Covid 19 : "The protection lies in our own hands"

By Vijaya Pushkarna

When the enemy is as deadly as the novel corona virus, declared pandemic by the World Health Organisation, how and why  does our protection lie in our own hands?

Prof Amod Gupta, former Director of the Advanced Eye Care Centre ,Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, has for decades prescribed “wash your hands regularly, don’t touch your face” to thousands of his patients.

In an exclusive interview, Prof Gupta , honoured as "the teacher of teachers"in ophthalmology, explains how this simple act of washing your hands often and not touching your face, can help prevent the spread of this infection, as well as make us a healthier nation.

Q: What is the reason behind your advise to patients to “wash your hands…”. 
 A: I worked in the PGI for 42 years, and almost every year there used to be an eye flu epidemic. Practically every resident doctor and the faculty members got this conjunctivitis. Except me! What I was doing was perhaps the right thing.

After I saw a patient who would walked into my clinic,  I would wash my hands. Patients also handle paper, admit cards etc. I would have to write on that paper, so I would use my pen. So I would wash my pen. I would take spirit and sanitise my slit lamp, and the microscope  I used. I would sanitise the door knobs, the surface of the table and also the arms of the chairs. This was an exercise I would  do after each patient that I saw, so that the next patient coming in would not get the eye flu. 
And equally important, I would never touch my eyes.

Q: How long would it take you to sanitise the place? Did you do it yourself?
 A: It does not take too much of time. This exercise would take just two minutes. I would do it myself. I would never leave that to anyone, because I wanted to do this to my satisfaction. So that every place I had touched while examining the patient, or the patient would have touched in the clinic is sanitized properly. It is about patient care and self care.

Q: What is the rationale behind these two actions?
A:  One thing about all these viral infections is that they don’t fly into your system, they don’t enter your system through air. They stick on surfaces and some of these viruses are hardier than the others, and they will stay longer. For the eye flu it could stay on a dry surface for almost a month, they had figured some years ago. Simply put it could last very very long. Not a few hours. So anybody who is touching a surface   is certainly carrying it in his fingers, on his hands. And everyone uses a door handle, a knob, the lift buttons, the switches and stuff like that, so everyone in the family would get it.

Q: Would the patients see the importance of it?
A:  I used to tell my patients  that if you don’t want your family members to get it, tell them not to touch their face with their hands unless they have washed their hands thoroughly. Washing their hands thoroughly and not touching their face would prevent the family members from getting the eyeflu ,and that way anyone getting the infection would not be able to pass it on to others.

The patient touches everything, he uses the same towel to wipe his face, so  we presume that everything is infected . The only precaution in the true sense is that you don’t touch your face with your hands. If you don’t bring the virus to your face, then it cannot get into your system. It is as simple as that. And many patients understood that.

Q: Is that true of any virus?
 A: I am sure of the eye flu virus, but  I am certain we can learn our lessons from that .It comes every year and  it comes in a big way. It is not like it is without consequences, including very serious neurological ones that could lead to paraplegia. People become handicapped because of the complications of these viral infections Since it doesn’t kill people, it doesn’t draw  the attention it should have drawn. 

Q: Please elaborate on how the act of not touching your face works…
A: The only way you can save people is by telling them not to touch their face, and it is a simple precaution—don’t touch your eyes, don’t touch you mouth,  don’t touch your nose. You cannot bring the virus just like that unless somebody is sneezing right into your face. Normally people would not cough into your face, they would certainly be more than three feet away, what is defined as social distancing. People wont come that close unless they are family members or very close buddies, so we do already maintain that distance.

But more serious is the possibility of unwashed hands coming into contact with your face, because everything is infected. The eyes, nose and the mouth are the three ports of entry. You don’t want to take the virus you have picked up into your system, so you don’t touch them.

Q: Are we doing enough to sanitize the public space?
 A: Nowadays buses ..trains..cabs .. are all being sanitized … But the question is why don’t we do it as a routine? We have so much of tuberculosis, every day almost a thousand people dying of TB… We have three deaths on account of corona virus, but thousands dying of TB, which is spreading by community contact where everyone is breathing into everybody, every surface is contaminated, people are spitting

Q: Is there a similarity between TB and Covid 19?
 A: TB also spreads by an aerosol. It goes and sits. It’s a droplet. These are very very microscopic particles which trap the bug, the commonest eg of that is the TB bug, you cough it out .And people in shared spaces are likely to catch it.

So it is important to sanitize..people spit, people  wipe they hands on the handle on the back of the seats, there is  sputum everywhere in share spaces like buses, public transport. People leave the bugs everywhere..the next guys shares that space, and that is how TB spreads..

Q: Can the current messaging  help target other health concerns as well?
A: If they take up all these sanitation methods consistently on a war footing our dream of eliminating TB by 2025 will be achieved. In fact if they teach people to wash their hands, basic hygiene, civic sense, many things can be achieved in one go .

Saying Namaste is fine, it looks glamorous, we are teaching the world that. But let us teach our people also not to spit, to wash their hands, not to touch their face. We don’t work hard on that, now is the moment. All the infections that we have , the typhoid, all the food coli form infections diarrhea, dysenteries  all come from contaminated hands—cooks don’t wash their hands, waiters don’t wash their hands etc The government  is advertising, conveying the message. I would say if everyone did all this all the time, many health issues will be taken care of.

Q: Health authorities are recommending home quarantine, self-isolation? And malls and cinema halls etc are being closed for a few days in many states.
 A: Self quarantine or self isolation is self discipline.  The only way you can kill this epidemic is by isolating people who are infected, because the virus will die its own death, because the natural defenses of the body will take care.

We are all the time threatened or challenged by bugs, we survive because of our robust immune system. The young people, children  who have a robust immune system don’t even show symptoms. Their body will eliminate the infection in a couple of weeks, so if we isolate them they will not spread it to the next person.

Q: What are the dos and don’ts around self-isolation?
 A: Anybody can go to the shop wearing a mask, to buy food or whatever, that is  fair enough, because he doesn’t spread the virus and he doesn’t catch it. Going out should be on a need to basis, it doesn’t mean shutting down the city, closing shops. Its not a curfew, but self imposed restriction .So avoid cinema halls, malls , schools which have in any case been shut down. Lead a normal life at home.

Q: How long will this continue?
 A:  Balram Bhargav  the Director General of the Indian Council of Medical Research is being very logical when he says that if we can maintain this for one month, we will not go into the community stage of infection. I hope the government follows this up.

Community stage is where you go into a crowd and don’t know who’s spreading the virus and who’s catching it.In India we are still at the stage where the infection is occurring only in those who are in very close contacts – family members of care takers -- of  those who have a history of travel, to China or somewhere.
So we are not getting the virus by going to the bazar or  a shop. We have to manage the next one month.


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