Prominent urologist, Dr M Salim Wani was stung by the contagion forcing him to get into nightmarish isolation. Caught between ostracisation and cytokine crisis, he overcame the crisis and shared his experience with Masood Hussain in a freewheeling interview
KASHMIR LIFE (KL): You are a fortunate doctor who fought the Covid-19 and is back to work. But have you any idea about where you contracted the infection?
Dr M SALIM WANI (DMSW): It is a professional hazard and as a frontline worrier you can catch it and your protective gear is no immunity to the disease. Soldiers in the battlefield do get injured while fighting an enemy despite being well equipped and protected. It was God’s grace that I am back to work and healthy.
KL: Being a busy urologist, how you spent your days in the fortnight-long battle, can you describe in detail – for the benefit of people – the highs and lows during these days?
DMSW: It has been a nightmare. It has been very hard because of the unfortunate stigma attached to it. We need to fight it collectively, otherwise, people in coming days will suffer from psycho-social disturbances with disastrous consequences. The stigma and attendant ostracisation are pushing patients into oblivion. I, as a doctor, with no co-morbidities was sure to overcome it but the fear of cytokine crisis developing and death of younger patients was haunting me too. As a patient, ordeal starts the moment the test result is declared positive and the constant ringing of the phone from various agencies. The changed behaviour of your neighbours, relatives is simply devastating. But I don’t blame society for all this. We need to educate the people and make it clear that our fight is against the disease and not the patient. For me, the days of solitude was a God-sent opportunity to introspect and submit yourself to God and ask for forgiveness. I am thankful to my hospital staff especially the sanitation workers, nurses and others who looked after me well during these tough times.
KL: We already have lost almost 160 people to this pandemic and nearly 10 thousand are infected. How you see the state and status of the pandemic as on today?
DMSW: It is almost common knowledge that we are yet to reach the peak. It is a matter of distress how people have let down their guard – there are many people who are not wearing masks, or markets and public places are full without physical distancing. On the response side, we have seen that the administration and the health sector have tried to grapple with the pandemic. They are doing a commendable job, but there are some lacunae. But we see that the response is continuously evolving, and there is an effort to correct the lacunae. Within it, the part on optimisation of resources is being now worked out. As many experts have stated time and again that we need to focus on medical care for symptomatic patients, and home quarantines for the asymptomatic ones. Also, we need to create a firewall between dedicated Covid-19 care hospitals and the rest, so that the larger medical care doesn’t suffer.
KL: How does Covid-19 impact the functions of the human body outside the lungs?
DMSW: The disease involves all the body organs besides the lungs. In fact, coronary involvement like heart attacks, acute abdomen like appendicitis are some of the unusual presentations. The mortality and morbidity are very high in patients with CKD, diabetes, various heart ailments and old age patients.
KL: Is there any new symptom of the infection that the patients suffering from urological issues must specifically look for? What are the routine symptoms?
DMSW: The routine symptoms are fever, sore throat, body aches, loss of sense of smell, acute diarrhoea. A recent meta-analysis has revealed that in patients with Covid-19, 7.5% developed acute kidney injury with a very high mortality rate (93.2%). The same study revealed 5.7% and 65.8% shedding of viral RNA in urine and stools stressing the importance of handwashing toilet etiquettes.
KL: What are your suggestions for patients who are fighting the infection?
DMSW: Maintain a positive attitude because it boosts immunity. A good nutritious diet, vitamins C, and D, deep breathing exercises and lye prone to prevent lungs from getting clogged. Most importantly don’t lose hope and remember your Creator.
KL: You were amongst the first to contribute your plasma. What is it and how it is put to use these days. We already had one plasma therapy at the SKIMS?
DMSW: I was not the first to donate plasma. In fact, before me, a doctor and a nurse did so. It has to be blood group-specific and you need to fulfil other criteria like age less than 60 years, body weight more than 50 kgs, Hb% more than 10, having recovered from Covid and tested negative.
Here I want to give suggestions to the authorities to create plasma bank facilities and prepare a ‘plasma donor information list’ so as to facilitate the willing donors to donate without any hassles. I believe the best time to counsel the patient about donation is when he or she has recovered and is being discharged from the hospital. It should be clear to all that plasma donation does not adversely affect the donor in any way.
KL: Lockdowns trigger hunger and restoring routine life activities helps the curve. How to manage life while fighting the epidemic?
DMSW: This is an ongoing battle, and we have to fight it collectively. There is no other way but to follow the guidelines which have been circulated time and again by WHO, ICMR and local health officials – wearing masks, physical distancing, avoiding unnecessary travel and crowding, hygiene practices related to hands. At the response front, clearly it has been dynamic and has evolved over the period. We need to have constructive engagements between the experts, policymakers and realise at the same time that everyone is going out of the way in their jobs. I repeat, that we need to emphasize the optimization of medical resources, by making distinctions for care for symptomatic and asymptomatic patients, and by creating firewalls between Covid-19 and non-Covid-19 hospitals.
There is one more thing I want to focus on since you have mentioned hunger. And there is a sense of urgency here. It should not be the case that Covid-19 should send people into poverty. For this, we have to think of people in the informal sector who have had numerous difficulties in earning their livelihoods. Similarly, we have to think of the Covid-19 patients and their quarantined families who may be dealing with financial problems. Here, I appeal to the administration and the society to come up with some sort of monetary aid for this group.
KL: Is there any empirical study that will offer some idea about the patterns of infection, the socio-economic or the geographic vulnerability in Jammu and Kashmir?
DMSW: At the time I was in the hospital as a patient, I got a lot of time to go through the emerging literature on the subject. I did not come across many empirical studies, but I am sure that we will have some good studies soon. We have many good researchers at the medical institutes and universities in Kashmir. Having said this, we should also be careful if the speed research and conjectures, which attempt to masquerade as science. Here too, I think, we need to promote a culture of honest and critical review and discussion.
KL: Is it correct that the health experts were playing second fiddles to the decision making on Covid-19 in Jammu and Kashmir?
DMSW: This was an unprecedented situation, and medical experts, as well as the policymakers, tried their best in the situation with the available resources. The situation is also evolving, and there have been many changes and course corrections. Within this interface between the two, it is also natural to have a healthy debate and honest criticism and evaluation at each level. This will release greater synergies, and help us to deal with the upcoming predictions of the peak in a better way. Associated to this, we need to be extra careful that all the specialists are heard for an honest review.
There is one more suggestion. There should also be the creation of consultative bodies which will include Covid-19 victors as well as experts from psychiatry and psychology. It is high time that we start addressing the stigma at a more concrete level.
KL: While fighting Covid-19, do you agree, the health sector shut eyes on other diseases as a result of which people died of issues otherwise treatable?
DMSW: This is an impression, but we will need an honest review and evaluation of the data to understand to what extent this has happened. As I have mentioned earlier, we need to create firewalls between Covid-19 and non-Covid-19 care. This is true for all levels of health care, but we need to be particularly careful at the super speciality level. Having said this, I have also seen that there is an impression among many people that they should maintain distance from the hospitals. We will have to actively counter this impression.
KL: How you see the existing infrastructure in the health sector and what we must quickly add?
DMSW: The best health care sectors of the world have collapsed because of this unforeseen situation so was the case, but we have still managed it better so far but the real testing time is yet to come. We need to prepare ourselves for the worst. Employment of doctors, nurses on temporary arrangements for Covid-19 care is one of the suggestions.
KL: How soon do you think Kashmir will evolve the herd immunity against the invisible virus?
DMSW: At this moment of time there is not enough evidence of herd immunity and studies have revealed less than 5% immunity at this stage and a Spanish study has revealed that herd immunity may not be easily achievable.
(Prof Dr Mohammad Salim Wani is head of the Urology and Kidney Transplant Unit at the SKIMS, Srinagar)