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Managing yourself and keeping your family safe: An experience of a COVID positive surgeon

      Keywords

      As surgeons, it is vital to understand how to diagnose and manage coronavirus infection or COVID-19, if one is unfortunate enough to catch it. Early data of the Covid-19 patients in the UK and USA, indicates that the Black and Asian people are more likely to be severely affected than the White people,
      • Kirby T.
      Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities.
      and I fell prey to it and being of Indian origin that concerned me.
      I was on-call and had to fix three urgent fractures on March 20, 2020. But, I had developed a generalized body ache, which worsened as the day progressed. Since this period was the beginning of the coronavirus pandemic, I believed it to be nothing out of the ordinary. That night, I continued to have body ache. On the next day, I operated but continued to have generalized body ache which got worse by midday and I developed fever (38.6 °C) in that evening. But for the first three days, I had a normal temperature.
      I was advised to isolate for seven days, and my wife for 14 days. The temperature persisted for four days, hovering around 38.6 °C. My body ache worsened, and I had a constant headache for five days, which did not respond to Paracetamol; however, it lowered the temperature. Also, my voice became hoarse, although I did not have a cough or shortness of breath (not everybody does!). From my colleague’s experience, if you get shortness of breath, it is advisable to go to the hospital, otherwise, stay and isolate at home. Diagnose yourself as having COVID, if you have the following signs and symptoms: Fever (>38 °C) in 98%, Cough in 76%; Dyspnoea in 55%, Myalgia or fatigue in 44%, Headache in 8%, Haemoptysis in 5%, Diarrhoea in 3%
      • Huang C.
      • Wang Y.
      • Li X.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China.
      and Loss of taste and smell in some.
      I had my COVID test (RT-PCR) done on the fourth day of symptoms, and I was declared COVID positive. I believe that the testing is vitally important, as it focusses on your mind and your family isolate stringently. If you are COVID positive, with symptoms, you need to self isolate for at least seven days. Here are some tips on isolating:
      • 1.
        Isolate in a well-ventilated room.
      • 2.
        Wear a mask.
      • 3.
        Have a separate toilet.
      • 4.
        No sharing of the towel, tableware, bed sheet etc.
      • 5.
        Your daily necessities should be placed separately (soap, toothpaste, etc.).
      • 6.
        Maintain a physical distance of at least 1 m from family (no eating or watching TV together!)
      • 7.
        Restrict activity and take REST.
      • 8.
        No visits by relatives and friends.
      • 9.
        Your caregiver should be a family member without comorbidities and should wear a special mask and washes hand before and after contact.
      • 10.
        Clean household articles and surfaces using disinfectants frequently.
      • 11.
        Frequent hand washing, with running water and soap should be practiced by everybody in the family.
      • 12.
        Separately wash the patient’s clothes, bedsheets, towels, etc. with ordinary soap and water.
      • 13.
        Do not shake contaminated clothing and avoid direct contact.
      • 14.
        The waste generated by the patient should be put into the closed bag, which is replaced frequently.
      By day four, I had also lost sense of smell and taste and could not eat as every food tasted pretty bland or extreme and there was a significant loss of appetite. If you have all these symptoms, then force-feed yourself and ask the family to make food that you like and enjoy the most. Hydration is also important; Green or Jasmine tea was good for me. Turmeric Latte with a drop of honey also helped me, along with a fresh lemon juice and ‘Rasam’ kept me hydrated. Avoid tobacco, alcohol and other drugs.
      I started Hydroxychloroquine and Azithromycin on day five, which resulted in diarrhoea. Honestly, I cannot say that these made any difference to my overall recovery, but like a drug, Paracetamol, was extremely useful.
      My recovery took about ten days, and I returned back to work on the 11th day, but was extremely drained out and tired. I had lost 7 kg of my weight, It took me another couple of weeks to get back my energy and appetite, so I would suggest not to hurry in returning back to work. You should be symptom-free for three days without Paracetamol and then should have a phased return to work. Once you return to work, continue to take all the safety precautions because even if you were COVID positive, it does not necessarily mean that you will have adequate antibodies developed and there is a risk that you may have a second infection and may also infect others.
      Your family may be still be isolating, so maintain physical distancing. Do remember that you are not alone; take support and help of your family members, colleagues, and supervisors. It will help to share your thoughts and listen to others. After recovering stay connected to friends and family. Take regular breaks from your phone and computer. Stay well-hydrated and eat healthily. After work, ensure you have some wind-down time.
      Here are some tips about managing your practice during the corona virus pandemic. Suspend all elective and non-emergency surgery. Many fractures can be managed non-operatively
      • Iyengar K.P.
      • Vaish A.
      • Vaishya R.
      Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic.
      and several procedures can be performed as a day case. In the outpatient clinics, maintain physical distancing of at least 1 m with the patients. Practice Tele-medicine wherever it is possible.
      • Iyengar K.P.
      • Vaish A.
      • Toh E.
      • Vaishya R.
      COVID -19 and remote consulting strategies in the management of Trauma and Orthopaedics.
      Avoid walk-in patients and screen the patients for viral symptoms and thermal screening before they are seen. Everybody should wear a mask. The staff members need to wear protective gear as required—wash hands with soap and alcohol before and after each patient. Regularly disinfect surfaces, keyboards, telephones. There should be proper disposal of rubbish and PPE in the clinics.
      I would suggest having an antibody test around six weeks after the onset of your infection. On return to work, including doing surgery, it is vital that a full PPE is worn as hand-washing and social distancing are strictly observed.“Safety is a common denominator across all aspects of life. Hence knowledge should always be shared. It is not a matter for the industry it is a matter for humanity” – Doug Bourne

      Declaration of competing interest

      The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

      References

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        Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities.
        LANCET. June 01 2020; 8: 547-548
        • Huang C.
        • Wang Y.
        • Li X.
        • et al.
        Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China.
        LANCET (N AM ED). FEB. 15 2020; 395: P497-P506
        • Iyengar K.P.
        • Vaish A.
        • Vaishya R.
        Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic.
        J Clinical Orthop Trauma. 2020; https://doi.org/10.1016/j.jcot.2020.05.010
        • Iyengar K.P.
        • Vaish A.
        • Toh E.
        • Vaishya R.
        COVID -19 and remote consulting strategies in the management of Trauma and Orthopaedics.
        Postgrad Med. 5th May 2020; https://doi.org/10.1136/postgradmedj-2020-137917