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Dr Ritesh Malik, Founder and CEO of Innov8 Coworking, who has been on the frontline of the COVID-19 fight at his family-owned hospital in Delhi, Radix Healthcare, in an exclusive conversation with YourStory reveals all that he has learnt about the virus in the past year.

In this unfiltered chat he talks about where we went wrong as a nation, when the second wave of COVID-19 will peak, the third wave, and most importantly how you can save yourself and your family at this time, among several other important things.

Following are the key highlights from his conversation with Yourstory Founder and CEO Shradha Sharma. (We are publishing his words, near verbatim)

Why is the COVID-19 second wave so bad?

History will always repeat itself.

Typically whenever viral pandemics come they come in cycles, the second and third waves are always more dire because the virus mutates. What we are seeing now is a different virus, different virulence from what originated in Wuhan, China, initially.

In the last wave (our hospital had) so many patients, but we had zero casualties. In the last three weeks, we have had three casualties already in a small (100-bed) hospital like ours. Around 60 per cent cases are of people who are less than the age of 45 this time. The cases are 2.5X more than reported government numbers according to me.

Where did we go so wrong?

Our priorities were towards (state) elections, Kumbh, these are super spreaders. Our priorities as a country were wrong.

In (poll state West Bengal’s capital) Kolkata if two people get a RT-PCR test done, one is coming as positive.

The government should have stopped this (poll) madness immediately. We did not focus on prevention.

As a country we spend time praying (at events like the Kumbh) , but nature is ruthless, if you don’t follow its laws you will succumb to it.

Shouldn’t have exported vaccines

We should not have exported 7 crore vaccines abroad, I feel India took a wrong decision. We should have vaccinated our own population (first).

What can the government do now?

Vaccinated people are getting the disease, so it’s not preventing positivity, but preventing deaths. But, out of 10,000 people who received the Covishield (AstraZeneca) vaccine, only two are positive.

The only solution is mass vaccination. If more than 60 per cent (of the population) is vaccinated we will have heard immunity, that’s the only way to beat the virus.

Even a single dose of the vaccine is very protective. Around 60 per cent infections are in the population below the age of 45 because there was no vaccine for them. There are young cases and young mortalities this time. This virus is extremely virulent, the same which caused mass casualties in the US, I believe.

But, it’s a long road

Prevention is the only way.

But, it will take 811 days to vaccinate 60 per cent of our population, which means two years, by my calculation. 

After partition this is the biggest calamity to hit our country. As a society let us adopt five (poor) people for vaccination, the community needs to come together. Help and be empathetic create a country wide bubble.

When is the COVID-19 second wave peak?

In spring or autumn you will always see the peaks.

May 5 – May 6 the peak will come this time. Around this time (of the year) fever, common cold, is very common and many think this may not be COVID, that is the biggest mistake. Even for mild fever isolate (yourself).

In Delhi, you can’t get tested (right away). RT-PCR has a waitlist of five days for getting the result, there is massive scarcity of test kits. Get a CT scan done, do not wait.

COVID is all about fast action. In spite of vaccination, you can die if you don’t start treatment in time.

But, if you do things methodologically, you will not die of COVID.

What if you test positive for COVID-19?

First thing is you get positive after a long time, there is a 7-11 day incubation (period). When you have COVID and meet me for dinner, I will get symptoms after nine days. Till I develop symptoms, I have already transmitted it to my family. So, the moment you have symptoms just isolate to prevent family members from getting it.  Observe and make a list of your symptoms.

Fever, dry cough and fatigue are the most common symptoms. If you have them you likely have COVID, so isolate.

Old people can have symptoms for 21-25 days. People who are thin with no comorbidity tend to recover fast, but for smokers it’s dangerous. We had a patient with a ‘smoker’s lung’, we lost him, smoking as such is very dangerous.

Which are the medicines typically prescribed?

It’s a basic regimen of antibiotics (like Azithromycin), Fabiflu (anti-viral), and a lot of vitamins. The antibiotic (under prescription) is to stop the super infection or secondary infection. 

You’ll have to take water solubles like Zincovit (multivitamin and multimineral supplement) and Limcee (Vitamin C supplement) as well. Montair-LC (a combination of two medicines: Levocetirizine and Montelukast, which relieves sneezing and runny nose) and cough syrups may also be prescribed. 

How to decode the ‘viral load’ in COVID-19?

Earlier we saw with the CT (cycle threshold) value that people with lower value were more susceptible, and the ones with higher were less. But the second wave is different, a patient with a CT score of 8 is doing well and one with 32 is going to the ventilator.

It has taken us by storm. We do not know where we are heading. I lost a 34-year-old family friend in a matter of 7-8 days. The patient was a non-drinker and non-smoker, we are seeing a lot of these kinds of cases too.

No answer to why these things are happening. No post mortem to understand the true cause of death.

How to protect yourself from COVID-19 now?

To not get COVID stay indoors and create a sanitary bubble around you and become paranoid. Whoever you are talking to, whoever is coming into your bubble, consider them COVID positive. Don’t leave anything to chance. Best thing you can do for your country is not get COVID. There is a waitlist of over 100 at my hospital. Create a bubble, if you have a house help, request them to stay with you or do laundry and housekeeping yourself. Nothing is more important than your health, for the next two months stay home no matter what.

Why do we need double-masks now?

New research suggests it’s an aerosol infection, it doesn’t go down to ground like a droplet infection, aerosol is much smaller and stays in the air.

Even if there was a COVID positive person in a closed room 10 hrs before, the virus can still be there. That is why double-masks are suggested now.

Wear a cloth mask, on top of that take an N95 mask and tighten the nose band, and do not touch your mask. The problem is Indians do not follow instruction, we are very indisciplined.

How to avoid infection from vaccination centres?

Vaccinations centres can become super spreaders. We are vaccinating at a community centre, not at the hospital. It is the responsibility of the hospital to take care of these things.

Go by an appointment, if there is too much crowd do not go there.

Better to wait than to go to a super spreader vaccination centre.

Masks cannot be taken off at hospitals at any cost, the hospitals need to ensure that. The moment you get out of the hospital change your mask and wear a fresh one.

Can you get re-infected?

New and bizarre thing is that earlier reinfection was not happening for 4-5 months, now people who got it in September are again getting it now due to the new mutation. Typically 3-4 days symptoms last and it’s still rare.

Get an antibody test done to see how susceptible you are to getting the infection again.

If you have gotten infected, 21 days after testing negative you can get vaccinated, this is what has been clinically practised.

How to increase immunity?

I am a big believer of Ayurveda, and a big believer in keeping your body in shape. Irrespective of COVID, be in shape, don’t smoke, take a high protein diet, eat coloured vegetables, have fruit juices. Replace medicines with food and replace food with water. Avoid eating junk food, once a week is fine but not more.

People who have higher BMI (body mass index) are mostly the people who die (of COVID).

Replace sugar with stevia, have amla, ashwagandha, methi seeds, these will help increase immunity.

How to increase your oxygen levels at home?

While checking your oxygen levels on an oximeter at home, sit straight and consider the 45th sec reading as the correct one. The moment your SpO2 (also known as oxygen saturation) hits 92, lie down on your belly in an ‘awake prone position’, there are five positions. If all do it 100 cubic metric tonnes of oxygen we will be saving. When you lie on your back your SpO2 level will be less, if you lie on your belly it will increase.

Why does COVID affect people differently?

It’s because of different (levels of) immunities. The first wave last year saw a very interesting pattern, males above 50 (years of age) were heavily affected.

This wave everyone is affected, and there are no answers. No virus that has been this infective, it’s mind bogglingly infective.

Comorbidity of obesity is very dangerous, diabetes too, and non-vaccinated and heart patients are also obviously susceptible. COVID causes coagulation disturbance (disruptions in the body’s ability to control blood clotting).

Why are some people without comorbidities dying from COVID?

The reason is thrombosis (the process of a blood clot), people who don’t have comorbidities, die of that. I lost a 27-year-old friend from thrombosis.

Watch video:

Ritesh, the doctor-turned-entrepreneur and investor, has donned his whites again amidst the raging pandemic that has engulfed the entire country. Since selling his coworking startup to Softbank-backed OYO in 2019, Ritesh has been an extremely active angel investor, while also being involved at the family hospital fighting the pandemic.