(Note: You can also read this article in Hindi and Tamil. More languages coming soon)
What is the coronavirus (COVID-19) and why are people worried about it?
The disease is called COVID-19 (Coronavirus Infectious Disease 2019) and the virus that causes it is a type of virus called the coronavirus. It is so named because it bears a set of spikes that resembles a crown (“corona” means crown in Latin).
A number of viruses cause diseases in humans. These include diseases such as polio, measles, influenza (the “flu”) and the common cold. For some of these diseases, vaccines exist. Some of these vaccines, not all, are part of the immunisation schedule of injections you take when you are young. There is a vaccine for the flu which you can choose to take when older, but which needs to be taken every year to provide protection. These immunisations ensure that your immune system can recognise and fight the virus when it enters your body.
The problem comes when the body encounters a virus that it has simply not seen before. This is usually the case with viruses that circulate in animals or birds, for example, pigs, chickens and bats, under normal circumstances. Occasionally, these viruses can “spill-over” into humans, causing novel diseases. COVID-19 is one such disease. The virus for it is believed to have originated in bats.
People are worried about COVID-19 for a number of reasons. First, it is a respiratory disease that spreads easily from person to person. Second, for a small number of people infected with the disease, it can be fatal. Third, we have no natural immunity to it, there are no vaccines against it, and there are no medicines we can take for it, as of now.
What do we know about how the disease affects people and how does the infection spread?
Most people have mild symptoms somewhat like those of the flu. Most often, these include a (high) fever, a dry cough and exhaustion. In some cases, body aches, shortness of breath, muscle and joint pain, sore throat, headache, chills and occasionally diarrhoea may also be present. The disease appears to affect older people more than it does younger ones. Those aged between 0 and 9 are much less affected. The disease has a stronger effect in those with some pre-existing medical condition, such as diabetes, heart disease, lung disease or suppressed immunity. More serious consequences of the disease, which includes pneumonia, are seen in about 1 in 5 patients.
The disease spreads largely through droplets that are emitted when someone who is infected coughs or sneezes. These droplets can linger on surfaces and then reach your lungs when you touch these surfaces and then touch your mouth or face.
Is there anything I can do to prevent myself and others from getting it?
Yes, indeed. The virus is transmitted through the respiratory route, i.e. through small droplets that are expelled when someone sneezes or coughs. These droplets can hang on to surfaces, such as the surface of someone’s hand or doorknobs or rails i.e. anywhere where people tend to touch. From there, little droplets carrying the virus can be transferred to your mouth and lungs. The solution? Wash your hands carefully to prevent the transfer of virus; for this follow the excellent videos that are available on Youtube (e.g. this one) that demonstrate the techniques that doctors and nurses use to wash their hands. If you wash the part of the tap you touch with soap and water before you wash your hands, you can open and close the tap at will to conserve water.
If you don’t have water and soap, an alcohol-based sanitiser will do fine. Avoid touching your hands to your face as much as possible.
Apart from that, avoid crowds as the chances of physical contact with infected people may increase. Maintaining such a physical separation from other people is called ‘“physical distancing”. A “safe” distance from people is usually considered to be between three and six feet. Avoid shaking hands. Use Indian greetings, such as a “Namaste” or an “Adab”, to minimize physical contact.
Do I need to wear a mask every time I step out of the home?
Wearing masks does more to protect others against the disease if you have it, rather than protect you from the disease if you come into contact with others who have it. More than that, high demand for masks from individuals deprives those who might need them more, such as healthcare workers. So, if you suspect you have a respiratory ailment, do wear a mask. If you feel OK, don’t.
Update on 15 May 2020: This answer reflected our early understanding of how COVID-19 spread could be controlled. We believe now that wearing a mask, even if you feel well, is a good idea. It reduces the chance that you will ingest droplets when someone coughs or sneezes in your vicinity, it makes you aware of the need to not bring your hands to your face without washing them well, and it also protects others just in case you might be an asymptomatic COVID-19 carrier. Also, it signals to others your seriousness in obeying public health measures that address the disease. More details can be found here.
What should I do if I have symptoms of cold/flu? Should I get myself tested and/or impose self-isolation?
Because the symptoms of COVID-19 resemble those of a number of other common diseases (flu, cold etc.), you may well be infected with one of those instead. If you think you are ill, the first (and in most cases, best) thing to do is to ‘self-quarantine’ i.e. stay at home or in a place where you can reduce your interaction with people as much as possible to avoid spreading the infection. This should be done as rigorously as possible — there should ideally be no direct or even indirect physical contact between yourself and those who look after you and your caregivers should be careful on their own not to get infected.
It is also always good to practice respiratory hygiene i.e. cough into your elbow or into a tissue that you can safely dispose of. Also, wash your hands regularly and get those around you to do the same, take rest, drink lots of fluids, and eat fruits to bolster your immunity. If you have difficulty breathing, call up the hotlines that are available to seek advice. In general, do not go to see a doctor directly unless advised to, especially if your symptoms are mild. This is because you will encounter other people en route who you could potentially infect if you actually turn out to be ill.
If you have a cough and/or runny nose you should be wearing a mask to avoid infecting others. Otherwise, a mask is of no particular help.
I have heard that those suspected of having the illness are ‘quarantined’. What does this mean and is this something to be afraid of?
There are two types of quarantines.
In one, you will be confined in rooms that the government has arranged, just so that your contact with others who are not infected is severely reduced. This is in cases where you are considered to be at risk of having contracted the disease because you reached India from a place where the disease is known to have spread and also exhibited symptoms of having caught it yourself.
Otherwise, if you are just suspected of coming into contact with someone who later tested positive for the disease, you may be asked to ‘self-quarantine’. This means that you will be required to stay at home or in any other place you can arrange where your access to other people can be properly limited.
Quarantine ensures that your physical contact with others is minimized. The health authorities will ensure that the state of your health is monitored and that you will be released from the quarantine requirement if you test negative at the end of the quarantine period, which is typically two weeks long.
There is no need to be afraid of quarantine. At most, being deprived of the sorts of physical and social contacts that we are used to experiencing can be a bit disorienting. But a well-designed quarantine facility will ensure that you can keep in contact with family and friends and in touch with the goings-on in the outside world. It will ensure that you are provided nutritious food and other amenities so that your stay is comfortable.
The rules surrounding quarantining are being regularly evaluated, as the progress of the disease is monitored. The government may decide at a later stage to have more stringent rules for deciding who should be quarantined and who need not.
Can I get the infection from eating, say, meat, or by using products from China?
No, not at all. First of all, this is a virus that is being transmitted between humans through a respiratory route; just any animal you might encounter won’t harbour it. So eating meat has nothing to do with getting a coronavirus infection. Also, viruses such as this one don’t last long on exposed surfaces and don’t tolerate high temperatures very well. The delays in a package reaching from China to India will ensure that no virus will survive the journey to infect you. It is thus safe to use products from China without fear of infection.
Should schools and offices be closed because of the possibility of infection?
Much depends on the stage of the epidemic. In the early stages and before the peak, when every effort is being made to contain it, closing schools is a useful strategy. But once the epidemic becomes widespread, the disruptions caused by such measures may not be worth it.
If, as the government assumes, we are in an early stage of the disease spread — a stage at which it is still possible to prevent it from spreading in the community — school and institutional closures will make sense. Such closures have been implemented in several Indian states by now.
However, whether schools and offices are closed or not, the concern should always be for elderly people or for those with some pre-existing health conditions, who have a higher chance of developing a more serious form of the disease. Every effort must be made to ensure that those with increased susceptibility to infection are protected as far as possible.
Is there a vaccine against it, or a medicine I can take if I get infected?
No, not yet, although many laboratories around the world are working on this. There are a number of vaccine candidates that are being developed and a number of existing medicines for other diseases are being tested on COVID-19 patients to see if they will work. Making a safe vaccine available takes time, up to a year or two at best.
I hear that infection can be prevented using herbal extracts and Ayurvedic and homoeopathic medicines. Should I believe this?
We know little about the effects of traditional medicines, although some people believe strongly enough in them. There is purely anecdotal evidence that they may work in some cases. Because health reflects the interaction of both body and mind, even strongly believing that a medicine might work — even if it actually doesn’t — often helps the body deal better with the disease. This is called the placebo effect.
However, it is far better established that simple physical distancing measures, respiratory hygiene and washing hands are very effective ways of preventing this and many other infections and of preventing their spread. As long as you practice such well-established methods of protecting yourself and others and do not substitute them with other untested or anecdotal methods, you should be fine. Also, boost your natural immunity by consuming fresh fruits and vegetables, get some sunlight when you can, and stay well hydrated. Reduce your stress levels as well, since stress lowers your body’s natural ability to fight infections.
What is the government doing to contain the spread of COVID-19?
The government is following the instructions of the WHO carefully and every level of public health machinery is aligned to it. The ministry of health is constantly updated about the numbers of cases and provides instructions to doctors and hospitals regarding the isolation and treatment of patients with the disease. The government has stopped the entry of people from countries affected by this disease by cancelling visas. Those who are suspected of having the disease are being tested. Quarantine facilities have been put into place in multiple locations. Ideally, a mechanism for testing anyone who suspects they have the disease should be put in place, but this is yet to happen.
Much will depend on how matters unfold in the near future. If there is what is called “community transmission” of the coronavirus, the numbers of those affected may become simply too large for the public health apparatus in India to cope with. It is for this reason that pursuing physical distancing, tracking down cases, the use of self-quarantine and monitoring of those who might develop symptoms later is crucial at this point.
Is this infection going to stay or disappear? Will warmer weather help to contain the virus spread? Will it reappear once colder weather returns?
This is particularly hard to predict. Some viral diseases (e.g. flu) are largely seasonal and tend to spread more easily in winters, rather than in the heat of the summer. We have no idea, as of now, whether COVID-19 will fall into this category. It could vanish altogether after the summer or — a perhaps more likely scenario — it could appear again in a second wave. We simply don’t know yet.
Where can I go to obtain accurate, scientific, and up-to-date information about coronavirus?
The websites of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) of the USA and the European CDC are all accurate sources of information. The web-pages of prominent newspapers and news organizations such as the New York Times and the BBC all carry trustworthy information. A number of Indian newspapers have carried accurate and well-researched reporting on the coronavirus and can be trusted. A good idea is always to go to the original source, typically the WHO or the Ministry of Health and Family Welfare which has current advisories.
How worried should I be, personally?
If you are under the age of about 60 and with no pre-existing conditions, you might not even notice that you have been infected with COVID-19. If you are elderly or have a medical condition that compromises your immunity, you should reduce close physical contact with others, even family members, for the time being, and monitor your health carefully.
Across all ages, however, you would be well-advised to follow the instructions regarding physical distancing carefully, wash your hands regularly, stay away from those who might be reasonably suspected of having the disease until they are cured, and contact the COVID-19 hotline numbers if you suspect you may be ill with this disease.
The author would like to thank Shahid Jameel, CEO, Wellcome Trust/DBT India Alliance, and Gagandeep Kang, Executive Director, THSTI, for their inputs.