Our part in the coronavirus lockdown of 2020

Dr Irengbam Mohendra Singh *

Before I begin I would like to pay my appreciation though living far away, to those doctors and nurses, other key workers and thousands of Manipuri women daily wage earners, as they face the new brave world with an unusual uncertainty of life. Calm determination prevails among Manipuris both in the hills and the valley as events unfold.

On this 1st May 2020, we're in survival mode, 'fight or flight' in the battle with a deadly and previously unknown enemy Covid-19. Lockdown is the only weapon to handle this global pandemic. While CM Biren and his ministers are grappling with many shortcomings of the lockdown, I would urge some people on the media, to shy away from contradictory solutions based on one size-fits-all policies.

I am one of the millions of people worldwide, caught up in this devastating crisis. We still do not know when things will return to normal. While I am helpless at 80+, I have encouraged my grandson Dr Jason working at the Apollo Hospital in Delhi to continue working, through his mother Dr (Prof) Sulochana at RIMS.

With a dramatic change in our lives brought on by this new coronavirus threat in the last few weeks and the realisation that older people like me, and anybody over 70, are more vulnerable to succumb, has brought our age into sharp focus. This has led to more renewed contact with long time trusted friends, sending each other hilarious quotations and songs to amuse each other in our home confinement.

DNA is a double-strand molecule that twist against each other like a spiral staircase (called the double helix of chromosome) while RNA (messenger of generic code) is a single strand molecule. A chromosome is made of DNA molecules. A gene is a length of DNA in the chromosome.

Coronavirus like any other virus, is not a living organism. They are not creepy-crawly. They don't eat us up. As they are lifeless DNA protein molecules they cannot be killed. They do disintegrate depending on the temperature, humidity and type of material where they lie.

For example, they can live for 24 hours on cardboard and up to 72 hours on plastics and steel. They don't survive on newspapers due to ink and printing. They are covered with a layer of fat, which makes them dissolve in the mucous membranes of eyes, nose and throat. The fat coating disintegrates by the foam of a soap that cuts into the fat with vigorous rubbing for at least 20 seconds.

These DNA virus molecules, when locked on to suitable "receptors" on the cell walls of the victim, such as humans, with their attached appendages, shed their messenger RNA inside the victim's cells. There, the RNA replicates producing innumerable similar DNA molecules. Ultimately they burst the cell and attack other cells.

Covid-19-virus [Corona Virus Disease-2019].

The virus was first reported to WHO by the Chinese on December 31 2019 as a new (novel) strain. In a severe infection, these viruses attack the lung cells and by destroying them they starve the patient of oxygen.

It's like dropping someone on top of Mt Everest from a helicopter. It can be diagnosed simply by attaching a small pulse oximeter to the tip of your finger to measure the oxygen content of blood. Pulse oximeter is now selling like hot cakes in America for $200.

In the UK where to date, over 28,000 people have died and the Government is being accused of doing things too late to curtail the spread of the virus, as they did in South Korea. It was indeed, fortunate that Manipur government took the stringent lockdown precaution. It took one businessman Daren Bland (50) from Maresfield, East Sussex, who first brought the virus to Britain.

He caught Covid-19 in mid-January, meaning the virus may have arrived in the UK a month earlier than originally thought. Mr Bland had taken a four-day trip at the resort in Ischgl from January 15 before displaying Covid-19 symptoms and passing the illness to his wife Sarah and their kids in his home in Maresfield.

The first transmission of coronavirus in Britain is currently thought to have been on February 28 and the earliest recorded case was January 31. In the weeks leading up to February half term, many people local to Mr Bland were struck down, with kids taking time off school. The Austrian ski resort in Ischgl where he stayed, meanwhile, is under investigation for allegedly covering up the outbreak there.

Two friends, from Denmark and Minnesota, USA, whom the IT consultant was skiing with, also fell ill with the same tell-tale symptoms. It is feared the infection was able to spread across Europe undetected for weeks possibly due to an alleged cover up by the Austrian ski resort. As a result, prosecutors this week opened a criminal investigation with hundreds of cases in surrounding places.

By February 27 2020, corona virus disease 2019 had affected 47 countries and territories around the world. Chinese doctors described 52 of 710 patients with confirmed Covid-19 admitted to an intensive care unit (ICU) in Wuhan, China.

The ICU mortality rate among those who required non invasive ventilation (normal nasal oxygen therapy) was 23 (79%) of 29 and among those who required invasive mechanical ventilation (patient's breathing taken over by a machine, 'respirator') was 19 (86%) of 22.

There is no known treatment for Covid-19. In fact nothing is known about it as it is so new. There is no curative or preventive medicine. The only preventive measure is to be on high alert and stay away from each other and detain anyone suspected or infected with the virus, in isolation Doctors globally learn from one another's experience across the continents. Some drugs that are currently tried are as useless as a placebo.

The only help a patient can get is from oxygen (O2) inhalation, which helps the patient to breathe but has no effect in the progress of the disease. There are four stages of coronavirus treatment in a hospital from a simple oxygen mask to bypass machine. The most important test is the measure of O2 level of blood to see if the lungs are functioning normally.

The most basic form of hospital treatment for Covid patients struggling for breath is to be fitted with a simple mask and piped O2 enriched air. The next step is an airtight mask and O2-air mix. Next step for deteriorating patients is a ventilator (respirator) for which the patient is put to sleep.

The ventilator keeps the patient alive with O2, giving their body time to fight the virus. This is the last resort, using an outside lung-bypass machine, like the machine used in heart bypass machine. This is called Extra-corporeal membrane machine (ECMO).

In spite of the last resort the outcome or the survival rate is extremely poor. On average 1 in 4 survives and among the survivors half of them die sometime later at home. But the point is without the care of the doctors, nurses, physiotherapist etc in the hospitals there would not be any survivors. There are only 5 centres in the UK with this machine.

St Thomas' hospital where PM Boris Johnson was admitted is one. While everything about which way the Covid-19 will continue to change he lifestyle of humanity, the source from which the Covid-19 originated remains a hot potato.

The story given by the Chinese sources that the virus was transmitted from the famous animal and seafood market in Wuhan, a city of 11 million in the province of Hubei where a huge Viral Research centre - the Wuhan Institute of Virology (WIV) is located, remains doubtful. It was initially a product of a joint venture with France.

The awful history of Covid-19 that has so far killed 211,000 people worldwide, is still in the making. Scientists (especially from Australia) believe that the virus most probably came from bats and transferred to humans via Pangolins a small scaly ant-eating animal.

Pangolins are delicacies in China and their scales are imported in tons for Chinese medicine, despite it being illegal. Allegation that coronavirus emerged from a laboratory in Wuhan as claimed by Australian scientists has been given warm support by American President Donald Trump, to the fury of Chinese scientists and authority.

He said "We are going to see where it comes from. I think we will have a very good answer, and eventually, China might even tell us." Britain, which is also taking part in the investigation, has not ruled out the allegation yet. While in Britain, as the death rate falls, it is poised to lift curbs, despite some worry that care home virus peak could be months away. This is to be announced in the next week.

What is known is that social distancing of two metres apart might be scrapped to allow more business and schools to open, amidst growing scientific evidence that coronavirus does not transit well in the air. The government has now a blueprint to get the economy back on track. Meanwhile, a businessman is launching a legal bid to challenge the lawfulness of lockdown, warning it poses "frightening restrictions to our liberties".

As of May 1, the number of people in the UK, who have died with coronavirus in hospitals, care homes and the wider community in the UK has risen by 621 to 28,131. The number of new cases confirmed was 6,201.

Having achieved the target of 100,000 per day of coronavirus tests, the idea is floating whether to focus on targets with contact tracing instead While the government is considering whether to lift the lockdown measures in stages, there is a plan for schools to reopen in June.

While Head teachers believe that year 10 and year 12 students should be prioritised for an early return, teachers insists on PPE (personal protective equipment) to be provided. The Football Premiere League season that is to start next month will be played out behind closed doors without spectators and on neutral grounds.

The British pubs the great British social institutions, which employ 457,000 people, and which could be the last to reopen after the lockdown, are struggling to survive this summer. Pubs are no places for social distancing. A tragic fallout of the lockdown in the UK is the massive 30% increase in the incidence of domestic violence since the lockdown.

For these hidden thousands for whom the current lockdown has been nothing short of an inescapable "nightmare", spending 24/7 with their abuser. Knowing their (more women than men) predicament, the government has urgently sanctioned 76 million pounds to

Domestic Abuse Charities to help provide safe spaces and helpline to enable victims to escape violence at home.To close this warming information, it is quite comforting to mention that Manipur has been very lucky with only two covid-19 positive cases, and both of them have been saved by doctors, nurses and ancillary staff in the hospitals of JNIMS and RIMS. They need a round of applause from all Manipuris.

Thank You.

* Dr Irengbam Mohendra Singh wrote this article for The Sangai Express
This article was webcasted on May 07, 2020.

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