By Dinesh Bhugra
IN MY entire medical career, I have never seen anything like it.
As a medical student in India, I remember seeing cases of infectious diseases and looked after them with careful protection. I recall seeing cases of smallpox and typhoid and other life-threatening diseases, but the current situation is truly unparalleled.
We have had previous epidemics – SARS, MERS, swine flu and others – but there has been nothing quite like it. If a year ago, someone had predicted that major parts of the world would be in partial or complete lockdown with over half a million diagnosed with a virus, nobody would have believed them. Covid-19 fears no borders and it is not a social class confined infection. Princes, prime ministers and politicians have got it, and the daily death toll is rising.
Having said all that, it is important to recognise that a vast majority of individuals will get very mild symptoms, may not even notice that they have got it and will fully recover.
We are not entirely clear about the mode of transmission – whether it is droplet infection, touching infected surfaces or actual physical contact with those who have sub-clinical infections. In spite of the UK government’s best efforts and public health messages, there are reports of people not following social distancing procedures and collecting in significant numbers in public places.
South Asian families have pressures and needs that must be taken into account by the population, community leaders, service planners and those who deliver services. Many families will have two or three generations of individuals living together. They may have a common kitchen, even when they are living next door to each other. Under these circumstances, what is needed to protect the vulnerable older adults, who may have pre-existing medical conditions, as well as others?
The first step is to keep up to date with the most recent reliable information from trusted sources. These could be the NHS, World Health Organisation (WHO) and various reputable charities through public service announcements and accessing their websites whenever possible. In addition, relevant information in other languages can be accessed. Social media can provide good quality information, but be careful in that they may also act as sources of misinformation.
Unless you are working in essential services and cannot work from home, keep your travel and contact with others to a minimum. Official advice does not advocate using masks, but having it on can reduce the chances of touching your face to a minimum. If you are travelling on public transport keep your distance and if that means moving to another part of the bus or the Tube, do so.
Try to work from home as far as possible and keep going out of the house to an absolute minimum, perhaps no more than once a day to exercise, or shop for essentials and medication. When you are out and about, try and use a mask even though its protection may be short-lived. Keep a small bottle of hand sanitiser in your pocket, try not to shake hands, and even with friends and neighbours keep your distance. If you are having things delivered, collect these, wash your hands in a careful 20-second manner.
If anyone in the household develops symptoms of a new cough lasting longer than four hours and gets a temperature try and isolate them to a separate room with no or minimal direct contact with others, making sure that they have plenty of fluids. One person, suitably masked, can get food and fluids to them. If the fever is high, paracetamol can be used as instructed. Do ensure that if anyone else in the household develops symptoms, similar isolation is made available. Where two or three generations are living together it may not always be possible but, in this period, adjustments are not only necessary but essential to combat the spread of the coronavirus.
There have been suggestions, specially on various WhatsApp groups that turmeric, garlic, Chinese herbs, homeopathic drugs or Ayurvedic medication works. There have been stories in the press that chloroquine (an anti-malarial drug) and various anti-viral drugs have been used successfully. At times of distress, it is human nature to explore all possible options but there is no clear clinical evidence. It is a virus which, when it causes pneumonia, will not respond to antibiotics. Hospital treatment will be required in a number of cases, but the best treatment is prevention.
When self-isolating or working from home, try and create a structure as if you are going to work – take short breaks, concentrate on work but have time for yourself. You can try yoga, meditation, listening to music, exercise, listening to religious hymns if you are so inclined or watching your favourite TV programmes on catch-up services in order to relax and manage stress. Keep in regular contact with friends, colleagues, peers, neighbours and ensure that those who are alone do not feel lonely.
We are all in this together and will get through it. This too shall pass.
Dinesh Bhugra is emeritus professor of mental health and cultural diversity at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.