Intramural spread of COVID-19 is the most difficult to control, says Ambarish Satwik

‘There is an overwhelming consensus that this is an air-borne infection and not a droplet infection that is spread by coughing or sneezing.’

Dr. Ambarish Satwik, vascular and endovascular surgeon at Sir Ganga Ram Hospital, New Delhi calls for the rationing of resources like blood tests so that severe patents who need results with a quicker turnaround time get their report faster. He also stresses on the importance of wearing a mask at home if there is a person developing a respiratory infection so that it does not spread within those living together.

Following are excerpts from an interview.

The nature of the virus is such that entire families are getting infected by just staying at home. How do you deal with such a situation?

The intramural spread, which is the spread of the virus inside a household or a closed space, is perhaps the most difficult to control. When you go out, you are wearing a mask but inside a building or office you are not wearing a mask. You obviously can’t wear a mask all the time but even if one person is infected and you are sitting around a table eating lunch, everybody around can get it. So at the slightest suspicion of a person developing an upper respiratory infection or fever, the patient must wear a light surgical mask if he or she is not breathless, and others around should wear an N95 mask.

There is an overwhelming consensus that this is an air-borne infection in addition to being a droplet infection that is spread by coughing or sneezing. Aerosols are produced even when speaking and linger around a room like a cloud. Especially now in summers, with air conditioners are on most of the time, the virus thrives in such a situation and can be around for a few hours depending on the viral load of the person. So, it is important to ventilate the space.

RTPCR tests results are taking long. Do you think people are not starting to take precautions early and are waiting for validation from test results?

In terms of precaution, it must be treated as COVD if a person has fever or an upper respiratory infection. However, medication or treatment should not be started without consulting a doctor. The report sometimes can also be a false negative depending on the quality of the test kit used. Some variants are also evading the RTPCR test. Communal air then is the biggest source of contagion. I am not saying that someone should wear a mask indoors all the time but if someone in the house has fever which is a sign of infection or high-grade fever which is a sign of pneumonia, they should sleep in a separate, well ventilated room. Loss of smell is also another indicator that should not be ignored even if the RTPCR test comes negative.

We have seen a lot of rush at hospitals over the past few weeks. In such a scenario, how do you choose who to admit and who not to?

Most hospitals are following a system of rationalization of beds and there is a system of who requires admission and who does not. This is where some of the blood tests advised to look for inflammatory markers assume significance because if there is a rapid or significant rise in inflammatory markers, then that could be suggestive of underlying pneumonia or a spiraling turn for the worse. Most cases of mild and moderate COVID can be managed and have been successfully managed at home if you are in constant touch with a physician through telephonic consultations and following strictly advice.

The government has been engaged in firefighting to upscale health infrastructure. What more needs to be done apart from adding more beds, ensuring medicines are not in short supply and uninterrupted supply of oxygen?

Nobody could have anticipated this kind of surge so our unpreparedness for this has been exposed. Both Central and State governments are I am sure doing everything possible to deal with the load of cases in the short term, but this is the time to rationalize. What happens is a blood test for instance is being prescribed numerous times even for a mild case of COVID. What this does is that it ends up clogging the system and increasing the turnaround time for a test result. A severe patient can’t wait three-four days to get their results as several important decisions such as starting steroids for instance can get delayed that could lead to a patient not getting timely treatment. You can’t squander your resources on patients who don’t really require such extensive investigations.

The government will get more beds and streamline supplies to deal with the surge but this is really the time to double down on masking and non-pharmacological interventions because you have to block transmission. Remember, somebody dying of COVID obviously got it from someone else who got it from someone else. If you physically block the chain of transmission, you are doing your bit.

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