COVID 19 महामारी बुरा दौर आना अभी बाकी : बरतें ये सावधानियाँ

        देश में कोरोना महामारी को आये चार महीने से अधिक हो चले हैं! पहला कोरोना केस 30 January 2020 को केरला में सामने आया था. और स्थिति ज्यूँ-ज्यूँ बिगड़ती जा रही है हम त्यूँ-त्यूँ अपनी सावधानियों में कमी करते जा रहे हैं!! जब कोरोना संक्रमितों की संख्या सैकड़ों में थी तो हम ऐसे बर्ताव कर रहे थे जैसे हर दूसरा करोना पीड़ित हो! अब जबकि संख्या लाखों में हैं और हर दूसरे व्यक्ति के करोना संक्रमित होने की पूरी सम्भावना है तो हम कुछ यूँ पेश आ रहे हैं जैसे की लगता है करोना वाइरस lockdown खुलते ही लम्बी छुट्टी पर चला गया हो!!

इस वक्त सर्वाधिक संयम, सावधानी और सतर्कता की आवश्यकता है।

1. घर से बाहर जब भी निकलें मास्क लगा कर ही निकलें।
2. जब तक बाहर रहें मास्क लगाए रहें।
3. मास्क सही आकार का हो और उसे सही प्रकार से लगाएँ |(नाक और मुँह पूरी तरह से ढका हो)
4. यह भली-भाँति समझ लें कि मास्क केवल आपकी सुरक्षा के लिए नहीं है...अपितु आप से अधिक आपके सम्पर्क में आने वाले अन्य लोगों को सुरक्षित रखने का साधन है! अतः एक दूसरे की सुरक्षा का सदैव ध्यान रखें!
5. छोटा हैंड sanitiser सदैव अपने साथ रखें! और समय समय पर अपने हाथों को sanitise करते रहें या साबुन-पानी की सुविधा उपलब्ध हो तो 20-30 सेकंड तक अपने हाथों को धोएँ! हाथ धोने की विधि YouTube पर सर्च करें! देखने के लिए यहाँ क्लिक करें !
6. Sanitiser का प्रयोग करते समय भी उसे हाथों पर मलने का तरीका वही हो जो साबुन मलते समय होता है | कहने का तात्पर्य यह है की जैसे साबुन हाथों के सभी भाग में अच्छी तरह से लगाते हैं उसी प्रकार sanitiser भी हाथों पर अच्छी तरह लगा कर ही उसे डिसइंफेक्ट/ sanitize करना चाहिए!
7. साबुन से हाथों को धोना, sanitizer से हाथों को sanitize करने की तुलना में corona वायरस से बचाव में कहीं ज्यादा प्रभावी है! अतः जहाँ तक संभव हो और सुविधा यदि उपलब्ध हो साबुन-पानी से ही हाथों को धोयें !
8. घर वापस आने पर अपने जूते या चप्पल घर के बाहर ही रखें या उनके रखने का स्थान सुनिश्चित कर सदैव वहीं रखें उनका उपयोग घर में बिल्कुल भी ना करें!
9. सामाजिक दूरी बनाए रखना केवल औपचारिकता भर नहीं है अपितु वर्तमान समय में महत्वपूर्ण आवश्यकता है| इस महामारी से बचने का उपाय हमारे द्वारा नित्य-प्रति बरती जाने वाली सावधानियों में ही निहित हैं!
10. दफ्तर में बार बार उपयोग किये जाने वाली या छूई जाने वाली वस्तुओं जैसे Mouse, keyboard, मेज़, कुर्सी का हत्था, दरवाजे/ दराज़ के हैंडल आदि को नियमित अंतराल पर दिन में कई बार sanitize करें या करवायें |
11. दफ्तर में भोजनावकाश के दौरान साथ बैठ कर खाना खाने की आदत को फिलहाल छोड़ दें | लिफ्ट का प्रयोग कम से
    
    कम करें सीढ़ियों का प्रयोग करें और चढ़ते उतरते समय सामाजिक दूरी बनाये रखें | अगर लिफ्ट का प्रयोग अपरिहार्य है तो लिफ्ट में उतने ही लोग एक बार में जाएँ जितने में सामाजिक दूरी बानी रहे! लिफ्ट में जब खड़े हों तो लिफ्ट की दिवार की ओर मुँह कर लें : एक दूसरे की ओर मुँह कर ना खड़े हों !
12. यहाँ-वहाँ न थूकें : अच्छा तो यह होगा की बहार कभी भी न थूकें ! 
13. तनावमुक्त रहें | तनाव हमारी रोग प्रतिरोधक छमता को कम करती है | इसके लिए नियमित योगाभ्यास करें, ध्यान करें, अपने परिवार जन - सगे सम्बन्धियों एवं अपने मित्रों से बातचीत करें | मज़ाक करें | हसें | हास्य तनाव को काम करती है और हमारी इम्मुनिटी को बढ़ने में मददगार होती है |
14. पानी ख़ूब पियें और नियमित समय पर भोजन करें। भोजन करना कभी भी ना भूलें या skip करें। नियमित फल खाएँ (कोई भी फल)! 7-8 घंटे की नींद प्रतिदिन लेवें-ये सब आपकी प्रतिरोधक छमता को बनाये रखने में महत्वपूर्ण भूमिका निभाते हैं!
15. अगर घर में एक ही शौचालय हो तो इस बात का ध्यान रखें कि संदिग्ध लक्षणों वाले मरीज द्वारा शौचालय के प्रयोग के फ़ौरन बाद शौचालय का प्रयोग न करें. मरीज के शौचालय प्रयोग के बाद एक्सहॉस्ट पंखा अवश्य चलाएँ ! अगर एक से अधिक शौचालय की सुविधा हो तो सुनिश्चित करें कि उनमें से एक का प्रयोग केवल मरीज़ ही करे !
16. फ्लश करने से पहले शौचालय का ढक्कन (sheet cover) ढक दें ! फ्लश की प्रक्रिया एयरोसोल (हवा में तैरती रह सकने वाली अति-सूक्ष्म पानी की बूँदें) उत्पन्न कर सकती हैं जिसमें COVID 19 के विषाणु हो सकते हैं क्यूँकि कुछ अध्यनों में यह पाया गया है की COVID 19 के विषाणु का मरीज़ के मल में कई हफ़्तों तक निर्वहन होता रहता है!
17. COVID 19 बिमारी के लक्षण जैसे बुखार, गले में खराश, गले में दर्द, खाँसी (मुख्यतः सूखी), स्वास में तकलीफ, बैठे बैठे या थोड़े श्रम से स्वास का फूलना या चढ़ जाना, सर दर्द, बदन दर्द, कमजोरी महसूस होना, सूंघने की या स्वाद महसूस करने की छमता में कमी आदि के आने पर बिलकुल न घबराएँ ! लगभग 80 प्रतिशत मामले मामूली लक्षणों के साथ स्वतः ही ठीक हो जाते हैं! केवल 15 - 20 प्रतिशत मामले में अस्पताल जाने की आवश्यकता पड़ सकती है.. 
18. कुछ चीजें जो आप अपने स्तर पर कर सकते हैं:
1. नियमित रूप से गुनगुना तरल जैसे गुनगुना पानी, नींबू वाली चाय, अदरख वाली चाय, ग्रीन टी, काढ़ा आदि लेते रहें | शरीर में पानी की कमी ना होने दें! 
2. गुनगुने पानी में नमक डाल कर दिन में तीन-चार बार गरारे करें!
3. पूर्ण विश्राम करें | COVID 19 बीमारी में मुख्यतः स्वशन तंत्र प्रभावित होता है! फेफड़ों की हवा से ऑक्सीजन सोख कर हमारे खून में पहुँचाने की छमता प्रभावित हो जाती है.. जो की पल्स ऑक्सीमीटर से नापने पर हमारे ऑक्सीजन संतृप्तता (SpO2) में कमी के तौर पर दर्शाता है! हमारी प्रत्येक गतिविधी के लिए हमारी मांसपेशियों को ऑक्सीजन की आवश्यकता होती है ! अतः हम जितना कम से कम गतिविधि करेंगे उतनी कम ऑक्सीजन की आवश्यकता हमें होगी !
4. अगर सुविधाजनक हो तो पेट के बल (Prone) हो कर लेटें:
   
   यह हमारे फेफड़ों से खून में ऑक्सीजन जाने की कुशलता (efficiency) बढ़ता है! अगर ऐसा न संभव हो तो दायें या बायें करवट भी लेट सकते हैं अन्यथा पीठ के बल लेटें ! 
5. विटामिन C की 500 mg की गोली सुबह शाम लें | आप संतरे मौसमी आदि जैसे फल खा कर भी विटामिन C की जरूरत पूरी कर सकते हैं! (लगभग 7 से 10  फल प्रतिदिन!)
6. बुखार या बदन में दर्द के लिए पेरासिटामोल (PCM) की गोली हर 6 घंटे पर ली जा सकती है... 
7. मास्क का प्रयोग, सामाजिक दूरी बनाये रखना, हाथों की साफ़ सफाई का समुचित ध्यान रखना तथा तब तक अपने आप को घर में सबसे अलग रखना जब तक कि COVID 19 बिमारी ना होने की पुष्टि न हो जाये या आप पुनः स्वस्थ नहीं हो जाते, अत्यंत महत्वपूर्ण है !

स्वस्थ रहें! सुरक्षित रहें!

डॉ. विराट कुंतलम
वरिष्ट चिकित्सा अधिकारी
न. दि. न. पा. प. (NDMC)
https://twitter.com/viraat_k
wanna say something anonymously to me CLICK HERE :-)

COVID Lockdown..what went wrong? - My point of view

#Lockdown What went wrong? - My perspective! 

        We went into lockdown too early probably and once we were in lockdown phase 1, we lacked the momentum/swiftness in tracing all the cases, their contacts and failed to isolate the symptomatic ones/ quarantine the asymptomatic ones well within time...and mind you by then the total no. of cases were in three figures only! Meanwhile we kept bringing stranded fellow Indians from foreign nations and let them go to their native places unrestricted! We should have made it mandatory to undergo 14 day quarantine (not home quarantine) for anyone who was travelling from abroad. After all corona virus didn't originate in India...It was clear from the begining that it has to come to India along with some foreign travellers returning home! 

        We ended/ eased the lockdown at the worst possible time! We did it when cases were still rising...it should have been when cases had at least plateaued or even better would have been when number of daily cases had started declining... Instead of containing and managing the spread of pandemic we unknowingly chose to spread it...by allowing people to migrate form one corner to another! We probably lost the resolve and buckled to the luring economic crisis...or probably got bored of staying home bound for too long...

        Issues of Migrant labourers should have been dealt in a better manner...we could have done better at this front! They could have been given daily/alternate day jobs near their residences after daily temp & symptoms screening... we could have repaired our roads in lockdown when roads were deserted or renovated our office buildings which were vacant etc ... similarly construction work could have been permitted after necessary precautions...thus creating fair daily wage job opportunities for them... all it would have taken was screening! This way the inhuman migration would have prevented and also most of the marginalised families would not have gone to the brink of starvation! We anyhow, started doing all these (at least most of these) now when we have cases in six figures!! But it easier said than done... 

        We are still far away from herd immunity (number wise)...even if mortality in our geographic region is relatively lesser than western world...we should not forget that we have a huge population base! Even 0.01 % (considering critically ill cases) would mean 1,35,000!! As on April 2020 we only have approx. 95000 ICU beds and approx. 47,500 vents (public + Private)*! So by the time we attain the herd immunity level theses resources can easily be used up if we let down all our guards! Therefore, it’s imperative for us to strictly observe the preventive measures. Given the prolonged recovery time associated with critically ill patients you can well imagine what a messy scenario it’s gonna be! 

Having said all the negative things, what we can do at our ends is simple! 

a) Observe social distancing, wear masks whenever in public and wash hands/ sanitise with >65% alcohol containing sanitiser whenever you have moved around in office and come back to your desk! This is the only proven scientific way to prevent SARS -CoV 2 infection which leads to COVID 19 disease in few cases (20-30%). 

b) Always assume that everyone is a potential corona carrier. This way you will be more likely  to stick to the precautions advocated. 

c) Remember that only portals of entry of corona virus are eyes, nose and mouth! So, avoid touching them when you are in public. 

d) Have healthy diet. Don’t skip meals (specially breakfasts). Have fruits and lots of proteins. They boosts your immunity. Have foods rich in vitamin C (amla, lemon, citrus fruits-oranges, sweet lime etc). 

e) Sleep well. Take at least 7-8hours of sleep daily. It not only helps your body to rejuvenate daily but also is essential  for optimal functioning of immune system apart from improving your longevity, apetite and memory altogether! 

f) Avoid chilled/cold foods and fluids. Sip Luke warm water frequently (hot water does no better!). Keep yourself hydrated. 

g) If you have been suffering from any chronic illnesses particularly diabetes or Hypertension, keep them in check, take your medicines regularly, maintain healthy life style...Walk! Walk for 30min daily in the park or in your society compound or on your rooftop or if none is possible you can do figure of 8 walking in your drawing room! (CLICK HERE to find out its benefits!) 

h) You can practise all things advocated by alternate system of medicines (AYUSH guidelines) - to a lesser or greater extent they will help you! 

i) Stay positive. 70-80% cases are going to be asymptomatic. There is 8 out of 10 chance that you might get infected with SARS CoV-2 and you will recover with minor flu like symptoms or may even not notice them as well. 

j) Sooner or later majority of us will get infected with Corona/ SARS CoV-2 virus! After all don’t forget, to attain herd immunity 70-80% population needs to get infected and recover! 

k) Be watchful of your symptoms (fever/cough/ headaches/body aches/ breathing difficulties/ shortness of breath etc...once you notice any of them isolate yourself from your near and dear ones (stay in one room, wear mask at all times, don’t allow anyone to come near you) and contact your doctor/ healthcare provider ASAP. 

“यक़ीनन वक़्त बहुत बुरा है जनाब,

एहसास तो सबको ही कराएगा...

बात इससे भी अच्छी यह है कि, 

हो जैसा भी यह गुज़र ही जाएगा..!” -unknown 

#Stay_Safe #Stay_Positive #COVID_Times_This too shall pass!

Dr. Virat Kuntalam

Senior Medical Officer

NDMC 

@viraat_k

*https://cddep.org/wp-content/uploads/2020/04/State-wise-estimates-of-current-beds-and-ventilators_20Apr2020.pdf

The Learning Enemy - Ticking Time-Bomb within us...!

                    Have you ever imagined why defence and offence strategies of our security forces are so Top Secret!? It’s simple because we  don’t want our enemies to be prepared for what all we have in our stock!!! 

                   Same principle applies to the vast world of microbes (pathogenic - disease causing microbes to be specific). We would not like the Salmonellas (typhoid causing bacteria) Vibrios (cholera causing bacteria), E. colis (many gut and urinary tract infection causing bacteria) and many others to be prepared for the gamut of antimicrobial agents (mainly antibiotics) that we today have and which we use in patients suffering form these diseases.

                 Therefore, need of the hour for we as doctors is to use antibiotics (for that matter any antimicrobial agent!) judiciously and cautiously… It’s really distressing to see the use of higher/next generation antibiotics for simple infections that too without any evidence (e.g. Culture sensitivity reports etc). But we all health care providers are more or less aware of this monstrous problem…and frankly speaking bit scared too…at least I am.. Specially after the emergence of ‘SuperBug’ few years back…!

We medical professionals need to USE ANTIBIOTICS WISELY, NOT WIDELY!

                   So, with this article I basically intend to enlighten the 'non-medico’ segment of the society. Why today? Because, Indian Academy of Paediatrics has undertaken this MISSION AAA (Avoid Antimicrobial Abuse) and is celebrating the Rational Antibiotic Use Day (28 September 2014) and Antimicrobial Awareness Week (28 September 2014 - 05 October 2014).

               Most of the common illnesses like Common Cold, Flu, Diarrhoea are basically caused by viruses…and hence use of antibiotics are redundant. They will not help you get back to office any sooner…! And so, for you- as patients its of utmost importance that you get over this inherent urge to buy prescription medicine over the counter from the pharmacist. ALL ANTIBIOTICS ARE PRESCRIPTION MEDICINES meaning thereby, its illegal to buy them without a valid prescription… and its rightly been that way.  Text below will make you understand why its important.

                      In 1953, there were more than 7,50,00,000 cases of malaria per year! And it was a huge public health burden. Govt. of India launched NMEP (National Malaria Eradication Program) and there was free lance use of DDT to kill the mosquitoes. It did work, temporarily though, bringing malaria cases to all time low of  50,000 cases per year in 1962!! But in next 10 years the number of cases rose 12times…leading to catastrophic failure of program. This happened because of the natural selection! Use of DDT killed the susceptible mosquitoes but spared the once which were resistant to DDT and in next 10 years these multiplied and led to increase in cases of malaria. Had other strategies would not have been undertaken, malaria and death due to malaria would have risen back to same 1953 level. Life subsists and so does mosquitoes and malaria. And by the way, this led to change in approach by govt. which reflects in name of malaria programs over the years: started with NMEP---> National Malaria Control Program (NMCP)---> Intensified Malaria Control Program (IMCP)!!

                        There was a period when we, kind of, lost our track as we were so goal oriented.! In order to decrease the cases of malaria and malaria related death we started giving presumptive treatment of malaria to all cases of fever suspected to be due to malaria, specially in malaria endemic regions. And we used Chloroquine the most common drug for malaria. As expected, it did bring the cases down initially but soon number of cases started to rise due to development of Chloroquine resistant Plasmodium spp. (parasite that causes malaria) but fortunately, this time we were intelligent enough to see the trend early and literally stopped the presumptive treatment. Now we use anti-malarials only in proven cases of malaria (either by microscopy or by RDT- rapid diagnostic test Kit). 

                        Another example where inadequate treatment (mainly premature stoppage of medicines prescribed) leading development of such a dreadful disease is: Tuberculosis!! Once easily treatable under DOTS (directly observed treatment short-course) program, TB is now rapidly transforming into difficult to treat MDR (multi drug resistant) TB, even more difficult to treat XDR (eXtremely drug resistant) TB and now there is TDR TB on the horizon...! (totally drug resistant, though WHO avoids the use of acronym TDR as it gives hint of hopelessness!). This is all because we as patient don't stick to the prescribed regimens...the moment we start feeling well we tend to forget about medicines...and leave the treatment mid way!! And remember is a contagious disease. If one has MDR TB, one will spread MDR TB!!! 

                  Similarly, when we take antibiotics irrationally we put selection pressure over microbial population. Sensitive microbes die…resistant ones survives…and now whole resource is available for the resistant ones which flourish rampantly…and the worst part is Resistant bug replicate into Resistant BugS!! 

             Also, Its important to take antibiotics for prescribed duration and in prescribed dosages. Most of the time you start feeling better just after few doses of medicine. Its because majority (NOT all) of disease causing bacteria are killed by the first few doses of antibiotics (provided right antibiotic has been prescribed!!). But you need to take the complete dose of medicine so that the infection is completely eradicated. If you take meds for sub-optimal duration there is always risk of relapse of illness with greater severity. 

REMEMBER, If we SAVE Antibiotics TODAY, They will SAVE us TOMORROW!!”

                    Other important thing is, microbes are enormous in number. Just 1gram of your faeces may have somewhere around 100 million-1trillions of them!!! And even though rate of mutation (random change in genetic material of an organism leading to change in its characteristics) is very low, mere number of these little bugs make it a significant event for them. Its nature’s experimentation for betterment of the organism. 100 experiment may fail, 1000 may fail, may be million experiments fail…which is unfair for them…but they are in trillions..!! Someday some random iteration in genetic material may work… and nature’s experiment continues creating newer forms of bacteria…some of which are inherently resistant to our antibiotics…but as long as these are in the company of their own 'cousins and nephews’ we have no problem as they have to compete with trillions of bugs to grow and survive with limited resource! 

Problem occurs when we use antibiotics irrationally and sub-optimally! This creates favourable condition for resistant ones by wiping out the billions of competitive sensitive bacteria…now all the resource is available for these dangerous bugs and they multiply!!! 

The other worrisome fact is we have already made antibiotics which act on all known targets of bacterium…there are hardly any novel antibiotics in pipeline. Also, in past decade or so there were only a few antibiotics which were produced. On the other hand bugs have developed resistance to all known antibiotics…fortunately they all are not present in same single bug so far…but if we continue like this with antibiotic abuse that SUPER BUG is not very far from reality…!

            So, irrational-sub-optimal and rampant use of antibiotics must stop. Otherwise, there will be so many superbugs that we probably will not be able to contain them! Instead of self medicating seek the expert and get optimal treatment…

Stay active…stay healthy…Do well!!!

Dr. Virat Kuntalam

Medical Officer

New Delhi Municipal Council

Parliament Street, New Delhi 110001

The Exercising Habit...

         Early morning yesterday...by early morning I mean- around 7-7:30am and please, don’t take it any other way..7:30am is early morning! At least for me!!! :-) I was at Talkatora Garden. Although, I was there for the physical fitness test of security personnels that NDMC (New Delhi Municipal Council, which happens to be my employing body as well) is recruiting and before all the equipments could be set up I had some time to explore the beautiful garden…after all, I had not been an early bird of late…specially on a weekend…! ;-)

         The garden is really beautiful and soul comforting. The chirps of birds, and playful shouts of children, that routine-synchronised-animated but altogether necessary loud laughters which you can hear in any garden/park of Delhi by the group of people mainly in their 60s and beyond…the sound of water at water fountain….the footsteps of jogging individuals…the excerpts of political chat by mostly older people while taking their break after certain amount of physical activity…the panting of competitive youngsters who just dashed the extra 50 meters-or-so after their self-set distance for the day...

          I really had forgotten that there are still so many people who are not only awake but fully functional that too so early!!! And among all these hustle-bustle

of early morning...I saw another of group of individuals at the far east corner of the garden near the cricket ground…this is that side of garden which is adjacent to Mother Teresa Crescent Road…There were individuals of all age groups…The sight at first amazed me..and later pleased me as a doctor! 

          I saw three generations of a family: the Grandfather, the Father and the Son working out together..and no need to mention that this habit inculcates in the younger generation from older generation itself. If you are active, likelihood that your son will lead an active and healthy life is fairly high..and so it is for your grandson provided your son is active too…! 

           Having said this and due credit given to the individual/family…I would not be just if I don’t mention the efforts taken by the NDMC and its staffs to provide and maintain the equipments at public parks/gardens like this one which make exercising fun and not something which is tedious and brings wrinkles on forehead…! These are the equipments which NDMC recently purchased from Garden Gym.

           Its amazing how simple basic facility encourages people to be active and thereby healthy… Though, initially it may seem like futile investment but as a doctor I can say this small initiative will translate into a greater good for I know a healthier society is a productive society… Not only this initiative will reduce the burden on heath care delivery system but also increase the outcome from each and every involved individuals.

           I would be happier to see more sets of such equipment in different corners of Talkatora Garden and also in other parks/gardens of NDMC and Delhi as well…! :-)

Stay Active...Stay Healthy...!! 

Dr. Virat Kuntalam
Medical Officer,
Palika Kendra,
NDMC