HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

This COVID-19 pan­dem­ic has crum­bled the lives of mil­lions of per­sons as health sys­tems buck­le, bor­ders close, and aca­d­e­m­ic in­sti­tu­tions and busi­ness­es col­lapse. The con­ta­gion coro­n­avirus, as it spreads, so too has mis­in­for­ma­tion fu­elling dis­crim­i­na­tion and un­healthy dis­course. HEALTH PLUS is work­ing with health ex­perts to pro­mote facts over fear, bring­ing cred­i­ble guid­ance and knowl­edge to our pop­u­la­tion. Now more than ever we need all sani­tised hands on deck and team­work by every cit­i­zen of Trinidad and To­ba­go to flat­ten this curve and re­store the health of our pop­u­la­tion and ul­ti­mate­ly the health of our na­tion. We will get through this to­geth­er.

HEALTH PLUS in­ter­viewed two ex­perts of The Trinidad and To­ba­go Med­ical As­so­ci­a­tion (T&TMA). This es­teemed as­so­ci­a­tion rep­re­sents doc­tors from all spe­cial­ties across the coun­try. Their ethos is to Teach, Treat, Men­tor and Ad­vo­cate to and on be­half of physi­cians and pa­tients. The as­so­ci­a­tion main­tains a role with the Min­istry of Health and the PA­HO since the be­gin­ning of the pan­dem­ic.

Pro­fes­sor Har­i­ha­ran Seethara­man is a spe­cial­ist in crit­i­cal care med­i­cine and ed­i­tor in chief of the Caribbean Med­ical Jour­nal. He is di­rec­tor of post­grad­u­ate stud­ies at the UWI, spe­cialised in Bioethics and holds a PhD in Health Eco­nom­ics.

Dr Dar­ren Dookeer­am is the Pres­i­dent of the Trinidad and To­ba­go Med­ical As­so­ci­a­tion. He is a spe­cial­ist in Emer­gency Med­i­cine, in­struc­tor of mul­ti­ple life sup­port cours­es and holds an MBA in Health­care Man­age­ment.

Q: Let us ad­dress the chal­lenges sur­round­ing MASKS – How they work and why they should be worn prop­er­ly.

T&TMA:

• To pre­vent Covid-19 vi­ral par­ti­cles from be­ing trans­mit­ted, every per­son MUST wear a mask. Clin­i­cal stud­ies have es­tab­lished re­duc­tion in the trans­mis­sion of vi­ral par­ti­cles when masks are worn con­sis­tent­ly and prop­er­ly. Flu­id me­chan­ics stud­ies have shown that when some­one talks, sneezes and coughs aerosols are gen­er­at­ed, which range from sizes of 50 mi­crons to 500 mi­crons. The lighter par­ti­cles trav­el up to a dis­tance of 12 feet max­i­mum. When one wears a thick fab­ric (at least two lay­ers) mask, the aerosols can­not trav­el be­yond 1 foot. With a sur­gi­cal mask, the vi­ral par­ti­cles are fil­tered fur­ther.

• Lose fab­ric masks and ban­danas still can leak aerosols and trans­mit the dis­ease. Vi­sors are NOT com­plete­ly pro­tec­tive against the aerosol par­ti­cles trav­el­ling through the side and hence vi­sors can be worn on top of the masks to pre­vent eyes from ex­po­sure.

• In the N-95 res­pi­ra­tor which is tight­ly worn, trans­mis­sion of al­most all the aerosol par­ti­cles are pre­vent­ed, how­ev­er if the N-95 res­pi­ra­tor masks are not ef­fec­tive­ly used, they can al­so leak through the sides. It is high­ly rec­om­mend­ed that they should be re­served for health­care providers who are car­ing for known Covid-19 pa­tients.

• Masks with vents de­feat the pur­pose of wear­ing masks. The one-way valves or vents al­low air to be ex­haled through a hole in the ma­te­r­i­al, which can re­sult in ex­pelled res­pi­ra­to­ry droplets that can reach oth­ers. This type of mask does not pre­vent the per­son wear­ing the mask from trans­mit­ting COVID-19 to oth­ers. There­fore, CDC does not rec­om­mend us­ing masks for source con­trol if they have an ex­ha­la­tion valve or vent.

• Al­so, one should make sure that the re-us­able fab­ric masks must not be touched on the out­er sur­face. Once any­one gets home, the mask needs to be re­moved from be­hind and washed. Dis­pos­able masks must be dis­card­ed. Wear­ing of tight-fit­ting masks dur­ing ex­er­cise is not rec­om­mend­ed by WHO be­cause sweat can in­crease the growth of mi­croor­gan­isms. It is there­fore im­per­a­tive to main­tain so­cial dis­tance while ex­er­cis­ing.

• In ad­di­tion to good mask hy­giene, keep­ing a dis­tance of 6 feet is ex­treme­ly help­ful even in the pres­ence of a fab­ric mask since there is al­ways a chance of aerosol trav­el­ling to at least one-foot dis­tance.

Q: Why is so­cial dis­tanc­ing im­por­tant?

T&TMA:

• The re­pro­duc­tive num­ber of the Covid-19 virus is high and hence from one per­son - with­in a short time­frame – many per­sons may get in­fect­ed.

• Re­strict­ing so­cial mo­bil­i­ty and so­cial iso­la­tion are im­por­tant for the pre­ven­tion of trans­mis­sion of the virus. This is the rea­son for par­tial and/or full lock­down, which is usu­al­ly de­cid­ed by the num­ber of cas­es re­port­ed to be pos­i­tive at a giv­en time.

• As men­tioned above, when aerosols are gen­er­at­ed, heav­ier par­ti­cles (clos­er to 500 mi­crons) may set­tle down on the sur­faces and the virus re­mains alive on the fomites (inan­i­mate ob­jects) for hours. Any oth­er per­sons touch­ing the sur­faces and fomites can con­tract the virus.

• Crowd­ing in a closed place, touch­ing the sur­faces and then touch­ing one’s face, nose and eyes with­out wash­ing one’s hands can trans­mit the coro­n­avirus pathogen to an­oth­er per­son.

Q: Should schools re­main closed? How are chil­dren af­fect­ed?

T&TMA:

• Chil­dren may not un­der­stand the im­pli­ca­tions of the trans­mis­sion of the virus. It is al­so dif­fi­cult to re­strict them and pre­vent them from in­ter­act­ing with each oth­er. Fur­ther, since they may car­ry the virus­es from school to their homes and in­fect their par­ents and grand­par­ents, they can be­come the so-called “su­per-spread­ers”. Con­se­quent­ly, un­til the pan­dem­ic sub­sides it may be a good idea to keep the schools closed.

• Al­though the mor­tal­i­ty in chil­dren is re­port­ed to be low, there have been re­ports of mor­bid­i­ty in­clud­ing “Kawasa­ki” type of syn­dromes in the pae­di­atric age group. It is re­ferred to as Mul­ti­sys­tem In­flam­ma­to­ry Syn­drome in Chil­dren (MIS-C). Signs and symp­toms of MIS-C can in­clude: Fever, bel­ly pain, vom­it­ing or di­ar­rhoea, neck pain, a rash, red eyes, feel­ing very tired, red, cracked lips, swollen hands or feet, swollen lymph nodes. They may or may not present with all the symp­toms.

Q: What are the sug­gest­ed and proven ther­a­pies ap­plied for this nov­el coro­n­avirus?

T&TMA:

• The most im­por­tant thing is that one should NOT pan­ic. Covid-19 caus­es crit­i­cal ill­ness in on­ly 5% of the pa­tients and hence pan­ic buy­ing and hoard­ing drugs are NOT ad­vis­able.

• When there is fever and/or pain, one can use any an­ti-pyret­ic (like Parac­eta­mol) and step up treat­ment on the ad­vice of a health care pro­fes­sion­al. For any ther­a­peu­tic in­ter­ven­tion, a pa­tient must be re­viewed by a med­ical doc­tor to as­sess sever­i­ty of ill­ness.

• Re­cent stud­ies have shown ben­e­fits of us­ing an­tivi­ral drugs (remedesivir) in se­vere­ly ill pa­tients and the use of sys­temic dex­am­etha­sone. But on­ly a doc­tor will be able to tell which drug is use­ful at what stage of the dis­ease. Self-med­ica­tion by read­ing ar­ti­cles on the In­ter­net and by so­cial me­dia can turn dan­ger­ous with­out care­ful ad­vice.

Q: Im­mu­ni­ty and vac­cines

How do com­mu­ni­ties build im­mu­ni­ty to dis­ease? How do we move for­ward?

T&TMA:

When­ev­er there is an out­break of an in­fec­tious dis­ease, there is de­vel­op­ment of the so-called ‘herd im­mu­ni­ty’, where­in a large ma­jor­i­ty of the pop­u­la­tion de­vel­op in­her­ent im­mu­ni­ty to the in­fec­tious agent.

Herd im­mu­ni­ty can de­vel­op by two ways:

1. By a large num­ber of peo­ple get­ting the dis­ease

2. By ad­min­is­ter­ing vac­cine against the in­fec­tious agent.

• In a pan­dem­ic such as Covid-19 with high trans­mis­si­bil­i­ty, the first op­tion will lead to mas­sive ca­su­al­ties with huge loss of life and hence al­low­ing peo­ple to get in­fect­ed for the pur­pose of herd im­mu­ni­ty is NOT the op­tion. Vac­cines are very ef­fec­tive against in­fec­tious dis­eases and there is es­tab­lished ev­i­dence that many of the killer dis­eases of the last cen­tu­ry have been erad­i­cat­ed / pre­vent­ed by ex­pand­ed pro­grammes of im­mu­niza­tion through­out the world.

• Cur­rent­ly, for Covid-19, at least 120 can­di­date vac­cines are be­ing de­vel­oped, of which 4-5 are in Phase II tri­als, im­ply­ing a re­li­able vac­cine may be avail­able by the turn of this year. There are NO sci­en­tif­i­cal­ly proven stud­ies that vac­cines are dan­ger­ous and/or they cause autis­tic dis­or­ders and com­mon peo­ple should NOT be con­fused by the fake news spread by an­ti­vaxxers in the so­cial me­dia.

Mask Hy­giene and hand-wash­ing in par­tic­u­lar re­main MOST im­por­tant.

Look af­ter your­selves and look out for each oth­er. Our best de­fence against the virus is stop­ping the spread of the host of the pathogen (hu­man move­ment).

So re­strict­ing move­ments as much as pos­si­ble, fol­low­ing pub­lic health rec­om­men­da­tions on lim­it­ing so­cial con­tact, keep­ing two me­tres away from oth­er peo­ple when we go out, reg­u­lar hand wash­ing, self-iso­lat­ing if nec­es­sary and tak­ing care of those who are iso­lat­ed and our most vul­ner­a­ble are all of great im­por­tance.