Covid-19: The fight is far from over

As the world remembers the first anniversary outbreak of novel coronavirus (in Wuhan, China) on November 11 last year, the three-pronged approach of the government of India namely: 1) Early identification 2) Prompt isolation and 3) Effective treatment has been a successful talisman for the treatment of Covid-19 patients in India. The recovery rate has been increased to 93.76% and the fatality rate has been reduced to 1.46%.

The relentless efforts of the political executives , administrators , doctors , nurses , paramedical personnel, police and innumerable voluntary organisations resulted in a dismal percentage of active cases when compared to recovered patients in the country (the recovered cases are about 20 times of active cases which is considered to be one of the lowest in the world).

The testing capacity of India reached 15 lakh tests per day with a vast network of 2134 labs (including 968 in private). The total number of cumulative tests reached 13 crores odd (approximately 10% of the total population which is a remarkable achievement keeping in view of country's global position in economy).

However, the Emergencies Director of the World Health Organisation (WHO) warned the world ready to face the second wave of coronavirus without vaccines. As if his word was under realisation, there was a sudden spurt in the number of cases in National Capital Territory (NCT), Delhi, Haryana, Rajasthan, Gujarat and Manipur.

With the surge in daily cases and spike in daily fatalities the spill over effect was seen in the neighbouring Haryana and Rajasthan States. The Central government has dispatched high level teams to all these States for effective containment, surveillance, effective testing, infection prevention, control measures and efficient clinical management.

In Canada, cities like Toronto are brought under lockdown again. In order to control the accelerated coronavirus in the capital of Britain and the important financial centre of Europe, London has undergone stricter lockdown since October 15.

In India, States like Gujarat, Madhya Pradesh and Chhattisgarh re-imposed night curfew in many cities. In Ahmedabad, Surat, Vadodara and Rajkot in Gujrat, lockdown has been re-imposed from every Friday night to Monday morning. As well the curfew has been imposed on the movement of people from 9 pm to 6 am.

The situation is the same in Bhopal, Indore, Jabalpur and Vidisha of Madhya Pradesh and Raipur of Chhattisgarh. 13 districts in Chhattisgarh have been on and off under strict lockdown rules. Even the District Medical & Health Officer of Raipur has recommended to carry on tests on each and every one entering into their district. In Himachal Pradesh, four major cities namely Shimla, Mandi, Kangra and Kullu are under night curfew till December 15.

States like Maharashtra re-imposed restrictions on travelling particularly air travel. Now the passengers flying from Delhi, Rajasthan, Gujarat and Goa are supposed to submit the negative report to the airport authorities or they have to undergo the RT PCR tests.

Bihar started a 15-day special campaign to drive home the three points: compulsory wearing of facemask, maintaining safe distance and repeated sanitisation of hands with soap or sanitiser. Karnataka announces from January 2021 all medical tests including Covid-19 will be done freely in all government hospitals/facilities. Of late, the Chief Minister of Rajasthan declared that the Covid is moving towards 'dangerous situation' reflecting the alarming situation.

Overall, States/ UTs namely NCT Delhi, Maharashtra, Gujarat, Rajasthan, Madhya Pradesh, Chhattisgarh, West Bengal and Tamil Nadu are leading the tally as far as number of positive cases are concerned. All efforts are being made by the governments to ensure continuous supply of oxygen and ventilators.

A total 160 oxygen plants are under various stages of commissioning. 10 RT PCR mobile Covid-19 testing labs started to function in NCT Delhi which can test around 3,000 samples each and give results within six hours. The total beds dedicated to Covid have been increased to 6,000, 500 additional oxygen connected beds and 250 additional ventilators (supplied by BEL, Bengaluru) are provided to NCT Delhi.

Moreover, 45 doctors and 160 paramedics working with Central Armed Forces have been deployed in various government dedicated Covid hospitals in Delhi to counter the severe situation. In cities like Surat the number of beds has been increased by four times to handle crisis like situation.

As far education is concerned, gradually many State governments are opening schools, colleges, institutes and universities. Bangalore University has been opened after many months. In UP, though colleges have been opened, the attendance marked was hardly 10-25%. In Himachal Pradesh, the schools will remain closed till December 31. In Maharashtra, the government declared to open the schools except in the Municipal Corporations Mumbai (BMC) and Pune (PMC& PCMC).

Overall, though in many States the educational institutions are opened for the students of 9th standard and above, parents and their wards are worried about attending the classes physically. Still, 90% students prefer online classes only. Particularly the primary school kids are being affected seriously, mainly their eyesight due to continuous clinging on to the screen (of laptop/mobile).

One international report recently revealed that due to the complete change of working style (work from home using laptops), online classes for students and distinct entertainment (confined to watch movies on mobile) increase the 'screen dependency' 10 times. During my interaction with famous ophthalmologist of Pune Dr Samita Moolani on this issue, she has revealed many interesting factors which would be helpful to all across the sections and different age groups.

When we continuously look at the screen, we tend to forget to blink eyes. It leads to dryness of the eye and thereby redness, pain, feeling of sand in the eyes, blurring and strain together with headache. Increased near vision has been associated with increase in minus in children resulting in progression of myopia/short sightedness. Digital screens emit all kinds of lights, particularly the blue one. In order to curb the negative effects of this, ophthalmologists suggest glasses which function opaque to this.

However, the results are scientifically yet to be proved. Excessive screen time affects neck, back and sleeping patterns also. Hence Dr Samita suggested to limit the screen time whenever and wherever it is possible. She also suggests to sit in a well-lit room with an ergonomically well-designed chair. Windy air evaporates tear very fast hence not to expose our faces directly to wind/fan air.

To reduce the effects of screen time, the rule 20-20-20 can be followed i.e. to take a break after 20 minutes, to look beyond 20 meters and to blink your eyes 20 times. To maintain pigeon blink, keep blinking 10 times per each minute. Dehydration causes dry eyes, hence one has to take plenty of water to prevent this. To have omega 3 fatty acids, consume fish or flax seeds which keep oil glands in the eyelids healthy.

The farther and larger the screen from eyes, the lesser the strain. For entertainment i.e. for watching movies and other videos, better avoid mobile and tablets. Never use a brighter screen in a dark room as it damages the delicate membrane/retina permanently. In the meanwhile, ever confident Prime Minister held a review meeting with higher level officials and the Chief Ministers of many States on the preparedness of vaccine manufacturing, storage and judicious distribution.

The Health Minister also expressed confidence that by the initial months of next year the vaccine would be ready to administer. Even the Bharat Biotech announced phase 3 trials with 26,000 volunteers throughout the country in collaboration with ICMR and NIV Pune. The Oxford-Astrazeneca, Pfizer-BioNtech and Sputnik- Moderna also are showing good results in advanced stages.

All said and done, the battle is not yet over; better to follow the three simple principles namely continuous wearing of facemask, safe distance and sanitisation of hands repeatedly.

The writer is Joint Commissioner of Income Tax & Inspection Authority into exorbitant medical bills on Covid-19 patients by Corporate Hospitals in PCMC, Pune. With inputs from Dr Samita Moolani, MD (Ophthalmology)