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Pandemic notes
- Dr. Srinidhi Chidambaram

April 28, 2020

I have often been questioned how it feels pursuing two very different professions - healthcare and performing Bharatanatyam - both having a steady parallel trajectory all these years in my life. The COVID-19 pandemic has for the first time, made me feel a deep sense of gratitude that I have these professions in my life, ensuring that no day remains unproductive, predictable and boring.

I am a Public Health medical postgraduate but my work at Apollo Hospitals spans many dimensions. I don't directly treat patients but with data, outcomes and communication. My work in health communication and my participation in our extensive online initiatives and our Project Kavach give me a great feeling of contributing what I can to help people. Of course, if the outbreak grows larger (which I pray won't happen), I will be there in the front line helping in whatever way I can with my medical training.

My other great passion Bharatanatyam helps me keep fit and energised. It is absolutely fabulous to dance without a performance angle (Though I do have Insta performances lined up!). I have pulled out videos and audio tapes of my performances when I was in my teens and twenties. Dancing to my Guru Swamimalai S K Rajarathnam's haunting music and jathis is wonderful. Zesty Vazhuvoor jathis and swaras at high speed is more than enough to test stamina and endurance after so many years have gone by! I am also practising dancing to the adavus in slow speeds to gain better form. With all of us house bound, it is precious time as my husband shuttles between the parliamentary constituency and Delhi, while my daughter studies at Cambridge University.

I have a planned fitness schedule with cardio, yoga in Zoom and weight training. I have at last realised that what my diet guru Rujuta Diwekar says about local seasonal food is 100 percent true. There is a special delight in simple uncomplicated meals of rice, dals, millets, coconut water, rasam and turmeric milk!

I have been trying to make short video clips in Tamil on COVID awareness for the people in my husband's constituency. I thought it might be useful to share some thoughts about COVID-19. This is like nothing we have ever seen recently, though the world is not new to pandemics. With literally every country being affected, the world has come to a standstill. There is so much written about on a daily or even hourly basis about the COVID-19 infection and there are loads of myths and rumours floating around. Research trials and treatment protocols are happening all over the world - all for two much awaited outcomes - a drug or drug combination that is proved to work and a vaccine. I am fairly sure that we will have both but they say it may be not before early 2021 at the earliest.

Meanwhile we have only the weapons of prevention, the only current gold standard for warding off the coronavirus infection. This means that we need to practice hand-hygiene at all times with soap and water, washing thoroughly for at least 20 seconds or using an alcohol based sanitizer in situations where soap and water cannot be used. Avoiding close contact with anyone showing symptoms of coughing and sneezing and following cough etiquette is critical. Make sure that all frequently touched items such as mobile phones, door knobs, backs of chairs, glasses, watches, home gym equipment are cleaned often with disinfectant. Practice social distancing and stay at least 6 feet away from others. Stay home and do not go out unless absolutely necessary. Wear a mask (even a cloth mask is fine if you don't have a surgical or N95 mask) when you go out.

While we are testing for the infection using the RT PCR tests and blood antibody tests, no specific antiviral treatment is recommended for COVID-19. Plasma therapy has been started, using blood drawn from a person who has recovered from the disease, serum separated and screened for virus-neutralising antibodies and then used to treat other sick people. There are many trials going on now to test the real efficacy of various drugs.

We often speak of flattening the curve with the lockdown. What is the epidemic curve? The "curve" refers to the projected number of people who will contract COVID-19 over a period of time. (To be clear, this is not the actual number but a number that's used to model the virus's spread.) The curve takes on different shapes, depending on the virus's infection rate. The faster the infection curve rises, the quicker the local health care system gets overloaded beyond its capacity to treat people. A flatter curve, on the other hand, assumes the same number of people ultimately get infected, but over a longer period of time. A slower infection rate means a less stressed health care system, fewer hospital visits on any given day and fewer sick people being turned away and dying. It also buys time to build capacity for testing, for tracking down contacts of those who are infected, and for treating the sick, by expanding hospital facilities, acquiring ventilators and preparing intensive-care beds. As there is currently no vaccine or specific medication to treat COVID-19, and because testing is not that high, lockdown and social isolation are the only ways to prevent an explosive outbreak.

The difficulty with any modelling or future predictions is this is an entirely new virus, and the scale of this pandemic is unprecedented in living memory. If vaccines are given to enough of the population (more than 60 per cent) the country will develop what is known as 'herd immunity' meaning the virus cannot spread so easily in the future. This herd immunity can also be (controversially) achieved by just allowing the virus to spread widely and letting individual immune systems build up a response to the virus.

Will there be lasting immunity? Will there be a seasonal spurt in winter? Will the vaccine be out then? Will the summer help in fighting the virus? Will the lockdown be lifted? Will there be a surge after the lifting of lockdown? Will herd immunity save us? These are questions that will be answered in the coming months.

As we all journey together in these challenging times, the fear of the future weighs us all down. We need to be alert and vigilant. Vigilantism and bigotry is quite different and it makes me shudder at how cruel people can be, as seen with the recent deaths of two doctors in Chennai. It is easy to ignore the plight of people who are stranded, locked out, hungry, frightened, panicked and running rapidly out of resources to live. I also worry especially about artistes from our dance community who may be feeling the pinch of a sudden shut down of all engagements.

While we watch the unfolding of this global nightmare, please do not fret or neglect routine medical care.

*With references from CDC, WHO, MOH AND F W GOI, INDEPENDENT UK

Dr. Srinidhi Chidambaram is a well-known practitioner of Bharatanatyam and is also a medical doctor with an MD in Public Health, currently working with the Apollo Hospitals Group, Chennai.

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