QUARANTINE: All the residencies of the Tourism Department are being used to keep a group of suspected coronavirus patients apart from the general population for 14 days, the maximum period for confirmation that the person is infected or clear of infection
By Rajiv Mendes
Simple explanations of big words like facility quarantine and institutional quarantine, not to mention isolation……
The COVID-19 pandemic has made several new terms and strategies such as quarantine and Isolation, used in the control of epidemics, a household name. In order to fight the pandemic everyone needs to understand the science behind these strategies. We have to motivate people to strictly adhere to the guidelines. We often see people riding bikes without helmets and suddenly when they see the police on the road, they pull out the helmet and wear it. Our behaviour during the pandemic should not be restricted to show others, but should be part of a new healthy lifestyle if we have to win the war against this pandemic. Social distancing and wearing masks should not be followed only when we are being watched, but should be part of our life as COVID -19 is here to stay for several months if not a few years.
During health emergencies such as the current pandemic it is important to stay informed. It is important to keep ourselves updated with the right protocols and cooperate with the government officials who are trying their best to flatten the curve. This article throws light on the terms quarantine and Isolation and the facilities we have in the State. These terms are often used interchangeably, but they are distinctly different.
What is Quarantine ?
It is the separation of an individual or a group of people reasonably believed to have been exposed to a communicable disease but not yet confirmed or have symptoms. It originates from the Italian word Quarantina, derived from the word Quaranta which mean forty. This refers to the 40 days of quarantine imposed on ships in the past that were suspected to carry an infection. So a person who has travelled from a COVID-19 affected region or state will have to stay in Quarantine. Depending on the risk and where they come from, they may have to follow different quarantine procedures. One needs to clearly understand that putting someone in Quarantine, does not mean that the person has been diagnosed and suffering from COVID-19. Having a Quarantine stamp on the hand does not mean they have the disease. Quarantine is a procedure adopted to keep the person away from others so they do not unknowingly infect others.
Facility quarantine is provide for all those who cross the state border. The people will be tested for COVID-19 and when negative will be sent for 14 days strict home quarantine if they are negative. If they are positive they will be sent to the isolation hospital for appropriate management.
Seafarers who have come to Goa are also kept in a facility quarantine for 14 days irrespective of the test result. This is a paid facilities in various hotels in different parts of Goa. the GTDC hotels, International center etc are identified as facility quarantine centers. When they complete the same they will be advised 14 days of additional home quarantine.
The guidelines change with our changing knowledge of the pandemic. One has to follow the instructions of the Health Department. Anyone who has close contact with a COVID-19 patient has to be quarantined. The high risk contacts of a COVID 19 patient for example would be kept in a facility quarantine for 14 days and would be released after completion of the period and after their test is negative. They will also be advised a further 14 days of home quarantine. The low risk contacts will be advised Home quarantine and will be asked to report immediately if they experience any symptoms of COVID-19.
Reverse quarantine
One might have heard the term reverse quarantine. This is not quarantine in the strict sense, but is a process of keeping the vulnerable people in a safe area. For example the elderly, immunocompromised and those with co morbidity could be separated from those who are considered to be at risk of having the disease (eg. Travellers from a COVID affected region). This has been tried in Kerala.
Home quarantine
This is advised to people who have lower risk and they can stay in quarantine in the comfort of their own home. People often take home quarantine casually. However this is also a very strict procedure and an important step in the management of the pandemic. Here the person who has a risk of possible exposure. If people refuse to follow home quarantine strictly, they will be put in facility quarantine by the police.
What should you do if you are in Home quarantine?
Identify a separate room for yourself with preferably an attached washroom to be used exclusively by the person who is quarantined. Do not leave unless it is necessary. Wear a mask. Dispose the mask as per the guidelines.
Do not share plates, glasses, cups, spoon, bedding, towels. Do not share these items unwashed.
Frequent Handwashing is extremely important. Hygiene is an important part of a quarantine. Wash hands for 20 seconds with soap and water. Cough or sneeze in the elbow. If you use a tissue, immediately throw it in a covered dustbin.
Definitely do not come in close contact with children and the elderly. The elderly are more vulnerable and have a higher case fatality if they get COVID.
Follow the guidelines of the health authorities contact them if you need some help or are developing symptoms.
Take all your regular medications if any, on time while in quarantine
If you are living alone, get someone to deliver the groceries or food to your doorstep and pick it from a safe distance.
Pets can stay in the house, but you should stay away from them. Avoid snuggling or petting them as they can mechanically carry the virus.
Staying alone and aloof can be stressful. One can keep in touch on social media and use various gadgets to keep connected. Do not get tempted to meet friends and family, you are putting them at risk. Remember there are people with COVID who are asymptomatic (they do not have fever cough breathlessness or any other symptoms) yet they can spread the disease. The disease can also spread in the presymptomatic period during the incubation period. The incubation period as per our knowledge extended to 14 days however we there are several cases where the disease has occurred much after 14 days and therefore the quarantine period is extended to 28 days.
What is Isolation?
Isolation refers to the separation of people or a group of people known or reasonably believed to be infected with a communicable disease and potentially infectious for those who are not infected. It is derived from the Latin word insulatus which means ‘made into an island’. In other words isolation happens when a person is diagnosed to have COVID-19 and is separated from people who are healthy. Isolation can be done in a hospital where it would be called hospital isolation. This is the current policy in the state of Goa. All those diagnosed with COVID -19 are isolated in the ESI Hospital under the care of an expert team of doctors. Isolation wards are also identified in GMC and district hospitals where in the suspect cases of COVID-19 will be admitted and managed while they are waiting for their test results. If they are positive they will be sent to the COVID-19 ward at the ESI Hospital.
Isolation can also be voluntary or commonly referred to as self isolation. This is when a person who is having a diagnosis of the disease, but has mild symptoms may be told to stay in Home Isolation as the health system is overwhelmed and cannot accommodate the rising number of cases. This is being followed in the countries where the pandemic is in an advance stage.
Our best bet is to try and stay in the green zone as long as possible. Detect isolated cases immediately and contain the spread to specific georgraphic region and reduce the speed of transmission through stringent social distancing, lockdown measures avoiding gatherings, wearing a mask, following cough etiquette. A low level of transmission would render herd immunity to the community while the scientific community develops the much needed vaccine.
Will we all be safe with the number of cases being nil in our state?
THE news is ripe with information surrounding the COVID pandemic. Companies like APPLE and GOOGLE have teamed up to track the virus and prevent spread. The number of new cases is decreasing in many places around the globe. Our state has declared zero new cases. Our government is thinking of lifting their lockdowns altogether. Yes, this is good news. This is the news we want to look forward to when this finally leaves behind us.
Let us have no doubt. This will come to an end. We will have approved treatments based on millions of patient’s data, a new vaccine, and new public health protocols laid by govt agencies to prevent another pandemic. However, this phase will leave some residual effects on some of us.
There are ongoing studies done by psychiatrists and psychologists in India and the USA. While around 60%-75% of participants seemed to be coping well, the rest of them have developed what is called COVID stress syndrome. These people have intense fear about being infected; the excessive worry of the economic and social impact of COVID-19, experiencing coronavirus nightmares, repeatedly checking news related to COVID-19, which in turn becomes a vicious cycle their minds get trapped into. The other fear that will arise amongst people is xenophobia – they may fear foreigners to be carriers of the virus.
Based on studies of previous pandemics and natural disasters, traumatic events are known to affect around 10%-20%, they go on to develop severe psychological problems like post-traumatic stress disorder or anxiety. The symptoms arise soon after the disaster. This includes both diagnosed cases and people who are not affected by coronavirus directly. Some people will develop germ phobias, striving to avoid touching “contaminated” surfaces or shaking hands.
None the less, an optimistic approach is what we all need to keep. If required there are methods to improve these skills; methods like cognitive behavioural therapy help learn new coping strategies. The father of our nation once said: “It is health that is real wealth and not pieces of silver and gold.” Yes, going back to work is essential, but there are a few things that we should keep in mind while we do so. Stay safe and keep others safe.
Will we all be safe with the number of cases being nil in our state? NO, the safest place is at home. Time spent outdoors should be minimized to the essentials.
There are a few precautions that need to be maintained after the lockdown order is withdrawn and these are:
A. Social distancing should be made a habit.
B. Make a travel kit/safety kit – Include items like cloth face masks, gloves, tissues/ handkerchief, disposable soap, hand sanitizer bottle (strength 60%-90% alcohol)
C. Make it a habit to use a tissue/handkerchief when sneezing/coughing anywhere, i.e., at home or outdoors.
D. Try washing hands a norm before to sit at your desk at the workplace; workplaces should make it a rule and try making temporary arrangements for hand washing before entering the workplace.
E. Watches, bangles, rings, and other hand and wrist accessories are an inoculation site for microbial organisms. Try avoiding wearing them until the situation improves globally.
F. Alcohol-based hand sanitizers are inflammable. Keep this in mind when working near a heat source to avoid burn injuries.
G. When you get back home from work/shopping/ outdoor walk, it is advisable to keep footwear outside, hand wash before touching any surfaces at home.
H. It is time we try switching our transactions from cash to electronic methods of payment. Contactless cards, UPI, BHIM, GPay, PayTm, Net banking and mobile banking are methods that do not require any physical contact when doing any transactions.
I. Video conferencing practices should be promoted.
J. Avoid parties and social gatherings as much as possible
K. Alcohol and cigarette smoking are well-known contributors to decreasing immunity and increasing the susceptibility of getting infected with COVID and other respiratory illnesses. It is the right time to modify and eliminate some of our habits.
Postscript: An additional note from Dr Pratik Jain says that he chose to go to the USA because, “USA medical system is based on evidence-based medical practices. I choose the USA to gain experience in research-based medical practice and gain hands-on experience with world-famous psychiatrist and psychologist. I am currently Education Commission for Foreign Medical Graduates certified and will be applying for residency in psychiatry the USA, I also am a research volunteer at the New York State University at Upstate Medical University. I have completed 4 months of US Clinical experience, 2 months in internal medicine, 2 months in psychiatry, and for the last 2 months as a research volunteer. My ongoing research is based on Depression, Agitation and decreasing the rates of agitation in the inpatient Psychiatry wards. I have also done certificate courses on Positive Psychology from the University of Pennsylvania (An IV league) program in the medical field. I also am the founder of a small organization named Swasth Drishti in which we young doctors who want to promote `Health Education for All’, we target basic topics such as sanitation, hygiene, women’s health, mental health, nutrition. We have recently started an Instagram page by the name – Swasth_Drishthi, where we post posters from certified medical sources, combine medical literature to layman terms for the general audience.”