'It is a war-like situation. We must be prepared for the long run.'
The nation has been in a lockdown for three weeks to ward off the coronavirus pandemic and Prime Minister Narendra Damodardas Modi has extended it till May 3.
In the meanwhile, hotspots have been identified, zones have been quarantined and patients have been isolated.
But the battle is far from being won. With over 10,000 positive cases of COVID-19 across the country, this is not the time to let up on the efforts to contain the spread of the virus.
Naturally, the one question on everyone's mind is, what next?
"The lockdown has to be lifted slowly. Health workers are getting sufficient time to prepare for a surge," Dr Dilip Mathai, below, dean, Apollo Institute of Medical Sciences, Hyderabad, tells Rediff.com's A Ganesh Nadar.
Lockdown, quarantine, isolation. What more needs to be done to control COVID-19?
The lockdown is to prevent movement of people, which is to prevent the haphazard transmission and infection. Those who are not immunised have to be careful.
Nobody has a vaccine, but epidemiologists are saying two different things. The optimists are saying we have some immunity and the pessimists are saying we don't have it.
The lockdown has to be lifted slowly. Health workers are getting sufficient time to prepare for a surge.
We have a 375-bed hospital, but so far only government hospitals are dealing with positive patients. When we take samples we send it to the government hospital.
We have to check out the hot spots. The strategy of containment is important. We need samples from hot spots.
There should be different standards for crowded and uncrowded places. In urban slums many people live under one roof. Workers come from that area.
Madhya Pradesh has notified three zones. We need to identify hot spots plus density of the population. We have to take samples and test closer to the hotspot.
We have to separate symptomatic and asymptomatic patients and identify their viral content.
Anti-bodies will be known by a blood test. Proper sampling has to be done. Till now it is related to foreign travel.
Once the lockdown is lifted, what precautions do people moving outside need to take?
They should wear proper fitting masks. Sanitisation is very important and they should not touch their mouth or face. Mouth and nose must be covered and side screen should be closed.
The mask must be comfortable, triple layered is the best.
People must wash clothes when they go home.
Do you think the BCG vaccine protects many Indians from COVID-19?
Where BCG has been used, the infection has been low. But it is difficult to be certain. We hope that it works. It is difficult to comment on it.
It is a drug for TB.
How effective will hydroxychloroquine be against COVID-19?
Groups of people are saying different things in different parts of the world. The world is divided on this, this happens whenever a new drug is used.
The toxicity risk is more than the problem.
We don't know if it will work. It is cheap and easily available.
It is effective for malaria. We don't know if it will work for this disease. Maybe it will work.
What are the precautions that maternity hospitals need to take during this time?
Every year India delivers babies equal to the population of Australia.
If people conceive now, we don't know the effect on the baby. We will know that only in the third trimester of the pregnancy.
For delivery the patient should have the same comfort as normal. We have to just assume the mother is positive and give her a mask.
It is important to talk softly to the mother. All doctors and nurses should wear masks as they are in the same room. Adequate protection should be there.
Mother to child infection will not happen as the virus is not in the blood.
If surgery is required for a caesarian delivery, then I prefer that younger surgeons should do it. If they are not available, then older surgeons will have to do it. Both should have adequate protection.
Before the surgery the mother should be tested with both swab and blood test.
How can dentists protect themselves?
When people call from home with an infected tooth the dentist should first suggest medicines and paste to be taken at home.
If that doesn't work they have to extract the tooth. They must wear masks and gloves.
Implanting teeth does not need to be done at this time. That can be done later when things return to normal.
What steps do hospitals need to keep their doctors and health workers safe?
They have to check if the patient has more than 100 degrees temperature. They have to check for breathlessness and cough. Patients are generally anxious that they have COVID-19. You have to calm them down.
The doctors must keep the patients are an arm's length. You cannot hurry with the patients. You can treat 10 patients in an hour. We have to separate the patients with fever and those who don't.
Then you treat the ones with fever.
Masks and gloves are essential. You have to frequently sanitise your hands.
It is a war-like situation. After two months I think it will come down, but we must be prepared for the long run.
How far are we from discovering a vaccine against COVID-19?
We are already in phase one. Laboratory mice have been injected with the virus and the mice are producing anti-bodies. It is effective.
Recovered patients also have it in sufficient amount to knock off the disease.
We have seen that the virus can be neutralised by anti-bodies both in humans and in mice.
The virus has spike protein and it is this protein that we have to attack.
Yesterday it has been tested on healthy volunteers and it is safe. It has also been tested on an 85-year-old lady and found safe.
It will be used after they see 90% success.
The immunity will be for a limited time, between 12 and 18 months.
Till a vaccine is discovered, how do we treat COVID-19 patients?
We have to try drugs that are anti-viral agents and modulators. This is available on a compassionate basis. We use it for serious cases only.
The pathology will take time to reverse.
