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Quarantine, Lock down and Covid 19

Introduction

I completed 14 day of home quarantine on 2nd April. Quarantine means strict isolation imposed to prevent the spread of disease. It is the separation of a person or group of people reasonably believed to have been exposed to a communicable disease but yet not symptomatic, from others who have not been exposed, to prevent the possible spread of communicable disease (CDC). Quarantine comes from Italian word quarentina, a period of forty days, derived from quaranta, Italian for forty. It was imposed on ships carrying infectious disease like plague

Isolation is when someone or something is set apart or separated from other person or things. Isolation happens when a person is infected with a communicable disease and is separated from people who are healthy to stop spread of disease.

So a normal person is quarantined and sick person is kept in isolation. So both the words and consequences are different and now is the time when we should all know this.

My experience in home quarantine

I returned from US on 18th march after a visit to my family which was cut short due to sudden explosion of Covid 19. My husband came to receive me from airport at midnight wearing mask and I was wearing one. We just said hello from distance like strangers!! I sat in the backseat of car to maintain distance of 1 meter. We stayed in separate rooms. I told all the household help not to come though I don’t have a full time domestic help. I didn’t want them to get a chance of getting infected in case I develop it. Being physicians and also having worked closely with public health department of Government, I knew the protocol and so did my husband who is a practicing physician. I started my home quarantine even before municipal corporation representative came and applied big red sticker on the house and also on the gate.

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AMC’s Quarantine Notices

So stamping was complete. It was not social distancing but social cut off. Like an outcast. Thanks to the wonderful instrument in my hand and social media for coming to the rescue. At least that way you remain connected to your world. Thanks to the kind neighbors and friends, we could get some vegetables, groceries and even milk which they would leave them outside the gate. Nobody made home delivery.

I have worked my entire life, of course after completion of studies. Getting ready for work, wearing nice clothes and jewelry and driving to work and seeing patients and taking rounds with residents and teaching them and medical students was all part of my daily work routine but now everything was on a standstill. I was not sick but confined. That feeling of confinement does not go well with human nature. I wore my home dress all 14 days. Of course cooking meals was mandatory. I washed hand thoroughly and cooked. I served food with no touch technique, with a restricted choice of dishes as I had to ration the ingredients in case I ran out of them. And you have to wash more utensils if you cook many dishes. Cleaning the house was optional as it was simply not possible on a regular level.

I did watch a lot of TV though frustrating as the sad news continued but also entertaining as I got a chance to see nice movies. We would sit apart on two far corners of the sofa and watch it. You forget that you are a doctor. You are not front line warriors now. You are in high risk group now. It made us realize that too. There was nothing to look forward to for the next day except that no symptoms should develop.

Of course I was blessed to be living in a nice house with garden to look at. So I could connect with nature. I was also touched by the feelings of many friends and relatives who called regularly. I also had some time for self introspection. I worried about my children who are in US. As parents it is our birthright and full time business to worry about our children. I thought a lot about the sudden calamity that had befallen on the world. I could not sleep soundly because of all the thoughts, and the stress that I may develop the disease due to travel exposure and jet lag. I read a lot about the disease and ultimately got fed up. I was thankful that 14 days were over. I know it is still a long way for the things to become normal but felt like a pressure was lifted, may be temporary but I did enjoy that day as it was a successful completion of the sentence.

From Quarantine to the Disease

This was my sentiment but I know, due to lock down, now they are the same sentiments of everyone in the world. It is that of frustration, insecurity, fear, boredom, despair, helplessness and bewilderment. But there is no option. It is lives against livelihood. We should thank God that we don’t have to worry about the next meal which may be the most important question for so many people in our country.

Well the situation is not same for everyone and the scenarios may vary completely for different people in India.

If a person is in close contact with a COVID positive patient, well then scenario will be almost same as mine and he also has to follow the same routine but they may be tested and if found positive but without symptoms, will be put in some temporary facility like a hostel or makeshift facility. The authorities would definitely take you and relatives also may want the same and it is the right thing to do. You will be under observation and alone for 14 days.

Well, the next scenario is a person developing mild symptoms like fever and cough and tested positive, they will be kept in the general ward. I am talking about the prevailing guidelines at present in India. Whatever your financial or social status you will be in general Ward. Of course cots will be at a minimum distances of one meter and plastic partition will be there but the person will be alone, in the sense that no family member is allowed. They would see some patients deteriorating and shifted to ICU, which is the next step and they will be praying that it is not their turn in the queue. This is one queue where everyone will be interested in going backwards rather than forward. They will count the days without knowing what will happen on the next day, as sometimes deterioration occurs suddenly on till ninth or tenth day. Suddenly you are not sure of your life and your dreams as there is a dark cloud of fear and uncertainty around you.

If they are lucky enough they will complete 14 days without any problem and will be tested two times and if both tests are negative they go home as the luckiest person in present COVID pandemic, as most likely they will have antibodies and will have immunity, and suddenly the tables have turned though it is still not certain how much and how long the protective immunity will be present.

Unfortunate ones will develop pneumonia and will be either breathless or stable. Stable patients will be closely monitored for all vital signed and oxygen saturation. If that is remaining OK, so far so good - but they are still alone in ICU scared and worried and seeing death in close proximity.

If they becomes breathless, God help them. You take breaths daily and never notice it but here every breath is an effort. A person feels imminent death with every breath and struggles for air. Both lungs are solidified with infectious material. Normal lungs are translucent on an X-Ray except some vascular markings, but in viral pneumonia they are seen as white shadows like the heart shadow. No functioning lung tissue remains. Oxygen saturation in blood will drop. They will be having all the tubes, and ventilator will be required. The machine breathes for you. Patients may be sedated but conscious, scared and again no family member will be allowed.

We saw what happened in Italy and some other parts of world. Exponential rise in cases occurred and mostly senior citizens developed viral pneumonia. So many were in need of ventilators but many did not get it. Those who were on ventilators died alone and just became one more number. They would have lead full lives. Love, family, dancing, parties, birthdays, graduation, kids and grand kids, happiness and sorrow — a whole life but in the end they die alone in the strange surroundings. As there is saying, you came alone in the world and are also leaving alone. We know that, but not like this. Patients can’t see their relatives one last time. The relatives can’t say final goodbye. The dead body is wrapped up in plastic so no one can see the face. Only very few are allowed in crematorium too. I read that in many instances relatives don’t even come to collect the ashes.

This is the grim scenario today but human race is resilient. It has survived many such calamities and came out stronger. Maybe we will get very effective antiviral drugs for this corona virus, or maybe we are just a prick of vaccine away. Then the entire above mentioned scenario will change. Maybe it won’t be the original one but very close.

Written by

Professor of Medicine GCS, Ex-HOD Medicine BJMC, Ahmedabad, Gujarat, India

Professor of Medicine GCS, Ex-HOD Medicine BJMC, Ahmedabad, Gujarat, India

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