A total of 332,134 people have been infected and 14,436 have lost their lives following novel coronavirus outbreak in Wuhan, China, in December 2019. What are our preparations for combating, preventing and controlling the infection. Sabitri Dhakal of The Himalayan Times talked to Anup Bastola, consultant tropical medicine and spokesperson for Sukraraj Tropical and Infectious Disease Hospital, Teku, about COVID-19. Excerpts:
What is coronavirus disease?
Coronavirus or COVID-19 is an infectious disease caused by a newly discovered coronavirus. The infection first occurred in Wuhan of China. It was initially transmitted to humans from animals. Whenever there is animal-human interface, there are chances of the virus spilling over. The virus can be transmitted from human to animals and vice versa. The virus has been transmitted to humans in the same way.
What are the symptoms of COVID-19? How is the infection transmitted ?
Fever and dry cough are the most common symptoms. Shortness of breath, aches and pains and sore throat are other symptoms. This virus causes lower respiratory tract infection, acute respiratory distress syndrome and pneumonia. It can also damage other organs such as kidneys, cause cardiovascular problems and difficulty in breathing and lead to death.
People can contract the virus from infected people. The disease can spread from person to person through small droplets from the nose or mouth when a person with COVID-19 coughs, sneezes or exhales. These droplets land on objects and surfaces around the person. When people touch the objects or surfaces and then touch their nose, eyes or mouth they get infected. One should cover his/her mouth while sneezing.
Does everyone with fever need to get tested?
No. It is not necessary to test everyone who has fever for COVID-19. S/he should meet the government criteria. It is also the time for seasonal influenza. Every fever is not COVID-19.
Who are at risk?
Those with cardiovascular diseases, pulmonary diseases, diabetes, hypertension, cancer patients and the elderly population are at high risk of infection.
People, especially the aged, succumb to the infection. Youths are also dying, but the number varies from place to place. It also depends on lifestyles. Mortality is higher in people who are above 60. Also, morbidity depends on co-morbidities, such as people suffering from various illnesses.
The mortality rate may be low, but the infection rate is high as the disease is highly contagious. Many people have contracted this infection within a short period of time in other countries. Transmission is caused by close contact. Anyone who doesn’t take precaution is likely to be infected.
How many people will need ventilators?
It depends on the infection spread in the population. Four to five per cent people might need ventilators according to records of other affected countries. Lately, youth have also been shown to be in need of ventilators. Data is coming in a different way. It depends on various factors such as number of death is more among smokers. Therefore, we need to look at the evidences and see how it will build up in the days if the infection spreads here.
A person in Bhutan tested negative thrice, but in the fourth test the person tested positive. Can this happen?
Testing of samples depend on viral load and viral shedding. It also depends on the testing procedure. How correct are they? The positivity rate also depends on the sample collected. There are different levels of virus in different people.
In some, the virus can be seen in high number, while in others, the virus can be seen in lower number. If we collect the swab when there is high number of virus, sensitivity increases. Various studies are being conducted to find out which sample is more sensitive.
Currently, we are collecting nasal pharyngeal and oral pharyngeal samples for testing.
Why do we need isolation and self-quarantine?
People coming from coronavirus affected areas should remain in self-quarantine for 14 days. This is practised to find out whether symptoms are built up within the stipulated time. A person in self-quarantine will help prevent his/her mobility and will not spread possible infection to others.
Isolation is where the COVID-19 infected and or/suspected are kept and treated. Health workers need to prevent contracting the infection when someone is in isolation. If they contract the infection they are likely to transmit it to other patients, their family members and people in community.
World Health Organisation has stressed the need to escalate the tests for COVID-19 to prevent infection. Are we doing that?
Tests are conducted on persons with fever and at least one symptom of respiratory disease (cough or shortness of breath). The person should also have a travel history or have resided in a country, area or territory that has reported local transmission of COVID-19 during the 14 days prior to the onset of the symptoms or has been in close contact with probable/confirmed cases of COVID-19.
The government has escalated testing now. Earlier, influenza negative and positive cases were not tested for COVID-19, but now the tests are being done. Also the government has formed teams for surveillance of suspected COVID-19 patients. Arrangements are made for finding cases from the community. Suspicious cases should be tested. We have raised the boundary for testing the samples.
When most countries are finding it difficult to handle the situation with cases soaring, many Nepalis do not believe Nepal does not have additional cases.
People should believe the test. There is no need to become suspicious of the tests we are conducting. The reason why the test is not positive is there are no cases here. Had there been cases they would have tested positive.
There are certain symptoms among infected patients. The first patient we admitted had fever and dry cough and difficulty in breathing. Similar typical cases are not there in 59 other patients admitted in the hospital. Though people may be asymptomatic, they may be carriers. But as the criteria for testing has been raised now, we will get cases if there are any. Our testing procedure cannot be questioned.
What role should an individual play to help prevent the spread of the disease?
People should abide by directions of the government. It is our responsibility. They should maintain social distancing. Anyone who has come from abroad must remain in self-quarantine. If there are any symptoms, they should immediately come to the hospital.
The government has taken measures to stop infection entry. It has requested people to practise health hygiene. People should be aware, but they should not panic. They also should not spread rumours and fake news about coronavirus. They must cooperate and help the government in preventing the infection. Together we can.
If anyone has masks or ventilators in stock, s/he should provide them to the government immediately instead of black-marketing.
How can infection from neighbouring countries be prevented?
The government should keep records of people coming from coronavirus affected countries. The health desk should provide information to people entering the country and those entering the country should go into self-quarantine for 14 days. They must follow this.
If we are to combat this infection, the government alone can’t do it. The individual must also play a role in helping prevent the infection. Citizens should follow directions. It is our responsibility to help the government now. If there is an outbreak, the government will take care, but everyone should help the government. Do not travel. Stay home. Social distancing is necessary.
What is the role of hospitals and health workers?
The hospitals should have infection prevention control mechanism in place. Doctors and other health workers should pay attention to this. Doctors should segregate patients. Distance must be maintained. If hospitals do not maintain infection prevention control mechanism, there are chances of the infection spreading among health workers and this could spread to others. Health workers should therefore wear masks and personal protective gear to help prevent infection.
Are we increasing the capacity of STIDH?
The government has designated STIDH for coronavirus treatment. We are adding 20 beds to deliver intensive care service to patients. Also ten ventilators have been brought to the hospital. The process of hiring manpower is under way. The government is also providing us a taskforce as back-up.
To care for coronavirus patients, we have referred our HIV/AIDS patients to take the service from Bir and Patan hospitals. Also discussions are under way for providing vaccination services for animal bites from Public Health Office, Kathmandu. The hospital has admitted 60 persons to its isolation ward since the first case was seen in January. It has been seeing at least 35 persons suffering from cough and fever in its OPD.
As the number is increasing, we have decided to increase the number of isolation wards. Currently, there are five isolation beds in the hospital. We are increasing our capacity to take 100 patients in isolation. Patients might need dialysis in the course of treatment and the process of bringing dialysis machines is under way.
What role should private hospitals play in combating the infection?
All hospitals should be ready to treat coronavirus patients. Private hospitals can isolate patients rather than transferring them to Teku. They should be prepared. What if their own staffers suffer?
What should be done in the hospitals?
There should be regular supply of personal protective gear. We are using 10 PPE per day. There should be proper management of ICU and skilled manpower to handle cases in the hospitals. If there are large numbers of patients, we will need regular supply of oxygen and ventilators.
Everyone should be prepared. Health practitioners are also under risk of being infected. Each hospital has plans and policies for infection prevention control and health workers should be aware about them. There should be a provision of PPE for health practitioners.
What are the ways of preventing COVID-19?
Wash your hands regularly with soap and water, or clean them with alcohol-based hand rub. People need to maintain at least one metre distance from people coughing or sneezing. Avoid touching the face. Covering mouth and nose when coughing or sneezing. One should stay home if s/he feels unwell. People must practise physical/social distancing by avoiding unnecessary travel and staying away from crowds.
A version of this article appears in print on March 23, 2020 of The Himalayan Times.