#NagalandFightsCOVID19: Doctor Speaks - Your most COVID-19 concerns answered

In an interaction with The Morung Express, Dr Sedevi Angami, Director CIHSR explains in detail what COVID-19 is all about and other related aspects surrounding the virus

Atono Tsükrü Kense
Kohima | August 3

As the COVID-19 graph in the state is rapidly on the rise with four officially reported deaths, and amidst the growing fear and anxiety, the impact of the Coronavirus crisis is enormous. The state government and its agencies have been relentlessly doing all it can towards prevention, containment as well as treatment of COVID-19.

As people continue to debate on the treatment, recovery, tests etc, in an interaction with The Morung Express through ZOOM meeting, Dr Sedevi Angami, Director of Christian Institute of Health Sciences and Research (CIHSR) explained in detail what COVID-19 is all about and other related aspects surrounding the virus.

Coronavirus disease (COVID-19), he explained is an infectious disease affecting mainly the respiratory system caused by a newly discovered Coronavirus, which is spread through person to person and the environment after touching the surface or objects with virus on it.

Incubation, infectivity timeline
Elucidating on the incubation period and symptoms timeline, Dr Angami said it takes 2-14 days with median time of 5-6 days while in most cases, symptoms occur within 4-5 days of exposure and the symptoms get worse within 5-8 days in those who gets serious.

On the period of infectivity and transmission, he explained “in mild patients, usually the infective virus is not present beyond nine days on the onset of symptoms while the viral RNA may be present for longer periods and maybe detected by tests but may not mean infectivity.”

“For serious patients, the viral RNA maybe present from 24-42 days after onset of symptoms” he explained and added “in stool, it has been reported that virus can be found 28 days after the onset of symptoms.”

Spectrum of illness severity
Asymptomatic: Carrier of the disease or infection, shows no signs of illness, looks fit and fine and can spread the infection to others. 

Moderate: Tiredness, fever, cough, body ache and sore throat. Severe: Breathing problem, new confusion, inability to stay awake and bluish lips.

Recovery timeline
Dr Angami stated that it may generally two weeks in mild cases and about 3-6 weeks in severe cases towards recovery.

The probable time for discharge from COVID facilities to home after symptoms, he said may take at least 10 days after the onset of symptoms to be able to go home if doing well, and at least 3 days since the symptoms have resolved completely without medications.

The vulnerable people
People with lungs problems, high blood pressure, smoking, obesity, heart problems, diabetic, cancer patients and people above 65 years are more vulnerable to the virus said Dr. Angami and advised that it is important to protect them with layers of protection around them.

Understanding death and recovery rates
“It’s all about the numerator and denominator” said Dr. Angami and explained that the more the test is carried out (denominator), the lesser the death rate (numerator) while age of patients tested is another factor with lower death rate among the countries with younger population and vice versa.

How is COVID-19 treated?
As the debate continue on the mode of treatment, he stated matter-of-factly that there is no known specific treatment for COVID-19 till today and named some potential treatment as Remdesevir, recovering peoples plasma, Tociluzumab, Dexamethasone, IL 1 or IL 6 inhibitor, Antivirals used in HIV treatment, Favipiravir, HCQ, Azithromycin, Ivermectin and Doxycycline. He however, cautioned that one must not try any new medicines or treatments without talking to a doctor first.

Contact tracing is not foolproof
The doctor maintained that contact tracing is not foolproof and some can be missed and pointed the huge resources are being spent on contact tracing and testing of all contacts. He opined that the strategies of contact tracing need some changes by tracing and test the ‘immediate contact’ and go for testing of those people who are symptomatic, which he viewed was more viable.

Stop talking about BSL!
While the demand for BSL testing grew left and right, Dr Angami maintained that BSL facility is used for validating antigen and also ‘quite expensive.’

He observed that BSL facility is not financially viable to go for a mass scale testing and can gobble up the ‘entire budget allocation and resources’ of the government, and can still end up not doing enough to contain the spread of the virus.

“Ideally speaking, I would advise for Truenat and Antigen test’ said Dr. Angami and explained that for RT/PCR (BSL facility) cost between Rs. 3500-4000 per test by highly trained manpower goes through multistage tests and requires about 6 hours for the result.

Truenat test cost Rs. 1350 requires minimal manpower and infrastructure and result takes about an hour with limited numbers possible in one machine while rapid antigen test cost Rs. 600-800 can go for mass screening but may still need RT/PCR.

The doctor also viewed that atleast 1 slot truenat machine at every private hospital will help and ease the burden a lot and that the government may take this to the highest level for ICMR to change the rule especially during this COVID pandemic.

QC, CCCs not feasible
The doctor was also of the view that it would be impossible for the government to continue to maintain and run Quarantine Centers (QC) and COVID Care Centers (CCC) as the cost will be phenomenal.

With more than 80% asymptomatic cases, Dr. Angami maintained that one doesn’t require hospitalisation and can take care of themselves by self isolating and resting at home and added that only severe cases need hospital admission and care. “Hospital beds should be reserved for people with signs and symptoms of COVID who need medical care” he asserted and added that everyone at home should be trained at home on how to take care of themselves and others at home.

Total lockdown is not an answer
As total lockdown has been enforced in various districts across the state, Dr Angami stated that “it is not an answer and doesn’t make sense for now” and that partial lockdown may continue with discontinued public gatherings, churches, schools and colleges.

To this, he explained “total lockdown may slow down the virus but it will not prevent transmission but will prolong the pandemic more.”

“Total lockdown is an absolute disaster as it will rather kill more people than the virus with no accessibility to hospital and livelihood and also give rise to law and order problem” said Dr. Angami citing some instances.

“No doubt, in the initial days total lockdown was useful in preparing ourselves but now there is no role for it” opined the doctor and was of the view that the markets and shops may be open for longer period inorder to avoid overcrowding where people can buy the essentials at their own time.

Please be rational
On the numerous incidents of discrimination and stigmatisation of health workers by family members and house owners, Dr. Angami has appealed for ‘rational way of cooperating with the hospitals.’

Citing instances where his own staff have been stigmatised who were forced to resigned by their relatives and house owners fearing eviction, he said “this must immediately stop” and questioned ‘if all the closed down with all the staff resigning due to discrimination who will suffer? It is ultimately they, themselves.”

The doctor also maintained that the authority must given strong instructions to the community with penalty for any case of discrimination and stigmatisation against the health workers.

Coping with stress and anxiety
“It's normal to feel anxious or worried about COVID-19. It's also normal to feel stressed or lonely when you can't do your normal activities or see friends and relatives” said Dr Angami.

Sharing some tips, he suggested on taking breaks from the news (avoid whatsapp groups), get regular exercise and eat healthy foods, find activities that you enjoy and can do at home, stay in touch with your friends and family members and by staying home to protect self and other people in the community.

“Keep in mind that most people do not get severely ill from COVID-19. It helps to be prepared, and it's important to do what you can to lower your risk and help slow the spread of the virus. But try not to panic” was his words of advice to the people.

Stop the madness of discrimination
“One of the major problems is that health care workers are told not to come back to their houses but stay in the hospital only by colony people and house owners. They are told that if they work in the hospital, they will be evicted from their houses,” Dr Angami shared while expressing concerns related to stigma and discrimination. 

“Nurses who are mothers with breastfeeding children are now stuck to work in the hospital and leave their babies or take their babies inside hospitals and expose them to infection. Several nurses and hospital staff are resigning. Soon hospitals will have very few staff,” he expressed with regret. 

“In that situation they will not be able to provide care to patients who come to hospitals. When the COVID situation becomes very bad, there will be very few medical staff to treat the sick patients from the community. The society which mistreats its health care workers will suffer more because of lack of doctors and nurses. This madness must stop,” he strongly urged.