What have we learned about COVID-19?

Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)
Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)

Here is the good news. The spread of the COVID-19 pandemic in Canada is slowing down. But the bad news is, health officials warned it could come back with a vengeance this fall if contact tracing and testing aren’t stepped up.

What we are trying to do is to contain the virus because there is no vaccine or medications to kill the virus. Once the lockdown is lifted, it will leave many people vulnerable to infection as they begin to venture out again.

Unless there is a miracle, SARS-CoV-2 Vaccine will take time to be ready to be used.

The COVID-19 pandemic is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Alberta has the third-most number of cases of COVID-19 in Canada. By June 3, there were 7,076 confirmed cases and 145 deaths. The majority of cases have been in the Calgary zone, which has 4,909 cases.

What do we know about coronaviruses?

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

There are people who are infected but have no symptoms. Others have mild to moderate to severe symptoms.

Classical COVID-19 symptoms may appear two to 14 days after exposure to the virus. That is the incubation period. The common presentation is fever, cough, and tiredness.

Other symptoms can include: shortness of breath or difficulty breathing, muscle aches, chills, sore throat, loss of taste or smell, headache, and chest pain.

Other less common symptoms have been reported, such as rash, nausea, vomiting and diarrhea.

People who are older or who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or have compromised immune systems may be at higher risk of serious illness.

It is important you contact your health care provider if you have any of these symptoms. You should call 911 if you have trouble breathing, persistent chest pain or pressure, inability to stay awake, new confusion, blue lips or face.

The virus appears to spread easily among people. Data has shown that it spreads from person to person among those in close contact (within about six feet, or two meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby.

It can also spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes.

Prevention is better than cure. Since there is no vaccine to prevent COVID-19 the next best thing is to reduce your risk of infection by doing the following:

  1. Avoid large gatherings
  2. Avoid close contact
  3. Stay home as much as possible
  4. Wash hands often
  5. Wear a mask in public places
  6. Avoid touching your eyes, nose and mouth.

Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease.

If you have COVID-19 related symptoms you are legally required to isolate yourself.

If you have symptoms, take the online assessment to arrange testing.

Take care. Stay healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

COVID-19: Cancer Care During the Pandemic

Are we ready for summer? (Dr. Noorali Bharwani)
Are we ready for summer? (Dr. Noorali Bharwani)

An article published in JAMA Oncology (online March 25, 2020) the authors report incidence and outcomes of COVID-19 in cancer patients who were treated at a tertiary cancer institution in Wuhan, China.

They found patients with cancer harbored a higher risk of COVID-19 compared with the community.

This increased risk of infection and death among cancer patients creates high psychological pressure of uncertainty. These patients and their families need guidance and support. Moreover, cancer treatments such as surgery, chemotherapy and radiotherapy suppress the immune system. This makes cancer patients more vulnerable to complications like infection.

Physicians and cancer patients have to decide: Does cancer treatment priority outweigh the risk of contracting infection with coronavirus?

An article in Lancet Oncology (Summary of international recommendations in 23 languages for patients with cancer during the COVID-19 pandemic – May 13, 2020), provides professional guidance to promote patients’ safety, treatment, and compliance, and ameliorating patients’ stress.

The authors identified six main areas of recommendations.

The first area concerns general considerations for patients with cancer during the COVID-19 pandemic.

Generally speaking, cancer patients’ immune system is not very strong. Especially the ones who are awaiting or undergoing treatment. The degree of immunosuppression depends on the type of cancer, the patient’s age, fitness, comorbidities, the type of therapy, and the time since last therapy.

Patients should familiarise themselves with COVID-19 symptoms. Early symptoms can be managed at home by way of self-isolation. Immediate medical attention should be sought for more severe symptoms, such as high fever, difficulty breathing, chest pain, confusion, and blue lips or face.

The second area of recommendation regards specific special measures that people with cancer should take to avoid COVID-19 infection. The best way to prevent infection is to avoid exposure to the virus by implementing strict hygienic and behavioural measures.

Hygienic measures include frequent hand washing, disinfecting objects, avoiding handling objects in public places, and washing fruits and vegetables.

Behavioural modifications include staying at home, not gathering in public places, and not touching other people. The use of a face mask is recommended.

The third area – patients with cancer should avoid people with a known exposure, infected asymptomatic people, and infected symptomatic people for at least 14 days and until their symptoms have resolved.

The fourth area of recommendation is related to mental health: guidance on managing anxiety and stress.

Some recommendations include breathing fresh air, engaging in physical exercise and creative activities, and having quality time with their families. Rest, sleep, and healthy eating are important. Talk to your friends and family frequently, engaging in pleasant activities, meditation, yoga and physical exercise. Patients who feel that they cannot cope with their stress should talk to their doctor.

The fifth area of concern is to maintain trust between physicians and patients to enhance patients’ confidence in medical staff decisions and improve their compliance with medical advice.

This may not be very easy. There has been a significant delay in continuity of care. Most patients understand the reasons for delay. But it is not easy.

As things improve with COVID-19 pandemic, cancer centers will be going through painful and difficult process of prioritising patients for treatment. Patients will be evaluated on a case-by-case basis, according to the overall clinical picture, the aggressiveness of the cancer, and the potential health risks from COVID-19.

Finally, the sixth area is the importance of containing spread of COVID-19 to vulnerable people. This can be done by keeping patients and visitors who have symptoms or have been exposed to an infected person not visit their cancer centre, but should first call their doctor’s office for further instruction.

We hope all patients and especially cancer patients get the treatment they need soon.

Take care. Be safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

A second wave could come later this year, or not.

Kin Coulee Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)
Kin Coulee Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)

“Epidemics are like fires. When fuel is plentiful, they rage uncontrollably, and when it is scarce, they smolder slowly.”
     -Justin Lessler, associate professor of epidemiology at Johns Hopkins University wrote this in the Washington Post in March.

The problem is we do not know how much fuel COVID-19 virus is left with.

This question has been bothering me. So, I went on the Internet and did my research. Here is the summary of what I learnt.

Pandemics are caused by new bugs that the vast majority of humans have no immune protection against. That is what allows them to become global outbreaks.

Let us define what is meant by second wave. Second wave occurs when new cases emerge after a sustained period of time when there is no infection or very few infections.

Is second wave of COVID-19 pandemic imminent? Experts believe it is quite possible but they cannot be sure.

The new virus has spread around the world and is expected to recede. A few months later, it will come back and spread around the world, or large parts of it, again.

While second waves and secondary peaks within the period of a pandemic are technically different, the concern is essentially the same: the disease comes back in force.

It is expected the second wave could emerge later this year and make for an even more dire health crisis. This is because the virus would have been contained, not treated.

The pandemic will resurface with renewed strength, causing a repeat of rising infections, swamped health systems and the necessity of lockdowns. Experts believe a second surge will be harder to contain. A second wave, could be in October, would require more extensive restrictions than were initially imposed.

If the COVID-19 virus mutates, just like the flu virus which mutates constantly, there will be a constant battle each year to find appropriate vaccine.

Experts have suggested that the key to keeping infections low without locking down everyone is to scale up testing and contact tracing.

Health authorities need to find infected people, isolate them, and identify their recent contacts, so they can be tested as well and isolated if necessary. Eventually, it is possible that enough people will become exposed to the coronavirus that herd immunity will develop and it will stop spreading, or that a vaccine against it will be licensed.

Herd immunity is also called community immunity and herd or group protection. Herd immunity happens when so many people in a community become immune to an infectious disease that it stops the disease from spreading.

Dr. Gregory Poland, a Mayo Clinic COVID-19 expert, offers his insight on the effect of a potential second wave of COVID-19 this coming fall in the U.S. (Mayo Clinic website):

  1. When you think about COVID-19 outbreak in the U.S., it started in mid to late February, so we were in fact past our influenza epidemic. It’s unlikely that will happen this fall. Rather, we will have, in an overlapping fashion, influenza epidemics and COVID-19 recurrence occurring.
  2. One problem with that potential scenario, he says, is that the symptoms of the flu and COVID-19 overlap nearly exactly.
  3. The second concern is the tremendous surge in demand on the medical system.
  4. The third concern will be the anxiety around that. Do we really close everything down again and do what we’ve just been through over the last several months?
  5. What’s really going to be key is to encourage everybody six months of age and older, which is the national recommendation, to get a flu vaccine and in this case to get it as early as it’s available – not wait until December and January.

We should be prepared to face the second wave of COVID-19 pandemic this fall and winter. We should get a flu vaccine as soon as it is available and NOT wait until December or January. And take all the precautions which are well known by now. Be safe and take care.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

What do different masks actually do?

An example of a surgical mask while Dr. Bharwani was a surgical resident in Edmonton in 1983.
An example of a surgical mask while Dr. Bharwani was a surgical resident in Edmonton in 1983.

“The wearing of face masks during the 2019 – 20 coronavirus pandemic has received varying recommendations from different public health agencies and governments,” says an article in Wikipedia.

An editorial in the British Medical Journal (COVID -19: should the public wear face masks? – BMJ 09 April 2020) says, “Yes – population benefits are plausible and harms unlikely.”

Is there any direct evidence that wearing a mask would help? The editorial concludes, “…given the gravity of the pandemic, indirect evidence of benefit combined with the low risk of harm should outweigh the absence of direct evidence supporting mask wearing by the general public.”

It has been about five months since COVID-19 hit the headlines and spread infection all over the world. Since then one of the big topics of discussion has been “to wear or not to wear” a face mask. There has been so much disagreement and debate among health agencies and governments, it has left the public confused.

Some groups recommend that all members of the public wear masks, while others recommend that only COVID-19 patients and their caretakers should wear them.

In some countries it is mandatory to wear a face mask. On the other hand, other countries are still struggling to provide appropriate advice to the general public. To top it all there is an acute shortage of masks.

Types of face masks, from least to most protective, include:

  1. Cloth face masks: Although good quality evidence is lacking, some data suggest that cloth masks may be only marginally (15 per cent) less effective than surgical masks in blocking emission of particles, and fivefold more effective than not wearing masks. Therefore, cloth masks are likely to be better than wearing no mask at all (BMJ).

  2. Surgical masks: The standard surgical mask, also known as a fluid-resistant surgical mask (FRSM) is designed to provide a barrier to splashes and droplets for wearer of the mask. It fits fairly loosely to the user’s face. They are used for a variety of procedures in community as well as hospital settings. These are single-use masks. They should not be undone and dangled round the neck between procedures. It should be worn with eye protection.

    Surgical masks do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the face. Surgical masks may be labeled as surgical, isolation, dental, or medical procedure masks.

    Surgical masks are recommended for those who may be infected, as wearing a mask can limit the volume and travel distance of droplets dispersed when talking, sneezing, and coughing.

  3. N95 masks: Also known as respiratory mask. It is a disposable mask. Masks ending in a 95, have a 95 per cent efficiency. An N95 mask is a particulate-filtering facepiece respirator. It filters at least 95 per cent of airborne particles. It is the most common respirator used in health care.

  4. Face shields and medical goggles are other types of protective equipment often used together with face masks.

In summary, personal protective equipment, including devices such as N95 respirators, gowns, masks, gloves and face shields, are medical devices in Canada and are subject to requirements under the Medical Devices Regulations. They should be used appropriately. Hope the information provided here helps. Be safe. Stay healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!