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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.