to movement in the country and production but it will save us from a real serious problem where we may not be empathetic, that is the fear. You have to balance is what I am saying. Even if you’ve used every recommended protection, you get infected and there is nothing you could have done. That’s why it’s very clearly demarcated that younger children and older people, especially with co-morbidities will have a higher mortality.
In this digital world we receive a lot of information through social media, and during this time of medical health emergency it is very important to differentiate between fake news and real news. We would want you to bust certain myths if they really are myths:
1) Children are immune to COVID-19
- That’s not true. There is a lot of guess work because you don’t have millions of children who’ve got infected but enough children have. So the point is, in children, the immune system takes time to develop. So up to the age of 6-7 it is very immature. That’s why we’ve said children below 10 are more vulnerable. And above 60, your immunity by age starts going down, that’s why there is a natural slowdown of your body and immunity system. But if you exercise and your muscle are fit, and you’ve not become a couch potato then you maybe better protected and your age will not be a factor. And in case of those with co-morbidities there immune system is already suppressed, making them more vulnerable, but if you take extra care that the best you can do.
2) Pets can become a medium of transmission
- No evidence at all.
3) You have to be with someone for 10 minutes to catch the virus
- As I said, it’s a very well documented study that it takes 10-15 minutes for a contact. But it doesn’t mean that you won’t get it if you were there for 5 or 3 minutes. Point is, there is a theory which we have no proof of as to how much viral load we need to overwhelm a person’s immune system. It is so varied that it cannot have a general rule. So both mask and short duration interaction is the safest.
4) Washing your hands with soap for 20 seconds continuously will prevent the transmission of the infection.
- From your hands, yes. That’s a fact. Find any technique to know its 20 seconds minimum.
5) Spraying alcohol on your skin or consuming alcohol protects you from the infection
- No truth in it.
6) Social distancing or maintaining a distance of minimum 1 metre will help in preventing the transmission of infection
- Absolutely true, and 2 metres is even better.
7) Infrared thermometers can detect coronavirus
- No, they can detect whether you have fever.
8) Drinking hot water/beverages and exposing yourself to sunlight can kill coronavirus
- No it won’t. You’ll have to drink boiling water which is not possible. The only thing we don’t know is that summer may reduce the impact the of this virus. But around the world where things have been hot it doesn’t seem to be helping. If you see Rajasthan which is a hotter state, is still experiencing arise. I don’t think what we thought will help, may be coming.
9) No vegetarian is affected by Corona. Corona requires animal fat in the body.
- Couldn’t be further from the truth. But then India has such a large vegetarian population then it wouldn’t hit India at all. But it is totally false.
10) Being able to hold your breath for 10 seconds or more without coughing or feeling uncomfortable means that you are free from the infection.
- That is totally false. But yes, if you have it and you are getting short of breath, then you can’t hold it for 10 seconds even that means you have to go to the hospital right now. It doesn’t show whether you have coronavirus or not, but it shows that your lungs are getting affected.