PG: Sir I am asking this to you on behalf of All India Ophthalmology Society’s Scientific Committee. Sir there is an enormous trepidation amongst practicing ophthalmologists regarding the Corona virus/ Covid epidemic and what is the best response for them. Should they just shut shop and stay indoors to prevent its spread? Or join their other physician colleagues in the fight against the virus?
Prof GV: We all chose to enter medicine and have taken the Hippocratic oath. So, we should be all prepared for the risk it entails. All eyes are on the health care system today. There are certain common steps that we all need to take:
1. Keep distance from the patients. Do not let patients and their relatives crowd at one place. Wherever possible, give appointments to prevent crowding. Even for emergencies. If there are no appointment system / no telephones, some at the gate / door can let in patients one by one. Those outside too maintain distance from each other.
2. Wash hands frequently with soap & water. Right up to the elbow. Wear short sleeves. The long sleeves are fomites for the virus.
3.For equipment like slit-lamps, have a guard between you and the patient. Wash the guard with mild soap and water.
Make your own Slit Lamp Breath Guard , demonstrated by Dr Amit Porwal , Member Scientific Committee. View his video by clicking here
Q2
PG: For how long we need to carry out social distance and hand washing measures.
Prof GV: For the next few weeks to a few months.
Q3
PG: When would we be able to say that the danger has passed
Prof GV: It may be 3-4 months before we can say that.
Q4
PG: Is curtailing all routine Ophthalmology OPDs a sensible and useful step?
Prof GV: It is as it frees valuable health care resource for emergencies and prevents crowding. The lock down may be needed for 2-3 weeks after which it may be eased. Routine refraction and OPDs could be postponed. But diabetes related complication, RoP, glaucoma crises and post-operative problems would still need to be tackled immediately.
Q5
PG: Should elective surgeries be stopped? For how long?
Prof GV: For the next couple of weeks at least.
Q6
PG: Where to contact in case there is a suspected patient?
Prof GV: Each city and district have a designated government health care authority.
Q7
PG: How long should contacts of suspect follow home quarantine?
Prof GV: At least two weeks.
Q8
PG: What are the chances that health care providers shall be affected?
Prof GV: Chances of health workers being affected are very real, so adequate health precautions should be taken by all hospital and health care staff. Use of specific protective measures is needed.
Q9
PG: How long would this shut down be needed?
Prof GV: Furthermost models for the virus pandemic come from China, Korea, Iran, Italy and Spain which are all temperate countries. Their average temperature is 11° Celsius, Virus viability reduces after 25° Celsius and few survive over 35° C. We shall soon have temperatures ≻ 40° Celsius. With high temperatures, virus viability would reduce but it could still infect by person to person contact. Effect of ambient temperature and relative humidity were not considered in the modelling. Thus, a lot of the models about its epidemiological curve, made by leading epidemiologists and health experts, may not necessarily apply to India. The jury is still out. In China, it took 3-4 months for it to run its course. But there also it is still surviving as a low endemic infection. So, with us it may disappear in summer and we may see another flare up in autumn when temperatures reduce. Usually virus epidemic cycles last for 2 years.
Q10
PG: Would this become a recurring affair?
Prof GV: India has had its share of epidemics down the ages. The plague of 1998 was confined to a city (Surat). Some epidemics have a propensity to come again. Usually a low herd immunity develops. Indian population does have considerable herd immunity to many infections. Swine flu still persists in India, but is not considered a public health problem of large magnitude. Perhaps something like that may happen with Covid.
Q11
PG: So, what we need to do in long term? Behavioural change?
Prof GV: Road traffic accidents still kill more people than Covid/ Corona. We need to focus on personal and public hygiene, sensible health measures and invest much more on public health and cleanliness.