Daily Times

COVID-19 is believed to be widely-spread in Pakistan. All of us now know multiple people from our own families and friends, who were infected with SARS-COV-2 (the virus that causes COVID-19). Sometimes, it appears that governments have stopped trying to prevent people from getting infected. They may be quietly hoping for herd immunity. But that is a long way of unimaginable deaths and misery; even with low death rate. Many of us also now know many who have died because of COVID-19 and many who had a long and painful disease before they recovered. Not all of them were old so there is no age immunity. Yes, the rate of complications and fatality increases with increasing age but there is no guarantee of safety for any age group. So, we must protect ourselves from getting infected until an effective vaccine or medicines are available. However, we also can’t stay isolated forever so we need to know our risks in different settings to make rational decisions. Our knowledge about SARS-COV-2 is also evolving at a fast pace so please note that following suggestions are based on current knowledge:

1. Limit your risk (exposure): Only go out if there is an absolute necessity. If you are a wage earner, certainly you don’t have a choice but discuss the alternative of working from home if your industry has that flexibility. For everyone else, minimise your exposure chances. Buy groceries online if that is available. If that is not available, call your local shopkeeper and tell him the list of items you need. Request him to bill and pack them. Many shopkeepers are providing deliveries but you could also go to shops and, instead of spending excess time inside, just pick the packed groceries. It’s not just about the exposure to the virus but to how much virus, which is becoming a major factor in infections. If you have to buy groceries yourself, prefer open shops and carts as outside, the chances are more of virus dissipating sooner. In any case, plan your shopping for a couple of weeks if possible. If you have to stay inside a building for your work or some other critical reason, encourage maximum ventilation and airflow by open windows and open doors if possible. If air-conditioners have to be used, choose the “fresh air” option in them to ensure there is ventilation. Remember this. In most studies, the transmission has happened in indoor settings and until today, the outdoor transmission is very rarely documented. So ensure that you could bring some components of the outside environment inside the building or your office to increase the safety level.

We must protect ourselves from getting infected until an effective vaccine or medicines are available

2. Mask, Mask and Mask: As there is still no clarity on the best way that SARS-COV-2 is spreading (droplet vs airborne or th level and range, if in small droplets) it’s better to be mindful of both. If all of us are wearing masks and keeping a distance of six feet, it will be difficult for the infected person to pass on this infection, even if the virus is transmitting airborne. However, if we are wearing masks and others are not wearing it, our protection level is very low and we could easily be infected. So please visit only those places where everyone is wearing masks. If not, leave and let them know why you are leaving. Follow all hand-washing and social distancing precautions. These measures, when taken together, will help us but in isolation, their effectiveness drops. Frequent cleaning of surfaces is still a valid way to protect you.

3. Social Distancing: We have seen a huge bump in cases and deaths after the mid of Ramzan and Eid, when people ignored social distancing rules and had parties and gatherings. Even very knowledgeable people visited each other on Eid. We all have seen the results now. Please remember that only people staying in one house are a part of your safe circle. Once your relatives start to mix in that circle, risk increases for everyone. We all have to come up with innovative ways in which we are not emotionally away from our dear ones. Virtual meetings should be an alternative. If you are not staying home (possibility of exposure) and you have to visit your parents, keep the six-feet distance, wear masks and if possible, see them in open. At this time, our elders need most protection but that also means ensuring they are not emotionally isolated.

4. Can we get coronavirus infection twice? This is the most asked question with the increasing number of recovered patients. This question is also a topic of massive research across the globe because if infection provides lifelong protection, governments could do big surveys to see whether a population is protected enough and has immunity. However, there are no clear answers yet. Yes, there will be some immunity but how long would this immunity last is an unanswered question. Some viruses just provide short-term immunity and others could provide immunity that lasts a year or even longer. So, we could say at this moment that you will not be immediately re-infected after you recover but we have to wait to see how long you could stay protected.

5. Another common question I get is that if the majority of family members have symptoms of COVID-19, should they still do isolation or not? My response is that even if one person is symptoms-free isolate him in the same house. He should not go to someplace else as he may already be exposed and be in a pre-symptomatic window. So, he should be separated from the rest of the family and he should take all precautions to stay protected. The course of coronavirus could range from very mild to life-threatening. We know age and other comorbidities (diseases like obesity, blood pressure and diabetes) increase your risk. But we are seeing unexplained severe diseases in perfectly fit and young people. So still, it is sensible to try to protect yourself at all cost even if you are a family member of the infected. But don’t risk others by leaving the house unless you move to an isolated room.

6. To get tested or not? What we are witnessing now is that suspects are not going for testing. They are worried that if they tested positively, their family would be forcefully separated. Even though the governments have changed these policies but the way this heavy-handed approach was implemented in Punjab, it would be a long time before the population could start trusting the government again. I wrote against it as we have experience of this phenomenon in every disease outbreak, which has a stigma attached to it. These people don’t go for testing and then, the transmission chains are never identified and problems keep on multiplying until they are too big to handle. So now, a huge number of suspected patients are not getting tested. My advice to all of them is that test or not, if you have coronavirus symptoms these days, you have COVID-19. Take all the precautions the way you would have taken once you have a positive test. There are many incidents where the PCR test had been negative but a person was suffering from COVID-19. Please note that PCR has a high false-negative rate. That means irrespective of your test results, if you have symptoms, take care as a COVID suspect. The antibody test is not meant to detect your current infection and it has also its validity issues.

7. How to increase immunity? Social media is rife with all the recipes of strengthening immunity by food, herbs and spiritual ways. Trust me, there is no quick fix. Regular exercise (even a few minutes of daily walk), good sleep (eight to ten hours), less stress and healthy food could do wonders with your immunity. Regular (even light) exercise helps your body secrete hormones, which have disease-fighting capabilities. If you are regular in it, you will feel an upbeat mood because of these hormones. Lack of good sound sleep has already been linked to bad health outcomes, including an increased risk of cardiovascular diseases. Our smartphones are one reason. Leave it in another room before you go to bed and read some book to relax before sleep. There are a lot of fruits available these days, which are rather inexpensive, so use this opportunity to get good sources of natural vitamins. Use less oil and sugar to stay healthy. On top of it, if you want to use some natural remedy, discuss with some knowledgeable person who knows what will be the right amount for you. Pandemics are huge contributors to mental health issues. Everyone feels stressed because of uncertainty and this further depresses your immunity. So focus on positives and identify some hobby for which you never had time before. Read interesting books and watch some comedy shows. Talk with your childhood friends and that is one quick way to start feeling younger and happier again.

These are some of the most commonly asked questions and their answers. But remember, COVID-19 is certainly not the end of the world. But to protect ourselves and our loved ones, we need to follow precautions religiously. None of us wants to play Russian roulette with our lives.

Dr Rana Jawad Asghar is an Adjunct Professor of Epidemiology at the University of Nebraska, US, and Chief Executive Officer of Global Health Strategists and Implementers (GHSI), a consulting firm in Islamabad. He has worked at the Stanford University, University of Washington and London School Hygiene and Tropical Medicine and with the US Center for Disease Control and Prevention (CDC)