Of Masks and Men

Covid 19

The Covid 19 Virus is a riboneucleic acid (RNA) virus belonging to the severe acute respiratory syndrome (SARS) corona group of viruses, COVID -19 (Corona virus disease that made its appearance in 2019).

What is a virus?

Viruses belong to the twilight zone of biology. Though they are made of biologic material (RNA and DNA) they do not have a life of their own like bacteria and parasites do. They thus depend on a host on whom they depend to proliferate and replicate themselves.

Why should you not touch your face?

  • These instructions should be a little more explicit.
  • Do Not touch the area around your nose. Do NOT put your fingers inside your nose or near your nose
  • Do NOT put your fingers into your mouth.
  • Do NOT rub your eyes
  • Why? The Covid 19 is a respiratory virus. It enters the body’s respiratory system through the nose and mouth. The tear ducts of the eyes open into the nose and it can enter the respiratory system through the tear ducts.
What is the purpose of wearing a facial mask?

It is meant to act as a seal and as a filter. It seals the wearers nose and mouth from the external environment. It allows the wearer to breathe filtered air. The mask has pores that will (it is supposed to) prevent the virus from entering the inhaled air.

  • To prevent the wearer from inhaling air that could be contaminated by the virus. For that purpose, the mask is considered as a filter of the air inhaled. The size of the pores of the mask should be considered. The N95 mask is commonly used for this purpose.
  • The mask should cover the nose and mouth. Some wearers allow the mask to drop below their noses. This is dangerous as it will not protect the person wearing the mask because the person will be inhaling unfiltered air through the exposed and unprotected nose.
  • If the wearer is infected with the virus it will protect others around from inhaling the virus contaminated air exhaled by the infected person. However, for that to occur the mask should be low leak, tight, snug fitting mask not allowing air to escape from the periphery of the mask as this will be unfiltered air. This is to say, air should not leak into the nose from a gap between the mask and nose. This is unfiltered air, both inhaled air and exhaled air could pose a health risk.
  • The principle of wearing a mask is “when I wear a mask I protect me from you and protect you from me as well”
How often should I wear a mask?

  • When ever leaving the house. It should be kept on for the entire duration of the visit.
  • When meeting another person, vendors, neighbours the mask should be worn correctly.
Should I wear a mask at home?

Only if you are under quarantine

Should I wear a mask when driving?

Yes.It is a police requirement even when the windows are up.

Should I wear goggles or eye protection wear?

Yes. It is needed especially when leaving home. Either goggles or transparent face shield is recommended.

Can I reuse the mask?

A mask is only as good as its condition. Ideally a maximum of three days of continuous wearing. Then the mask should be discarded. However, if treated carefully it can be used for a week or so but in situations of unprecedented shortages it can be used for extended periods of time. A well used mask is better than no mask at all.

Can the mask be reused after sterilizing it?

To be done only if facial masks are in short supply. The best way to sterilize it is to allow it to remain in direct sunlight for several hours for 2 to 3 days. Ethylene dioxide is a sterilizing agent but is available in hospitals and is expensive.
It is always better to use a fresh, new facial mask.

Can it be washed?

This is not recommended.

Is a facial shield also recommended?

Yes. It is recommended that it be worn along with a facial mask especially when leaving the house and going shopping or performing chores outside the house.

Are cloth masks good enough?

They are not ideal. However, if such a mask is worn the wearer should also use the following precautions. (a) The cloth mask should be snug and have as little a gap between the face and the mask. The wearer of such a mask should also wear a face shield, gloves and maintain social distancing.

  • In this pandemic the following are strongly recommended when going out or when meeting others.
  • The best possible face mask
  • Social distancing.
  • Transparent face shield.
  • Paper cap.
  • Gloves.

The above measures when adopted correctly are found to be quite effective and offer adequate protection.

  • When getting home the following measures to be carried out.
  • Take off face shield, cap, gloves and then mask.
  • Wash hands carefully with warm water and soap thoroughly. Careful attention should be paid to washing between the fingers and under the nails.
  • After this is complete then the face should be washed with warm water and soap.
Fomites

Fomites are inanimate objects that can become contaminated with infectious agents and serve as a mechanism for transfer of disease from one person to another. Droplets of infectious material can settle down on a doorknob or handle. The next person touching it can then allow it to settle on his fingers and can be infected. Pots, pans door knobs, etc handles are all possible sites to act as fomites causing transmission of disease.
Fomites act as a secondary route for exposure for the covid 19 to infect another person.
For this reason frequent washing of hands is extremely important to avoid contracting the disease.

What is herd immunity also known as community immunity and how is it achieved?

  • Immunity/ community immunity is when the majority of the population are protected from a disease by having become immune to it. How does herd Immunity take place? It can occur through 2 ways
  • Many people contract the disease and in time build up an immune response to it (natural immunity). The problem with this method is that many people will also fall sick and may even fall seriously ill before recovering. No one can predict the outcomes of this method. This method is unpredictable and can cause vast damage and consequences that may be worse than the disease. Some persons will also die in this process. Many ethicists consider this unacceptable and term it ‘cavalier’ because it deliberately puts the very vulnerable at significant risk of succumbing to the disease. The morbidities and mortalities can be significant. At times there is no telling when the herd immunity acquired by this method of exposure to the disease will be sufficient to protect the general majority of the population.
  • Herd Immunity is best achieved by vaccination.

When a significant size of the population is vaccinated against a disease the vaccine provides protection for some persons who have not developed immunity.’

When a very large percentage of the population is protected through vaccination against a virus, the protection offered by the vaccination makes it difficult for a disease to spread because there are very few susceptible people left to infect.

This effectively stops the spread of disease in the community. It is particularly crucial to protect people who cannot be vaccinated for various reasons

What are the symptoms of Covid19?
  • Fever
  • Sore throat
  • Bodyache
  • Cough
  • Loss of smell (anosmia)
  • Loss of taste (dysgeusia)
  • Breathlessness
  • Happy Hypoxia. This is a term used to describe that though the patient’s oxygen levels in room air are low the patient does not feel breathless.
What should the person do?

Seek immediate medical attention in a hospital. The person concerned should wear a mask and a face shield so as not to inadvertently infect others.

A swab from the back of the nose (nasopharynx) will be taken to confirm if the person is infected with covid 19. This takes approximately 12 hours for the report to be given.

An Xray Chest or a CT scan of the chest will be taken to confirm if the lungs are infected.

What is the next step?

The person is paced in isolation and is monitored

Most importantly oxygen is given and if the persons condition deteriorates then the person is transferred to Intensive care for further management.

What are comorbidities?

Comorbidities are simultaneously existing health problems like diabetes, high blood pressure, chronic lung disease, heart disease, cancer, HIV etc.

Comorbidities can compromise a person’s health and affect their health adversely and impair the functioning of their immune system. Their immune system will not be functioning optimally and thus predispose them to infections such as covid19

These comorbidities will also have to be factored in when being treated for covid 19.

Is there a cure for Covid19?

NO. There is no cure for Covid 19. Certain medications like Remdesivir are being tried out to lessen the course and severity of the disease. It is under clinical trials.

Is there a vaccine against covid19 just now?

At this time there are no vaccines available against covid 19

What is the role of a ventilator?

The ventilator assists in helping the person to breathe, it also simultaneously provides oxygen to the lungs. When breathless, the person can get exhausted from breathing hard. The ventilator takes over and regulates breathing and oxygen inhalation, thus giving the person’s breathing muscles a rest.

What are immunomodulators and when are they given?

Immunomodulators serve to regulate the immune system so that it responds optimally and appropriately especially in the face of the covid 19 pandemic.

  • Useful immunomodulators are the following
  • Hydroxychloroquine.

There is a lot of controversy surrounding this medication with some people advocating it and some disagreeing. It is a medication commonly used to treat malaria.

Vitamin D and Vitamin C, Colchicine are also other useful immunomodulators. Doctors should be consulted before using them.

What are the features of covid19 that doctors find particularly alarming?

  • The extreme contagiousness of the disease
  • The sudden and unexpected deterioration in a person’s condition.
  • Acute Respiratory Distress Syndrome also known as ARDS
  • Thrombosis and coagulation (clotting) of the blood in the blood vessels.

All these are triggered by a situation termed cytokine storm.

What is a cytokine storm?

This is also known as the cytokine release syndrome. When the virus enters a cell in the human body it takes over the cells mechanisms to produce progeny (daughter viruses). When the progeny exit the cell they cause the cell to rupture

When the cell bursts open it discharges its contents into the body’s system. This elicits an inflammatory response. The body’s immune system becomes hyperactive. This causes inflammation to become excessive and go out of control. This process of inflammation causes fever and can cause the lungs to fail and the blood to clot. The cells in the lung termed pneumocytes, are also destroyed and thus cannot participate in the oxygen exchange process. This causes the lung to fail causing ARDS. Excessive inflammation can cause other organs to fail like the kidneys.

Can the cytokine storm be prevented?

There are medications that can abort and reduce the impact of the cytokine storm. These are known as IL6 antagonists or CD6 antagonists. These are humanized monoclonal antibodies. However, timing is crucial. It should be given when cytokine storm is imminent. When given at that precise moment they are usually effective. If given when the cytokine storm is fully in progress, then its value is very limited., because the cascade of inflammatory events cannot be halted once set in motion.

What is convalescent plasma?

Convalescent plasma is the plasma( taken from blood) taken from a person who has recovered after suffering from covid19. It is thought that these persons have developed antibodies against covid19. These antibodies are then transfused to another person suffering from covid19 with antibodies to help fight against the virus.

How is that some persons get mild manifestations and others more severe?

It is thought that there could be various strains of the virus with some being more virulent than others. Nutrition, genetics, comorbid factors and immunity also play a role in the severity of this disease.

What purpose does quarantine serve?

  • It prevents the infected person from infecting others
  • It allows undisturbed recovery.
Viral shedding. What is it?

Viral shedding occurs when a virus duplicates itself inside your body and once it does so it is released (shed) into the environment. Another uninfected person can get infected with the virus if exposed to the person who is undergoing viral shedding. Most available evidence suggests that covid19 is most contagious when symptoms are at their worst. It is also known that viral shedding can occur in the early phase of the disease.

Can a person who suffered from covid 19 get reinfected with covid19 again?.

Yes, reinfection is possible.

What should a person do to avoid getting infected with covid19?

  • Correct Social distancing
  • Wear a good face mask
  • Wear a good face shield
  • Wear rubber disposable gloves
  • Do NOT put fingers inside the nose or mouth. Do not rub their eyes
  • Make sure conditions liked diabetes, high blood pressure etc are all treated and should be within normal limits.
What is the bottomline in Covid19?

Prevention is better than a cure.

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