Doctors on the front line swear by hand washing
NEW DELHI: When people are sick, they visit a neighbourhood doctor or clinic. That’s what Delhi’s first two coronavirus (Covid-19) patients did before reporting sick at an authorised government laboratory, which said on March 2 that they had tested positive.
In doing so, they unwittingly risked infecting the staff and other patients at the clinics they visited; all of them were immediately home-quarantined, and have not tested positive so far.
Although the nature of their jobs puts health workers at high risk of catching communicable diseases, doctors and scientists at the forefront of dealing with the coronavirus are not hastening to don hazmat (short for hazardous materials) suits or wear masks.
The reason? They are simply not needed.
Washing your hands with soap and water frequently offers better protection from infection than face masks, which should be used only by people with symptoms and those who are treating or caring for people with symptoms, say the country’s top doctors, who are the best trained to contain infection both in the hospital and in community environment.
“There is no need for paranoia, we are not even using masks at the hospital full of patients. There is no community transmission of the infection, the general public don’t need masks. Only people caring for those infected need personal protection equipment,” said Dr Naresh Trehan, chairman, Medanta-the Medicity, where 14 Italians who have tested positive for Covid-19 are hospitalised in an isolation ward.
PROTECTION, WHEN NEEDED
The risk of infection is highest for the immediate family and health staff, who are often exposed to infection before the disease is diagnosed, as in the case of Lini Puthussery, 28, the nurse who died of the Nipah virus disease after getting infected while treating patient zero and his family in 2018 during an outbreak in Kerala, which claimed 17 lives.
Personal protection equipment includes face shields, gloves, glasses, gowns, head covers, masks, respirators, and shoe covers that are used to protect both the health worker and the patient from cross-infection through droplets, contact, and during high-risk activities such as placing patients on ventilators or collecting sputum and blood samples for testing.
Medical staff at hospitals take all infection-control measures, but only when needed. “All staff in the waiting area of the pulmonary medicine OPD use masks and gloves because it is spacecrowded with patients with highly-infectious diseases, such as multiple-drug resistant TB. If you ask me, the risk of MDR-TB is higher for our team than coronavirus. They are the ones who need protection, but I don’t use one in my OPD,” said Dr Randeep Guleria, director at the All India Institute of Medical Sciences (AIIMS), New Delhi.
Hand washing is enough, said Dr Guleria. “I wash my hands or use a sanitiser at least a 100 times a day on OPD days. And I scrub my arms with soap and water as soon as I reach home, which has been enough to protect me from all kinds of infections like TB and pneumonia over decades,” said Dr Guleria.
UNDIAGNOSED CORONAVIRUS
Even in cases of undiagnosed Covid-19, hand washing works. “Covid-19 is caused by a droplet infection, so keeping at least one metre or so away from a person who is coughing is enough. The risk is higher from infected surfaces, where the droplets land, so the best protection is washing your hands frequently with soap and water,” said Dr Harsh Mahajan, chairman, Mahajan Imaging, a diagnostic centre.
Even in case of undiagnosed Covid-19, handwashing is more effective than sanitisers, which should be a replacement for when soap and water are not available. “Sanitisers should have 60% alcohol to do the job, which means that even if you rub your hands with whiskey, it won’t work because that is 42% alcohol,” said Dr Mahajan, who follows the routine infection-control protocols in the chain of imaging centres across north India.
Regular surgical masks don’t work anyway as an N-95 mask is needed for protection. “Masks don’t offer the general public much protection against the virus because most people don’t know how to put them on and take them off safely. It’s difficult to breathe while wearing N-95 masks, so people tend to move them, leading to leaks. These masks also can’t be worn all day, so the best protection remains thorough and regular handwashing,” said Dr Sri Ganesh, chairman, Nethradhama Hospital, Bengaluru, who uses masks only in the operating room.
OFF-KILTER PROTECTION
Experts say that people tend to obsess over face masks, but forget about other sources of infection, like contaminated surfaces, which infect hands. “There a risk of infection while removing the mask or rubbing the eyes, so people must remember to avoid touching the face, and if they must, wash hands before doing so,” said Dr Ganesh.
What most of them have done is to cancel non-essential travel overseas. “At this stage, I’ve just cancelled non-essential overseas travel because getting quarantined in another country would be very inconvenient,” said Dr Nirmal K Ganguly, former director general, Indian Council of Medical Research.