Manage COVID After A Recess

While the US, EU, UK, Brazil and South Africa were smoldering with the newer variants of COVID, many in India thought COVID was done and dusted. Life was back to normalcy, hardly realizing that India was in the same stage of ignorance as it was exactly an year ago. COVID is back, and this time it will be with a vengeance. What do we do now? I have discussed the relevant principles so that you can make changes to your lifestyle in accordance with the emerging threat from the newer variants.

A few weeks back, when I talked with several Commissioners and Administrative officers from Maharashtra, Tamil Nadu, and at the Center (Delhi), the palpable feeling was that Covid is “done and dusted”. Life was back to normalcy, and all cautions were out of the window.

A few weeks back, when I talked with several Commissioners and Administrative officers from Maharashtra, Tamil Nadu, and at the Center (Delhi), the palpable feeling was that Covid is “done and dusted”. Life was back to normalcy, and all cautions were out of the window.

I cautioned that it is not yet out, and I shared a blog called a tale of two worlds (link shared below) along with a few reports on the raging pandemic in the US, EU, UK, Brazil, and South America. The ignorance was high, and most felt that they had achieved herd immunity. ICMR reports indicated 24-26% national seroprevalence; Chennai’s reports indicated 40% seroprevalence, which again meant inadequate herd immunity. However, facts are generally relegated, and sentiments take precedence. Once again, I wrote another blog on Herd Immunity (link cited below). Always remember TWO MOST principles of herd immunity –

  1. The entire population should be 60-80%
  2. The epitope (in this case, the viral protein) should be constant, not changing

It is in the nature of this virus that the structure is changing every few weeks. Another blog that was written a long time back on this nature of virus was shared with the medical community. To summarize, the covid virus has a defect with RDRP, an enzyme that helps in multiplication. It creates typos, like the one we unintentionally do while typing. However, with covid, those typos change the structure (changes to S or Spike protein is an example) that renders the immunity from previous infection less effective.

Thus previous infections or vaccines are likely not to provide the anticipated immunity. Besides, this virus’s immunity lasts for 3-6 months, as against the smallpox vaccine, which lasts life long.

So, what do we do next?

  1. Should we stop all our social activities?
  2. Should we stop interacting with our professional friends, coworkers, staff, and others?
  3. Should we quarantine and put ourselves in lockdown?

None of these are practical and pragmatic. Before I tell you what is appropriate, let me share what is inappropriate. Yesterday, I talked with a prominent businessman from Nagpur. He said he uses the alcohol-based hand cleaning solution, cloth-based face masks, and takes a shower after returning home, and puts the laundry clothes.

All except face masks are not required. This is an airborne virus, not a virus spreading through fomites (bugs on your clothes or body via touch).

What is airborne and aerosol? When an infected person sneezes, he/she blows almost over 50 million copies of the virus in one bout of coughing/sneezing. These are invisible and disperse in the air around you. An aerosol is similar to airborne, except that you can see those droplets.

Either way, noninfected people end up inhaling those viruses and ultimately increase their risk of getting infected. There are several factors involved between the sneeze/cough bout and infection by normal people. Closed space versus open space influences the outcome. Similarly, centralized air conditioning circulates the virus via the duct system, thus exposing people in other contiguous areas.

Using n95 or similar masks is THUS CRITICAL. I generally add another layer of the surgical mask when i presume exposures are likely to increase.

Social distancing helps, but it is not a panacea. Just imagine, I am not on the same floor as the infected person but connected via centralized air ducts. Will it help? No. I am logically in the same environment though I am in a different place physically. That also means you have to focus on the principles and not just the practices. Understand the principles and act accordingly.

Lockdown or Quarantine?
The most considerable toll this pandemic has taken is from lockdown. Even during the first lockdown implemented in March/April 2020, I was firmly against global lockdown. The answer is never global lockdown; it is always micro lockdown.

What is Micro Lockdown?
Only lockdown that part of the city or segment where the incidence is likely to be high. However, even micro lockdowns are easier said than done. It is difficult to identify a community of infected (but asymptomatic) people and quarantine them against a traveler arriving outside (by flight, vehicle, or train). Remember, once lockdowns are implemented, they ideally last 3-5 weeks, unlikely to be gone in one week. However, it is best to contain and segregated those suspicious of carrying the virus, be it communities, individuals, or activities.

Curtail all Social Activities
Certain activities are unavoidable, critical business, social activities (marriages, deaths, illnesses, and adverse events). However, remodeling our way of interaction is always possible. Certain principles are absolute and non-compromising (wearing a good quality mask); yet, remodeling can be done for the day’s activity, the place, the interaction, etc.

Let us understand those and tailor our activities.

Dr. Shashank Heda, MD
Founder and Chief Executive
CovidRXExchange
(A US global non-profit initiative for disseminating medical expertise and insight; working for Covid since March 2020)

Links to the blogs below –

If only we proactively spread the message within our network, engage in an active dialog, resolve the misgivings around the vaccine, start Fastrack the process to curtail the virus. Our ability to bounce back, as a nation and as a community, depends upon how we counter the virus. https://mymilieu.org/2021/02/01/evangelizing-vaccination/

The variants with the infectivity, implications on testing, therapy, and vaccines. https://mymilieu.org/2020/12/26/emergent-variants-and-infectivity/

That provides a simple explanation of how vaccination will halt the spread of the virus. https://mymilieu.org/2021/01/28/a-triple-whammy-variant-vaccination-and-complacency/,

It is an ultimate hope that the vaccine provides herd immunity or the virus comes to a state of symbiosis with humanity. Luck is never the best strategy, but it had to happen. We wish to stumble across a variant that is as good as Common Cold, leaves minimal health impacts, and possibly with minimal mutations to stabilize. In the search for this haplotype, I shared this perspective https://mymilieu.org/2021/01/10/in-search-of-a-haplotype/

https://mymilieu.org/2021/02/06/covid-a-tale-of-two-worlds/

https://mymilieu.org/2021/01/28/a-triple-whammy-variant-vaccination-and-complacency/

https://mymilieu.org/2021/02/01/evangelizing-vaccination/

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