Dr. Gurshan Singh Gill is an MBBS, MD. He is Assistant Professor, Department of Preventive and Social Medicine, Christian Medical College, Ludhiana. Dr. Gill is currently in the frontline of the battle against Covid-19. In this interview, Devadeep Chowdhury discusses pertinent questions that we face during this time.
Q: We come to the ubiquitous question of immunity — is it even relevant?
A: Immunity can’t really be boosted unless someone gets the virus, but one can try to remain healthy to counter not only Covid-19 but any other disease in general. Health has two aspects: physical and mental. During times of lockdown, mental health becomes crucial. One can do a little bit of meditation or yoga every day to remain calm and positive. It has remarkable advantages on a person’s physical well-being. Make it a routine if possible and continue even when the crisis is over.
In terms of physical health, one has to maintain a balanced diet with a harmonious intake of carbs, fibres and vitamins. One must remain well-hydrated. During the outbreak of the first Coronavirus or SARS in early 2000, it was seen that people with Vitamin D deficiency got more acute symptoms — so it is advisable to take dietary supplements. Vitamin C helps in healthier oral mucosa. As we all know that Coronavirus can be contracted through the mouth, Vitamin C intake should be increased by having citrus fruits. In general, a basic diet should consist of a balance between food grains, pulses, fruit and dairy.
Q. What are the general precautions one can take at this time?
A: Coronavirus can affect anyone. Immunity will depend on someone contracting a milder or severe course of the virus. Right now, people with travel history should immediately contact their health care department or nearest doctor even if they have mild flu-like symptoms. In some cases, diarrhoea patients who come with travel history are kept in quarantine and tests are conducted. If the test is positive, they are treated in an isolation ward. When they get better, they undergo two more tests before they are discharged.
If people cannot make it to a doctor and have no travel history, they should be careful too in terms of keeping distance from their family members so that widespread contraction can be avoided. They must not smoke or consume alcohol. Remaining hydrated during the entire period is essential. People affected with milder symptoms should avoid meeting the elderly. It is likely that the younger population will get better on their own; senior citizens are not that lucky. Also, people with diabetes, asthma or any other lung ailment should rush for medical attention even if they have milder symptoms of Coronavirus as their condition can worsen rapidly.
Q: It has been observed that even after contracting the virus, people can be asymptomatic. How do they spread the virus if they don’t cough or sneeze?
A: The virus has an incubation period — the time between it enters the body, and the body starts to show the first set of symptoms, that is, fever, dry cough, difficulty in breathing. The time period before the first manifested symptom could be anywhere between 14 to 21 days. But from day one of contraction, the person becomes a carrier.
Coronavirus spreads through droplets and the droplets can settle on fomites. Even an asymptomatic person would most likely sneeze or cough a few times during a no-symptom window. The droplets (which are laden by the virus) coming out of that person’s mouth could settle on any fomite such as door knobs, railings or handles. Healthy people who touch those surfaces could contract it.
Q: But is it possible that someone can contract the virus and not fall sick at all?
A: That depends upon the immunity of the person. It is extremely unlikely that there can be someone who does not show any symptom at all of Coronavirus. However, it can be mild enough for someone to ignore it completely. As of now, barring some rare cases, the severity of Coovid-19 is most ruthless on people with pre-existing conditions and the elderly. A body which is already sick or old can’t develop the immunity that is required to ward off the virus. To answer your question — everyone who contracts the virus will show some signs of it.
Q: There have been some cases where patients who have recovered fully have fallen sick again with Coronavirus. Does it mean that even after getting cured, a person can be a carrier for some weeks?
A: It is too early to say anything definitive about this. As we all know, there is no medicine for Covid-19. People who are getting cured are either being administered a combination of drugs, or they are developing antibodies that kick the virus out of their system. Drugs work in two ways. First, there are drugs such as hydroxychloroquine which inhibit the virus from replicating progenies. Second, there are drugs that are used on HIV patients which prevent the virus from attaching itself to human cells. It helps people to recover from their symptoms, but in no way does it guarantee that they are not going to be re-infected, though the course of the infection is likely to be much milder. However, patients who have developed immunity are not going to get infected. Therefore, the Indian Council of Medical Research has given the green signal to try plasma treatment for Covid-19, which takes blood plasma cells that have antibodies of cured people to treat sick people.
Q. What is the efficacy of the BCG vaccine?
A: One study — and I emphasize — only one study as of now, has shown that a population which has taken the BCG shot are less likely to get sick with Coronavirus. It is not very conclusive. The usage of hydroxychloroquine is more complicated. It is not a cure as proclaimed by some. It is recommended as a preventive medication for people who are in close touch with Covid-19 patients such as healthcare staff. In vitro studies have shown that people who are in direct contact with patients should take Hydroxychloroquine as prophylactic. One must bear in mind that usage of this drug has its side effects — one of them being cardiac arrhythmia. Simply speaking, it can lead to a complication of the heart such as a heart attack. So, it must not be taken without medical consultation.