JULY 2020
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

Corona Virus Pandemic: Part II

Concern About Resurgence of Cases

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,
MD, FACC

Presently, America is fighting two pandemics simultaneously: first is the Covid-19 virus that has already claimed more than 120,000 lives in the U.S. and the death toll is rising. The second is the nationwide racial riots and protests that are feeding into the first one. After all the advice about ‘social distancing, wearing masks and avoiding large gatherings,’ here we are doing the exact opposite. I am horrified to see tens of thousands of people filling several blocks in major cities, chanting and shouting without taking any precautions. Sadly, they didn’t come out here to celebrate victory over the corona virus after America started reopening from this long shut-down.

Well, this vicious virus is anything but gone; on the contrary, we are beginning to see the early signs of a second wave. Instead of plateauing, cases seem to be skyrocketing in many states particularly in Arizona, California and Florida. While countries like New Zealand and Greece have controlled their pandemic already, USA is experiencing the exact opposite. In India too, the case load is going up. “As the long, hot summer of 2020 begins, the facts suggest that the U.S. is not going to beat the coronavirus,” according to one report. And the new projected model predicts 201,000 deaths by the end of October.That sounds dismal!

The reason? Sadly, many are still not following the prevention strategies already laid out in the CDC guidelines and if this trend continues, “Hillsborough county alone may see 13,000 to 18,000 new Covid-19 cases a day,” according to USF professor Dr Thomas Unnasch. Just to reemphasize those prevention protocols:

  1. Avoid social gatherings in groups of more than 10 people and keep the social distancing of 6 feet or more all the time. In our temple, there are spots marked at 6 feet apart for devotees to stand and pray along with other directions as to how to conduct one while there.
  2. Always wear a mask appropriately to cover the nose and mouth when going to any public places. N-95 is the best but any surgical or cloth mask will do for non-hospital workers. Sadly, this is not enforced in many places here. But in Chicago, one my friends said, in any store you walk into, the policy is “No mask, no service.” Now, that’s great!
  3. Practice good hygiene that includes washing your hands with soap and water appropriately, especially after touching any item or surface outside your house, avoid touching your face and nose if possible and always cough or sneeze into a tissue or at least into the inside of your elbow. The sanitizers and commercial disinfectants can kill the coronavirus, but some can also cause chemical burns and allergic reactions on the skin, particularly in babies, so beware.
  4. If you are an older person, have heart disease or diabetes or of low resistance to infections from whatever reason, stay home and avoid discretionary travels and don’t visit a nursing home because of the many recent Covid-19 outbreaks in those facilities.

Clinical symptoms of Covid-19

Recently, Mr. G.M., a 63-year-old Indian accountant in New York City, developed a little cough, sore throat and fever but his family physician asked him to stay back in his apartment because of the high number of Covid cases in the hospitals there. Even when he developed shortness of breath, the doctor didn’t advise him to go to the emergency department, nor was he seen in his clinic. A few days later, he was taken to the hospital with acute respiratory failure and remained on a ventilator till his death three weeks later. The moral is that if you suspect any significant medical problems, Covid-like illness or not, please get quick medical help and a trip to the hospital ED is the right first step; the earlier the treatment is started, the better the outlook.

The initial symptoms of the disease are generally ‘upper respiratory’ like cough, sore throat, headache, rhinitis, fever, etc., often mistaken for a cold or flu and hence not taken seriously. But shortness of breath would suggest the lungs are being affected and a clue to get prompt medical attention. Sometimes, anosmia or loss of smell may be the first symptom. Also note that corona patients can present with acute heart attacks and strokes because of the high propensity for clot formation in the corresponding arteries. Other symptoms include diarrhea, myalgia, headache, fatigue, insomnia, etc.

One major problem that has come to attention now is that patients who develop non-classical symptoms of major diseases like mild chest discomfort or back pain (heart attack?) dizziness, transient weakness or blurry vision (stroke?) etc., are less likely to go to the ER for fear of being exposed to coronavirus. Even when they finally decide to seek medical attention, the delay can increase the complications from any of these diseases. So, beware of the atypical presentations and take the right steps to get urgent treatment.

To be continued …

M.P. Ravindra Nathan, M.D., is a cardiologist and Emeritus Editor of AAPI Journal. For further reading, “Second Chance - A Sister’s Act of Love” by Dr. Nathan from Outskirts Press, can be found at www.amazon.com


Eye Care

Look In when Locked In: Time to Reflect! PART II

Dr. M. P. Ravindra Nathan

By DR. ARUN C. GULANI

Don’t just Return, Rebuild!

This is also a great time to prevent a rebound jump back to the previous treadmill of life. Take stock and rebuild if necessary. Do you need to change, modify or stay your correct course?

In the lockdown period, nothing changed for me besides not seeing my dear patients and performing surgery. I have been busy teaching in back-to-back worldwide webinars, and designing new fashion line for men and women while also planning new surgical instruments. I authored a textbook, spent time with family, saw movies, walked on the beach, conducted community fundraisers and took calls from colleagues. But I did this every weekend anyway. It is gratifying to know that I don’t need to change anything.

During this time, I also initiated a worldwide competition (MASK-A-RATE) for people to make masks at home with materials available at home and this became a global event. My daughter led the nurses support movement during nurse’s week that resulted in collaborating with Mayo Clinic to honor the unsung heroes.

We also indulged and celebrated graduations, anniversaries and birthdays with family on Zoom and experienced a first-ever, 6-foot-apart-graduation ceremony to watch our son deliver his salutatorian speech.

As for how, have I changed our practice protocols now that we are open? Well, even before Covid-19, my patients were scheduled one at a time in my lobby (not a “waiting” room). Whether they traveled from 40,000 miles away across the world or from across the street, I always kept 40 minutes in between each patient. So, what only changed were the new COVID-19 precautions; the style of practice actually testifies to the future.

Everyone everywhere is affected by this pandemic and doctors are no exception. However, we still occupy a privileged status in society and should remain cognizant of that responsibility.

We could travel anywhere in the world and have a job whether it be the Amazon rainforest or the outback of Australia or literally anywhere people exist.

As doctors, we are by nature empathetic and will surely help patients in future. Demand for treatment will not diminish, but patients’ ability to pay might. Consequently, we need to exceed in kindness and leniency: working with patients on payment plans, extending credit, lowering costs or even working at cost for patients who are in trouble financially, can help to ease the burden. In fact, there is a possibility of an increase in surgical volumes and consults since people might realize how fragile life is and take care of their vision as soon as they can.

I am also educating and encouraging the eye care industry and pharmaceutical companies to help medical practices in a similar fashion to lessen the financial strain the pandemic has created. Essentially, we have the opportunity to express our shared humanity and foster kindness.

This is also a good time for doctors to stop being envious of each other. As he put it, we’re all in the same boat. Raise your goals, and the bottom line will automatically rise.

Now is a good time for doctors to re-evaluate their financial situation and the health of their practice. If doctors find themselves struggling to pay staff, for example, they may be overstaffed or have too much overhead or costs. Similarly, if a practice is in good financial health and does not find itself struggling, doctors can come back with the confidence that they were doing things.

Yes, I certainly feel like the world is going through a great reset at the moment. Rather than panicking or falling prey to fear mongering, taking this opportunity to deeply evaluate your life can prove invaluable. The evaluation can be on the practical side, such as with finances or business function, or it can be on the more philosophical side, like evaluating personal fulfillment.

What will you leave behind? It’s a question for the ages. Taking stock of the bigger picture — gaining perspective on your role in the world and how you help humanity — can lead to deep contentment and a satisfying life.

A forced meditative retreat this is. Let’s pray for and help in every way, all of those who were adversely impacted while leading and supporting those as we re-build for the future.

Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at gulanivision@gulani.com or visit www.gulanivision.com

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