2020 is a watershed year. It will be remembered as a year of lockdown, huge expectations and surmounting frustrations. Country after country bowed down before the Corona virus. Everyone waited for a miracle drug and vaccine with baited breath. Both of them are elusive and attaining them appears distant. Leaders all over the world have declared that we must learn to live with the virus.
How do we learn to live with the enemy and yet keep it at bay? For this, we must first gain insight and knowledge into its mechanism of offence and our body’s defense systems against it. The Novel Corona virus gains entry into our body through the nose eyes or mouth. Breathing carries these particles to the lower respiratory tract. The spike proteins of the corona virus act like a key and lock into the epithelial cells that line the respiratory tracts and air sacs of lungs. A rapid and well coordinated immune response represents the first line of defense against viral infections. Most of the people will kill the virus and develop antibodies and immunity against it. They may remain asymptomatic or suffer from mild, moderate or severe disease depending on the extent of initial viral load and their immunity. Lower initial viral load and higher innate immunity favor the chances of a complete recovery.
However in elderly patients and patients with co-morbidities excessive inflammatory innate response and impaired adaptive host immune defense may lead to ‘Massive release of cytokines and chemokines’ popularly known as “Cytokine storm”. This can cause extensive tissue damage both at site of entry of virus and systematically. An uncontrolled cytokine storm is responsible both for increased morbidity and mortality for the elderly and patients with co morbidities.
The battle against Corona has to be fought on multiple fronts. Only if we fortify ourselves socially, emotionally, tactically, physically and as a herd can we hope to defeat it.
Solidarity not stigma
There is a palpable stigma surrounding the term’ COVID +’. This leads to a reduction in people seeking medical care/testing and people adhering to interventions (self isolation). Society needs to show solidarity and support to COVID positive individuals and their families. They should be dealt with compassion and empathy. According to WHO, our dogmatic approach towards the disease will lead to under reporting of cases. This will be a major stumbling block in our fight.
Fight the Fear
On a personal level, each person needs to fight the fear of the disease. While we need to keep ourselves safe and break the chain of transmission, we must not be afraid of the disease. Total number of COVID positive cases in India has been 1.2 Million and around 31 thousand have succumbed to it. The mortality rate is around 2.3%. Since we are testing only the symptomatic population, the actual projection of COVID positive population could be at least ten times. This would bring the mortality rate down to 0.2%. “Caution not Fear” is the call of the hour.
Reduce the exposure to virus
As the prevalence of the disease increases, the war has shifted from the hospitals to the community. Each person is now responsible for protecting himself, his family, his community and his country. Reducing the exposure to virus and viral load is the crux of the issue. Breathing, talking, coughing and singing create virus carrying droplets. These different types of exposure carry different viral loads. Enough virus has to make itself over to you to cause infection.
Successful infection=Virus exposure x duration of exposure
In nut shell, Proximity, type of exposure and duration of exposure are crucial factors deciding the viral load and transmission.
Tactical steps to be taken to reduce virus transmission
- Sanitization and hand washing
- Herd Masking
When the entire community wears a mask, it provides an effective transmission barriers against the spread of disease. Use of mask by both carrier and healthy contact can reduce transmission from 90% to 1.5%.
- Social distancing
Maintain at least 6 feet distance in your work and social interactions.
Avoid handshakes, touching, kissing and hugging. The Indian ‘Namaste’ is the best form of greeting.
- Duration of exposure
Limit duration of interaction with each person. Keep interactions as brief as possible.
- Avoid indoor spaces. As far as possible, interact outdoor or in large ventilated spaces.
- Avoid public bathrooms and restaurants
- Avoid large gatherings, parties, weddings concerts and cinema halls.
When a herd moves, it keeps the weakest in the centre to protect them from invasion. We should keep the elderly, diabetics, hypertensive, and people with low immunity protected. While the young and healthy should move out, the vulnerable population should continue to restrict their movements. Look after your elders. Over time the elderly will get exposure to virus in low doses from the younger family members and develop immunity. Also as more and more people get immune the chain of transmission would be broken and the entire herd would be immune and safe.
Healthy and fit
Times are tough. We need to be physically and mentally strong to tackle them. Our immunity is our shield against the disease. Some steps which will help us to improve our health, fitness and immunity are listed below.
- Drink lots of water.
- Avoid excess salt and sugar.
- Eat protein rich food. Eat small portions. Avoid oily and starchy food.
- Avoid snacking. Eat lots of fruits and salad.
- Take your daily dose of Vitamin C, Vitamin D, and zinc. They act as immune boosters.
- Amla, Chyawanprash, Cod liver oil, green tea and masala tea with spices like basil, cinnamon, ginger black pepper, and cardamom are also said to enhance immunity.
- It is essential to have an exercise regime with cardio and stretch exercises in your daily routine. This helps in maintaining both physical fitness and mental health.
- Avoid stress. It can cause unprecedented weight gain, hypertension and diabetes. Practice meditation and count your blessings. A stress free positive attitude is a great immune booster.
- Get your immunity status assessed. TFPL offers Antibody (IgG) to COVID 19 testing and immunity profiles at economical profiles to help you assess your immunity status. Knowing the immunity status of ourselves, our family and our workers can help us to take proactive steps in the right directions in these uncertain times.
All these steps taken in unison will help us in ‘Keeping the Corona virus at bay’ individually and as a community.
Dr Vibha Tomar
Tomar Foundation Pathology Lab