FAQs

The suffering of the survivors of Covid is not only related to the traumatic events; rather, the subsequent life events and sufferings in the post Covid life cause higher emotional problems if an adequate, community-based, psychosocial care approach is not adapted. Individuals are not in any real sense autonomous or self-sufficient, their loneliness during the pandemic is real and healing occurs in the context of family, friends, and community.
Rehabilitation introduced the notion of a bio-psycho-social medical model, initiatives need to integrate psycho social care as an essential part of the overall care and rehabilitation. Those who receive a spectrum of care including health care, psychosocial, livelihood, educational, developmental activities would have less emotional reactions, better functionality and quality of life. Effective rehabilitation methods for persons who survived Covid and those suffering from post Covid social and other traumatic events including loss of loved ones to being children who were separated from the parent due to quarantine and their complications needs to address the problems posed by various potential events.
The post Covid rehabilitation planning continuum is broad in scope and must address collaboration across agencies and organizations, advance preparations, as well as needs assessments, event management, recovery and rebuilding efforts.
It is important to facilitate understanding of the meaning of personal and community losses and also to ensure adjustment and acceptance of change. To ensure this, working with individuals/families, facilitating support groups in the community, development of community-based organizations, community solidarity, and many other interventions are crucial. Failure to provide these services definitely will show higher distress, disabilities, and lack of social well-being. Local community support in coordination with Government functionaries need to reach each every families by providing with appropriate services. It is very important to focus on population than individuals to create a supportive and a resilient community.

Well, older kids can follow Covid- Appropriate Behavior to protect themselves.

We do not recommend mask in children below 2 years. In fact, we have observed it is difficult to make children between 2 to 5 years wear masks. So, it is advisable to keep them indoors. But don’t forget to engage them in playful and physical activities as the first five years are crucial for a child’s mental and physical development.

Every family member who is above 18 years of age should get vaccinated. If adults are protected, our children too remain protected.

Vaccines have been found safe for lactating mothers. So, they too should take the vaccine.

In such cases any person who is not COVID positive should nurse the child. However, a lactating mother should extract her milk and feed the child. If there is no one else to take care of the child, the mother should wear a double mask and face shield, wash her hands and sanitise her surroundings regularly. Mother’s milk is important for the child’s proper growth and development. The milk of an infected mother has antibodies against coronavirus.

This can happen if the child has contracted the infection from someone outside the family. So, firstly, each member of the family should get oneself tested for Covid-19. The caregiver should wear full protection gear—double masks, face shield, gloves—while nursing the child. Care should be provided under the guidance and supervision of a doctor. The caregiver and the child should isolate themselves from the rest of the family.

We don’t recommend any medicine for asymptomatic children. In mild cases, but prescribe simple paracetamol to manage fever and other mild symptoms. Similarly, diarrhoea is managed with oral rehydration fluids and plenty of fluid. In moderate to severe cases, the treatment is the same as that for adults.

Immediately consult a doctor if you observe respiratory distress, increased respiratory rate, severe cough that is interfering with feeding, hypoxia, uncontrolled fever, or any other unusual symptoms like skin rash, excessive sleepiness in children.

There are cases of Long Covid-19 in children as well, in which a patient develops a new disease such as diabetes, hypertension even after the 3-6 months of recovery. The parents should be in touch with their doctor for follow up of children who have recovered from acute COVID illness.

A vast majority of children either remain asymptomatic or develop a mild disease. In a household, if several adults are diagnosed with COVID 19 infection, there is a high possibility that the children will also be infected. Fortunately, in most such cases, the children particularly those below 10 years are usually asymptomatic or have mild, common cold like symptoms, or diarrhoea.

However, children with congenital heart disease, diabetes, asthma, or those suffering from childhood cancers, or on immune-suppressants are at a higher risk of developing severe disease.
The parents should watch COVID sick children closely. Many of the serious complications in children occur in or after 2nd week of acquiring the infection.

Overall, there is no evidence that children have special predilection of developing COVID 19 disease during this wave as well. Due to larger number of persons getting infected, the absolute number of affected children has also increased.

Thousands of children, in all age groups, from across the country have been tested positive for Covid-19, during the second wave, creating panic among parents. The experts say that though most children develop mild disease, there is a need to keep them protected from getting infection. Dr. Narendra Kumar Arora, a paediatric gastroenterologist and a senior member of the National Covid-19 Task Force tells how to treat and care for children who have contracted Covid-19. Excerpts.

Recently, a lot of States have reported an increase in the number of children tested positive for Covid-19. Do you think more children are being infected in the second wave of the disease?

Children are as susceptible to catching the Covid-19 infection as adults and according to our latest national sero-survey also, 25 percent of children surveyed were found to be affected by Covid-19. Even children below 10 years were also found to be as infected as other age groups. National data on the disease tells us that around 3-4 percent of children were symptomatic during the first wave of Covid-19 and this percentage remains the same during the second wave also. However, since the total number of cases has gone up, it has affected more number of children this time.

In April-May there was a huge surge in the Covid cases, mortalities as well as over-dependence on the vaccines and oxygen for the patients. Even though the oxygen and vaccine deficit can be tackled, Covid-19 infection is still lingering. The basic precautions which have been advised to follow remain of crucial importance.

Dr. Deepak Khedekar, MBBS-M.D, Professor of Anatomy, LTTMC - Lokmanya Tilak Municipal Medical College

Fatigue is a known aftereffect of Covid 19. Hence, it is advisable to take it slow as your capacity to exert your body and exercise would have decreased considerably in the post-recovery period. However, you may be able to take upon the daily activities gradually. So rest up, till you are back to your usual energy level before taking up heavy jobs.

Dr. Meha Sharma. Consultant Rheumatologist - Specialist of Immune Disorders, Cedar Superspeciality Centre, Dwarka, Delhi

A couple of factors – seeing too much of each other, not having a structured routine, inability to step out for relaxation and being cooped-up with work, domestic chores, uncertainty about future etc—have led to relationship issues. This has manifested in the form of heated arguments, interference, nagging behaviour, hostile comments, passing judgements among couples. Here are a few ways you can mend your broken friendship/ relationship with your partner.

• Be in harmony with your own self first, then you will be in harmony with your partner. Drop your ‘me attitude’ and adopt a ‘we attitude’.
• Respect the four pillars of a relationship: Communication, Trust, Empathy and Respect
• Prioritise your needs by keeping a flexible schedule, juggling between family time and work time
• Ensure responsibilities between partners are shared. Multi-tasking by just one partner often drains the person out and lowers his/her threshold. Hence, there should be a rational division of roles and responsibilities of running the household.
• During lockdown, there is an increase in substance abuse, be it alcohol, drugs or cigarettes. This is a form of maladaptive coping mechanism and should be addressed through building motivation to quit and seeking psychiatric advice.
• Keep your body language positive while communicating with partner and do not indulge in stonewalling.
• Couple yoga is a good way to bring in positive vibes and filling the vacuum in a relationship.
• If one of the partners, however, is showing signs of personality disorder, abusive behaviour, substance abuse, projecting suicidal thoughts, obsessive-compulsive signs, significant changes in behaviour, mood, appetite or sleep, then consult a psychiatrist for timely recognition, rectification and treatment.

• Invest in the people: Human beings make mistakes during stress. Health and socio-emotional needs have to take precedence in a time like this.
• Corporates could give rotatory day offs/ reduce timings or alter timings for WFH practises to accommodate the needs of working parents, or those with elderly parents to look after.
• Maintaining a sense of collective and belonging is essential.
• Starting forums like “listening circles” or “chat with someone when you are feeling alone”, helplines to call when quarantined or isolated, are all helpful to prevent and alleviate the exhaustion that is prevalent right now.
• The recognition that this exhaustion is not just about work but about the increased thinking and planning required to stay calm, that the needs of a household and therefore the requirements of presence and effort to nurture themselves and other members within a family has completely changed. If we can help each other acknowledge and provide for this need, burnouts can be mitigated. Resources within communities, when synergised are immense and are the way forward.

By looking at the drivers that have led to this above cluster of symptoms - do we think the children are finding it meaningful to be passive recipients of the pandemic?

They have been told that adults are handling it- they just need to comply- regardless of the absolute change in standard- including our about-turn on screen time usage- preference for working harder to keep our jobs over family time.

The need is to recognise what the last year has taught us.

1. Ask yourself – what are the skills and qualities that have helped most of us in this time?
2. When you have your answer e.g. The sense of the collective over the sense of the individual (the “me” to the “we”), the humaneness, compassion, empathy, resilience, communication skills, looking after our own bodies, being able to connect to others, the ability to stay by and within one self and create our own grounding and joy—whatever the answer – the next step is to ask: Am I providing an environment where my child is being taught these skills? Or am I nurturing these qualities in them? If not, be mindful of nurturing these life skills in the family. When families and children are far more connected to the collective and to their inner sense of purpose and meaning- the loneliness and irritability decreases.
3. Engage children in collective roles, make them understand their privileges over those who don’t have them. If adults appreciate each other and express gratitude, children will emulate.

It is normal to feel anxious when you find out that your family member has contracted Covid.

Acknowledge these emotions. Give yourself time to work on stress management strategies, including exercise and meditation. Talking with your friends and family members, and reassuring yourself with the progress they are making daily, will help you manage your stress levels.

Dr. Meha Sharma. Consultant Rheumatologist - Specialist of Immune Disorders, Cedar Superspeciality Centre, Dwarka, Delhi

First of all, offer support in a more practical manner. When a family member develops the infection, because of anxiety family members may not pay attention to their own well being. See if you can arrange meals, medicines or help them get registered for a bed. Offer to help out with procuring masks, sanitiser etc or groceries. Send encouraging messages and do not give any medical advice unless you are a doctor. Reassure them when they are anxious and ask them to note down their symptoms so that they can have an informed discussion with their doctor. Allow them to rest and don’t call them again and again. Assure them of your support in case of an emergency. Provide them with information about local volunteer group numbers and local triage centres. Provide hope, humour and lightness.

FOR YOUR PARENTS: 1. Be in isolation for 14 days 2. Do not share dishes or any equipment 3. If you have to share space, make sure the room has good air flow 4. Use gloved hands to clean dishes with hot detergent liquid 5. Stay connected with doctor

FOR YOU, THE CAREGIVER: 1.Double mask yourself in the house 2. Practise Covid-apt ways: handwashing, avoid touching face and wear gloves 3. Quarantine yourself for 14 days and stay in touch with doctor.

Dr. Bimal Prasad Padhy, Consultant Neurologist, Care Hospital, Nampally, Hyderabad

Most patients of Covid-19 recover completely, regaining their usual strength and immunity after a few weeks of infection. Those having severe pre-existing illness may have problems persisting beyond four weeks in what is termed post-Covid-19 syndrome or ‘long Covid-19’. They may suffer from chronic fatigue to more severe organ dysfunctions. As we are grappling with a relatively new disease, it is too early to tell what Covid-19 survivors are likely to experience in a year’s time.

Dr. Bimal Prasad Padhy, Consultant Neurologist, Care Hospital, Nampally, Hyderabad

There is no correlation among blood groups and severity of Covid-19. Infection is more severe in senior citizens and those with comorbidities.

Dr. M Narayanan, MD, DCH, FIAP, Consultant Paediatrician, SAN Children's Clinic, Ernakulam

It is difficult to differentiate Covid-19 infection in children from other viral infections such as common cold. One can suspect Covid 19 when there is a history of contact. One should be alarmed if the child has any of these  symptoms – Irritability; feeding difficulty; breathing difficulty, fast breathing, tiredness, fever and reduced urine output.

Dr. M Narayanan, MD, DCH, FIAP, Consultant Paediatrician, SAN Children's Clinic, Ernakulam

Getting maximum people vaccinated is definitely the need of the hour. However, as is the case with any other vaccine, there is an efficacy level to each of the jabs. Till the whole world is vaccinated, people will have to follow the Covid protocol.

Dr. Amrapali Keny Pawar, Senior ENT Consultant, KB Bhabha Hospital, Bandra

1. The suffering of the survivors of Covid is not only related to the traumatic events; rather, the subsequent life events and sufferings in the post-Covid life cause higher emotional problems if an adequate, community-based, psychosocial care approach is not adapted.
2. Individuals are not in any real sense autonomous or self-sufficient, their loneliness during the pandemic is real and healing occurs in the context of family, friends, and community.
3. Effective rehabilitation methods for persons who survived Covid and those suffering from post Covid social and other traumatic events including loss of loved ones to being children who were separated from the parent due to quarantine and their complications needs to address the problems posed by various potential events.
4. The post Covid rehabilitation planning continuum is broad in scope and must address collaboration across agencies and organisations, advance preparations, as well as needs assessments, event management, recovery and rebuilding efforts.
5. Failure to provide these services definitely will show higher distress, disabilities, and lack of social well-being. Local community support in coordination with Government functionaries need to reach each and every family by providing with appropriate services. It is very important to focus on population than individuals to create a supportive and a resilient community.

• If feeling guilty, tutor your mind to process that the situation was beyond your control. Accept the fact that the pandemic hit the world and you did the best you could for your loved one.
• One of the ways to live with a loss is by remembering positive aspects of the departed person. Think of the happy memories and talk to your friends about good time shared with the person.
• If you have kids, tell them that the departed person is living through you and them. In a sensitive way, explain to kids how genetically you are connected, and therefore, will never be disconnected with the departed person.
• Rituals help in some amount of healing process. If you are a relative of the departed person, try not to be inquisitive about cause and nature of death. Rather, focus on sending positive vibes and help during the quarantine period.
• If the person who has lost a close family member, shows signs of weight loss, prolonged irritability, sadness, signs of clinical depression, one should not hesitate to approach a psychiatrist for timely recognition, rectification and treatment.

When a family member is infected, the situation is more challenging, First all the family members should be screened, as everyone in the house qualify as primary contacts. Infection is always higher among primary contacts, therefore family members should strictly follow covid-specific precautions. They must maintain social distance, must wear masks and sanitise regularly.

Dr. Amalaselvam A (MD, MDRC) Physician Diabetologist Joseph Medical Centre, Laxmipuram, Bengaluru

A vaccine is a dead or alive attenuated virus, which when given in a required dose, produces a mild infection, triggering the body to produce antibodies. When a person is infected with corona virus, the antibodies produced will neutralise the virus. It will take 6-8 weeks from the second dose for immunity levels to increase.

Dr. Amalaselvam A (MD, MDRC) Physician Diabetologist Joseph Medical Centre, Laxmipuram, Bengaluru

No major side-effects have been observed barring  some cases with fever, body pain, and pain at the site of injection. They are not worrisome symptoms and may last for 1 to 2 days. During this period, the vaccinated person is advised to take rest as much as possible and consume plenty of fluids. One can take anti-pyretic drug such as Paracetamol to control fever.

Dr. Deepak Khedekar, MBBS-M. D, Professor of Anatomy, LTTMC - Lokmanya Tilak Municipal Medical College

There is simple mantra of mindfulness meaning staying in the moment. It is a dynamic form of meditation that keeps you grounded and helps you manage your stress. Be it Covid- 19 or exam stress, it impacts the body and its immunity. Keeping away from negative news, maintaining gratitude log, meditation, mindfulness, taking a break from screen time and maintaining a dietary and sleep discipline would help you maintain your mental balance in these turbulent times.

Dr. Sweta Singla - Senior Consultant, Unit Head, Neurology Department at Venkateshwar Hospital, Dwarka, Delhi

Almost every family has been affected by Covid in some way or the other. While adults may have gone through health issues to financial problems, for children, the access to the usual spaces that formed their ecosystem for holistic development has been suspended. One needs to, therefore, be prepared for transition even when the pandemic is contained. For, a lot would have changed when the world gets back to work—business styles, how schools will function, how people would be looking out for new jobs, how new skills would be sought after, how women would have learnt the art of multi-tasking and in fact, even in the way the families would function.

• The two-year stressful period and unprecedented change has had an impact on people’s minds, far more than what meets the eye. Many people have lost their loved ones and hence, organisations must give employees time to heal and allow at least a partial closure of the tragedy, until they feel fit enough to resume charge.
• Give people some time to accept the fact that a lot has changed in the past two years—be it in employment status, salaries, peer bonding etc. Hence, realistic goals and targets should be set, keeping in mind what the employee is going through in his personal life.
• When employees get vaccinated, firms should facilitate a smooth transition from ‘work from home’ to resuming normal office by giving them options such as taking up WFH for three days a week initially and then, gradually moving to 6-days office. In fact, a hybrid environment is the way forward.
• Psychological counselling is a must for those employees who have just recovered from Covid and are facing post-Covid fatigue.
• Facilitate team bonding exercises to heal the overworked staff, motivate the ones facing brain fog and calm the cantankerous employees.

There is no definitive guideline on timeline for vaccination post covid recovery. But general consensus is that you should recover from active infection before getting yourself vaccinated. So, it is prudent to wait for atleast two weeks of your first day of symptoms before you get your Covid 19 jab.

Dr. Sweta Singla - Senior Consultant, Unit Head, Neurology Department at Venkateshwar Hospital, Dwarka, Delhi

A fitted, good quality mask, if worn properly, will prevent the person from coming in contact with the virus. Besides, it does not influence the intake of Oxygen in any way. Masks are the most-effective way to be safe in this pandemic and is easily available, cost-effective, and covers all age groups. One life saved by any health care worker is worth a million-dollar smile and is the best gift of God. That's the way we keep our morale high by supporting one another.

Dr. Sushil Poddar, Child Specialist, Director Poddar Hospital, Jaipur

Kids should stay at home, eat home-cooked food, wash hands well and wear masks even at home, if possible. Children should take immunity booster in diet like multivitamins, vitamin C, and D along with fruits and vegetables. Besides, taking a good nap, limited usage of gadgets, regular gargle, and steam inhalation can work wonders. And of course, wait for shots for kids in India.

Dr. Sushil Poddar, Child Specialist, Director Poddar Hospital, Jaipur

There are two ways of looking at it—one is acceptance and the other, resigned acceptance. Acceptance is a defence mechanism, where you resolve conflicts in a healthy way. However, resigned acceptance leads to a sense of defeat, lack of purpose. Try to accept reality.

Dr. Sanjay Chugh, Senior Consultant Psychiatrist, New Delhi

When negative thoughts overwhelm you, a therapist practises cognitive behavioural therapy. So, if you are to describe an event that has led to a stream of negative thoughts, evaluate the thought in an objective way and figure out if it is valid, appropriate and healthy. If not serving any purpose, then find alternative solutions that serves a purpose.

Dr. Sanjay Chugh, Senior Consultant, Psychiatrist, New Delhi

Good nutrition is crucial during Covid. The ideal plan is to follow the WHO- recommended balanced diet with adequate amounts of carbs, protein and fat. The regular Indian meal usually fulfills this. Drink plenty of fluids.

Dr. Bimal Prasad Padhy, Consultant Neurologist, Care Hospital, Nampally, Hyderabad

Covid infection causes inflammation in the body that leads to the platelets sticking together to form a clot in the arteries. That is why it is important to do the inflammatory markers like D'Dimer and CRP to predict the complications.

Dr. Varsha Rele Shirvekar, M.S. ENT

After vaccination, expect some body ache and mild fever for 24 hours.  You may take paracetamol for the first three days. Immunity develops after three weeks, so continue to wear the mask, washing and sanitising your hands.

Dr. Varsha Rele Shirvekar, M.S. ENT

There’s no consensus in this regard but it can be said 3-8 months. Immunity can occur naturally after developing Covid-19 or from getting the Covid-19 vaccination.

Dr. Gurpreet Singh Bali, SR, Alchemist Hospital, Panchkula

There are no specific precautions prior to vaccination, but if you have flu like symptoms you must inform the vaccinating personnel about the same and also about any previous drug allergies. Post vaccination one may get fever, body aches, lethargy – which is a part of the post vaccination symptomatology; only paracetamol and good hydration needs to be done as symptoms may last for 24-48 hours. An immediate (and rare) side effect post vaccination is anaphylaxis, which will cause choking sensation/rashes/breathlessness. This has to be addressed immediately in a hospital.

Dr. Gurpreet Singh Bali, SR, Alchemist Hospital, Panchkula

Once a person is diagnosed with Covid, it is crucial to monitor O2 level once in 4hrs, & also do a 6minute walk test to see the possible chances of O2 drop. If SpO2 level is below 95% on room air, one should be alert & reach out for medical services and start right medicine as per your physician’s advice ( at times inhaled steroids or oral steroids ) along with other medicines. 

Apart from this, lying in PRONE-POSITION (see graphic) has shown to improve oxygen levels at initial stages. This position has been medically proven to improve breathing comfort and oxygenation in patients with low oxygen. This is because it helps keep the alveolar units open.

Dr. Supritha K M, Spandana Health Care, North Bengaluru

It is important for everyone to take the vaccine. However, if a person has had Covid already, then the patient must wait for 6 weeks after recovery to take the vaccine. Yes one can get infected for the second time. To reduce the chances of contracting again, self-isolation is the best way.

Dr. Shashikantha, HOD General Medicine, Adichunchanagiri Institute of Medical Sciences, B’luru

Hand hygiene can significantly reduce the risk of infection and transmission. But then one needs to club it with social distancing and masking. Soap and water is indeed the best way to clean your hands but in the absence of the same, rely on hand sanitiser to protect yourself. Protect yourself by wearing gloves as you can’t keep sanitising surfaces.

Dr. Pravin Garg, Consultant Physician, Ahmedabad

We need to understand that the recovery period of Covid differs from person to person in terms of length and physical parameters. The person, who has recovered becomes non-infectious after 10 to 14 days of infection. We, however, need to keep follow Covid protocol post-recovery too.

Dr Pravin Garg, Consultant Physician, Ahmedabad

As we have a large group of population below 18 years of age, chances of vaccinating children any time soon seem unlikely. The country is facing vaccine shortage, and also, trials on kids are not yet complete. The Govt is currently working on building paediatric makeshift infrastructure, keeping the third wave in mind.

According to research, children express higher levels of two specific immune system molecules: Interleukin 17A (IL-17A), which helps to mobilise immune system response during early infection, and Interferon that combats viral replication. So far, understanding of Covid shows that children tend to have less severe infection as per available data from first wave.

Dr. Rajendra Gunjotikar, Nephrologist, Director, Kimaya Kidney Care, Gunjotikar Nursing Home

Covid-19 has led to an explosion of mental health issues, especially depression. Many, including kids and teens, are going through anxiety and depression. The reason for this among young adults is anticipation about their future. It is advised that there is timely recognition and treatment for the same.

Dr. Sanjay Chugh, Senior Consultant, Neuro Psychiatrist, Delhi

Children facing Covid cases within their families are going through tremendous stress. The important tool to employ in such situations is to find a channel to vent out your feelings. But with peers also facing similar traumas, it's not easy to find someone who can listen to you and understand you. So, talking to a helpline is a good way to get an objective listener who can help you. Try this helpline set up by Delhi Police - 9311551393.

Dr. Sanjay Chugh, Senior Consultant, Neuro Psychiatrist, Delhi

There is nothing unsafe about standing in the balcony, as long as there is adequate distance between the households. From the very beginning of the pandemic, the WHO has said that only in close contact (less than 6 feet) can there be transmission of the virus through cough/sneeze droplets, and that’s why one needs to wear a mask and sanitise when in a crowded space.

Dr. Tauseef Ahmed, General Physician, Nishat Hospital, Lucknow

If you are developing anxious thoughts, palpitations, nightmares, notice changes in sleeping and eating pattern, finding the world irrelevant, getting irritated, having anger spells, or start crying for no reason, especially during this time, then talk to a therapist for identification and rectification of the symptoms. Additionally, divert your mind to positive chores/routine. Eg: Taking a walk, pursuing a hobby, avoiding negative messages from people.

Dr. Prashant Bhimani, Sr Consultant Psychologist, practicing in Ahmedabad

One needs to avoid overthinking and understand that around 80-90% of people recover during in-home quarantine and isolation. We need to see things scientifically with caution and not with illogical fear. If you don’t panic, your family will be emotionally stable and recover faster. As a child, just help them to remain happy and communicative. You can send funny videos and good thoughts, and keep them happy.

Dr. Prashant Bhimani, Sr Consultant Psychologist, practicing in Ahmedabad

Loneliness is being considered the new pandemic. What can you do to feel less isolated?

1. Trying to stay connected and allocating time to stay in touch with family and friends including online group activities.
2. Having a routine.
3. Indulging in some daily rituals – like spending time in your balcony with plants, trying to learn a new skill, using your time to organise things at home- your paper, accounts, clothes.
4. Finding ways of helping and supporting others – like within your circle or a volunteer group.
5. Having a clear boundary between work and home especially if you are working from home.
6. Move a lot. Get up every 20 minutes from a position and move around, stretch and walk a little even within the house.
7. At the end of each day write down three things that you were able to do- not just work but anything that you did for yourself or others.
8. Maintain a diary – either writing or audio where you jot down your thoughts and ideas.
9. Keep a balance between bad and good news. Don’t avoid keeping up with the current situation, at the same time also pay attention to the happier things. Humour is a good way of forgetting all the problems for just a while.

Being in an ICU can be extremely isolating and lonely and scary even in non COVID situations. In the COVID pandemic, no relative can visit the ICU, the staff, nurses and doctors are in PPE and you can’t see them or identify a familiar face and there may be a lot of suffering and even deaths in the ICU. All this makes it an extremely isolating experience.

The main thing which will help them is to stay connected with family and dear ones through frequent video calls or messages. Having something familiar can also be calming and a photo of a loved one, a religious symbol or a good luck charm or some music playing in the ICU can soothe.

Doctors and nurses need to provide information about procedures, what they are doing, and mention about any improvement that is happening or when the situation is stable.

When speaking to your loved one who is in the ICU or when messaging them, send messages of hope, record your voice with a soothing message or some chants or soothing music, jokes and humour which they can play for themselves or the staff can play for them. If there are grandchildren, let them give messages and cheer them up and provide hope. Make sure they have their glasses or hearing aid, or a pen and a writing pad.

Once they are discharged from ICU and come home, many may continue to have flashbacks of the time in the ICU and relive the trauma. They may get anxious  or have nightmares and dreams. Some people may do the opposite and feel numb and not want to talk about it at all. Respect their individual wishes about this. If the anxiety, flashbacks, nightmares and sleep disturbances are too much- that is suggestive of PTSD. If anxiety is overwhelming, we might want to use some grounding techniques like encouraging some sensory stimulation using the five fingers method. In PTSD, people feel that they are in the traumatic situation again rather than realising that they are now out of danger. To make them get back to the present and for the brain to recognise that the threat is over and they are safe, these grounding techniques help;

1. Name Five things that you can See at this time wherever you are
2. Name Four things you can Hear at this time- the fan, kitchen noises, rain, dog barking, birds chirping are some examples
3. Name Three things that you can Touch – touch different surfaces and describe the sensation
4. Name Two things you can Smell
5. Name One thing you can Taste

This will help in grounding, bringing the person back to the present and decrease overwhelming anxiety. If the problem is too much then, encourage them to seek mental health support.

It is very difficult indeed and we are all going through so many emotions. We hear about so many people dying or being critically ill that it is hard to stay positive. Remember that the pandemic will take time to come down. Many things are being done like vaccination, improving hospital services and having volunteer groups.

Each of us has our own threshold for feeling sad about the situation and anxious about it. Identify your threshold and be aware of how you are feeling. The moment you feel that you are overwhelmed, try to delink from the news or the conversation and pay attention to something else. While you cant stay positive always, what you can do is identify what stresses you out most. Is it your fear, is it death and dying, is it the fact that oxygen or beds may not be available- which kind of news makes you feel overwhelmed. Try not to shut yourself away from all news because that will lead to avoidance. Avoidance can increase anxiety because it increases your sensitivity to becoming anxious. You may find that if you are avoiding all bad news, you get triggered even with small things.

Also try and involve yourself in helping someone. Even if it a small thing like talking to an elderly person in your family over a call daily, organising food for the needy, doing an hour of volunteering or helping in the neighbourhood with some information. All this will make you feel that you are contributing and feel less out of control.

Stress if excessive is known to decrease immunity overall and not specifically against COVID 19 alone. It is important therefore to follow a daily routine with four components- work, play and leisure, some social and family interaction which are supportive, rest. Try and balance all these components rather than focusing on one aspect only. Many a times when you are stressed it maybe due to HALT- Hunger, Anger, Loneliness, Tiredness. So if you are getting stressed try and label it, identify it, try to understand what the main cause of worrying is, specify it so that it becomes less overwhelming.
For eg- the stress maybe because you have a family member admitted with COVID 19. Try and see that you are not always thinking only about that and be aware that if you are too stressed, you will become less effective. Instead, make a list of things you have to do, try do some chores, spend time with a child or a pet or talking to a friend or relative, water a plant. All these things while appearing mundane, will help you calm down which is required when you have to handle a crisis.

One of the reasons of Vaccine Anxiety is getting a lot of misinformation about side effects and hence there is a fear of the unknown. Also most adults in India have not really had a vaccine in their adult lives so it seems really anxiety provoking for those who fear injections and hospitals.

For others there is worry about actually being able to get an appointment and go to a vaccination centre where they feel they may have chances of COVID infection if there are lots of people.

So the way to handle anxiety is to

1. talk to someone who has already received the vaccine and find out their experience and how they handled the pain in the arm or the fever that might have happened after the vaccine. 
2. Get informed about what a vaccine does. And if you have doubts ask a doctor to give you the correct information.
3. Prepare yourself beforehand by having a painkiller or paracetamol tablets at home so that if there is fever or some pain you know how to handle it.
4. Tell yourself that if you and everyone around you gets vaccinated- ultimately you will be able to go out without much fear and anxiety about getting COVID 19 infection.
5. Anxiety will not affect your immunity or the vaccination. Wear comfortable clothes when you go for the vaccine so that your arm is not tense. Tell your work place that you may take a day off if there is pain or fever and want to rest.
6. If anxiety is too much- try square breathing- Inhale 1-2-3-4, hold 1-2-3-4, exhale 1-2-3-4 and hold 1-2-3-4. Do this 5-6 times a day whenever you see anxious thoughts coming in
7. When you go to the vaccination centre maintain 6 feet distance, wear a good mask and sanitise, The nurse will keep you there for half an hour after the vaccine. If you get any doubts and feel you have fever or pain after the vaccine, keep a doctors phone number so that you can contact them.
8. Remember vaccine is a friend and is the nest way of tackling the current pandemic.

Doctors should guide a Covid-19 patient about how to look for its early signs. At the hospitals, doctors and nurses should check for the symptoms in patients being treated with steroids or other immunosuppressive agents.

Besides, it takes around 4 weeks for the steroids’ effect to wear off. So, it is important to keep oneself protected during this time. Patients should avoid visiting damp and dusty places for a few weeks post Covid recovery. If it is unavoidable, wear a three-ply mask, gloves, and fully cover your legs and arms. 

keep Covid-19 patients’ oxygen mask and canula sterile to prevent mucormycosis.

It is necessary to keep a regular check on water used in oxygenation for any possible contamination. 

Dr Arun Sharma, Director, NIIRNCD-ICMR and Community Medicine Expert

Yes, if detected early, it can be treated effectively with the anti-fungal drugs. In severe cases, however, to save the life of a patient, doctors may have to choose a more aggressive mode of treatment, including surgical removal of the part affected. It may require a multi-disciplinary approach involving specialists from internal medicine, microbiology, ophthalmology, ENT, neurology, pulmonology, dentistry, and reconstructive surgery to treat mucormycosis effectively depending on extent and severity of infection.

Besides, it is important to monitor and manage a patient’s blood sugar level and discontinue immunosuppressants. It is important to strictly follow the prescribed treatment for the prescribed duration to rule out the possibility of reoccurrence of the infection.

Dr Arun Sharma, Director, NIIRNCD-ICMR and Community Medicine Expert

It is generally affecting Covid-19 patients who are prescribed steroids or those who have uncontrolled diabetes. Though steroids are an effective treatment for some of the Covid-19 patients who develop severe inflammatory response. But steroids should always be given under medical supervision as if given too early, too muchandfor too long a duration, these can make one susceptible to catching secondary bacterial or fungal infections.

Dr Arun Sharma, Director, NIIRNCD-ICMR and Community Medicine Expert

Mucormycosis or black fungus infection is caused by a group of moulds known as mucormycetes, which are present in the air, water and moist surfaces around us, in damp places. It appears as black spots in the nasal cavity, mouth, throat. In a healthy person, the body’s immunity does not allow it cause infection. However, in an immunocompromised person this can cause severe infection. 

Dr Arun Sharma, Director, NIIRNCD-ICMR and Community Medicine Expert

Most cases of mucormycosis are treatable. And if we detect them early, the damage can be controlled. Drug Amphotericin B is highly effective.Its liposomal version allows doctors to give adequate doses over a relatively shorter duration than possible with conventional preparations of this drug, thereby helping control the infection early.

There are two other preparations: Posaconazole, which we have used as a stepdown drug after we control the infection with amphotericin; and Isavuconazole. The latter is a relatively newer drug, but initial information suggest that it is also a promising agent for treating mucormycosis.

Along with medications, surgical removal of the dead tissue is also strongly advocated.

Dr Nikhil Tandon, Professor and Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi

This fungus is present almost everywhere so, it is difficult to completely avoid the exposure.  However, one can limit it by avoiding going to damp and humid places, farms, and dusty construction sites.

Further, one should take all the precautions to protect oneself from catching Covid. Follow Covid-Appropriate Behaviour: wear masks, wash hands, avoid crowds, maintain physical distancing, and take the vaccine. If a person has diabetes, they must do everything to keep it under control. Another important point that we tend to forget is any infection can lead to an increase in blood sugar levels. Besides, steroids also can cause an increase in blood sugar levels.This aspect must be kept in mind by the patient and the treating team – periodic screening for blood sugar must be done in all patients with COVID, so that early treatment can be initiated as soon as the blood sugar shows a tendency to rise.

Dr Nikhil Tandon, Professor and Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi

Black Fungus is a term given by people. Mucoromycetes is not black coloured fungus. It is an invasive fungus; it invades smaller and bigger blood vessels, diminishes the blood supply to the tissues and kill them. The dead tissue looks black in colour. Mucormycosis , if not detected and treated, is potentially damaging. In immuno-suppressant individuals, it can cause lots of morbidity. For example, if it travels from the nose and sinuses towards the eye, it can damage the vision. If it travels into the brain, it could be fatal.

Dr Nikhil Tandon, Professor and Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi

Mucormycosis is a fungal disorder. Fungi are present extensively in our environment. If mucormycete spores enters the nostrils of a healthy human being, the body’s immunity fights off the infection and does not let the disease happen. But in people with compromised immunity, these spores, transform in to hyphae, invade and cause the disease. Prior to the COVID epidemic, the mucormycosis infection was observed in patients with uncontrolled diabetes, especially in an acute condition called  diabetes ketoacidosis, cancer patients,especially in those on chemotherapy, and individuals with HIV disease among others.

The current wave of mucormycosis, however, seems to be directly related to Covid-19 and is widely affecting people who have Covid or are recovering from it.

Three reasons that may have contributed to this sudden surge of mucormycosis cases are i) a large number of Covid-19 patients in a small duration of time, ii) new variants of SARS-Cov-2, and iii) concurrently uncontrolled diabetes in these Covid patients

Early data from AIIMS suggest that a significant number of patients currently being diagnosed with mucormycosis had uncontrolled diabetes. Over and above this, we have seen a significant increase in the use and misuse of steroid. Steroids though a preferred treatment for moderate to severe Covid-19 patients, have to be given at a specific time, for a pre-defined duration, and in pre-defined doses. Injudicious use of steroids, including by self-medication can do more harm than good. All these factors have led to the recent surge in the mucormycosis cases.   

Dr Nikhil Tandon, Professor and Head, Department of Endocrinology and Metabolism, AIIMS, New Delhi

Till last year, we were seeing only 9-10 per cent of overall cases of Covid-infected children but this year, we have seen a huge burst of paediatric patients getting infected. In fact, even new-borns getting infected. The symptoms in children being presented last year were cold, cough, breathlessness and fever but this time, we are seeing symptoms of diarrhoea, skin rashes, conjunctivitis and other kinds of miscellaneous presentations. 

The RTPCR, at the best, is approximately 67% to 83% sensitive and hence, it is not a foolproof test. Hence, we have to take a combined picture of clinical symptoms, lab values in case it is required and the RTPCR. 

When you see a child with such symptoms the first thing you need to do is isolate the child, get the test done on day 2 or day 3, which is RTPCR, and make sure that the child gets adequate treatment initially just for fever with paracetamol. Consult your local physician and do not start on any antibiotics and other combination drugs at home.

With regard to the vaccine, it is the most important health intervention, which is known to mankind and the only we can arrest the pandemic. The vaccination so far for the pediatric age group have not been licensed in India as yet but the clinical trials have been completed and the mRNA vaccine in the US and Canada are now being approved for below 15 years of age up to 12 and soon, it will be even for a lower age group beyond 6 months of age. 

Dr Sanjeev Bagai, Senior Consultant Paediatrician and Neonatologist and Paediatric Nephrologist

It is mostly safe to be administered the Covid  vaccine even when on anxiety drugs as prescribed by the psychiatrist. Still it shall be useful to discuss it with the treating psychiatrist before the vaccination. It is noteworthy that in case of high grade fever, disorientation or drowsiness post the vaccine, alongside the general physician the patient should consult one’s psychiatrist for needful. 

Dr Sameer Malhotra
Director, HOD, Department of Mental Health and Behavioural Sciences, Max Hospital, Saket and Panchsheel Park New Delhi

While a lot of people are doing exercises to keep their mind and body fit during the Covid time, it is advisable that just before the vaccine or soon after it, to not indulge in heavy load exercises. 

Dr Sameer Malhotra
Director, HOD, Department of Mental Health and Behavioural Sciences, Max Hospital, Saket and Panchsheel Park New Delhi

There have been a few reports of Cerebral Venous Sinus Thrombosis reported in patients post vaccination, but these are rare cases. Hence, it is thoroughly recommended that all patients go in for the vaccine, especially those in the high-risk groups. In fact, data from the UK, US and Israel has shown that there is considerable impact in curtailing the disease with most people being vaccinated in these countries. Answering the second query, yes a person with COPD (Chronic Obstructive Pulmonary Disease) is also recommended to take the vaccine. In fact people with COPD, much like people with high BP, diabetes or heart disease are at higher risk of dying from COVID. Hence, they are likely to benefit even more from the vaccine.

Dr Rajiv Agarwal
Senior Director Cardiology, Max Smart Super Speciality Hospital

Pfizer and Moderna have shared safety data on the vaccine that has been clinically tested on 94,000 women—frontline workers, pregnant women and women with comorbidities. However, Covishield and Covaxin have not done so. The Office of the Director Of Public Health and Preventive Medicine issued a circular on May 6, 2021, stating the ‘vaccines at present in use are contraindicated in pregnant and lactating mothers.” Moreover, the Serum Institute and Bharat Biotech also does not recommend such vaccination, the circular states. 

Dr Anjila Aneja,
Director obstetrics and gynaecology, Fortis la Femme GKII
Director and Head Minimal Access Surgery, Fortis Memorial Institute, Gurgaon