<p>Dr Rajendra A Badwe is one of the world’s foremost cancer surgeons and research pioneers. The Director of Mumbai’s Tata Memorial Centre, India’s leading cancer institute, shares an optimistic perspective on the pandemic and offers advice for cancer patients for life after lockdown. India, he believes stands on a rock as compared to western nations.</p>.<p class="Question"><strong>How hopeful and afraid should we be at this point of time?</strong></p>.<p>Nobody fears a cold, cough or a running nose until they kill. In Wuhan, Iran, Europe and the US, the number of deaths hold significance rather than the number of cases revealed by the number of tests performed. One must consider the number of deaths per million population rather than per million patients. If out of say 5,000 that are diagnosed in a day or two, around 3,500 recover, it’s almost 95% without ventilators. We should hence take it in the right stride and try to continue our business maintaining all the precautions we are currently taking like masks, social distancing, thorough hand washing and never touching your own face (like during conjunctivitis). A small amount of exposure will allow<br />immunity to develop in society and we shall overcome it. The lockdown has achieved its goal. Along with precautions, there should be curbs on mass gatherings, eateries, and schools. However, if we stop treating other diseases, we will lose many more lives. A balance must be maintained.</p>.<p class="Question"><strong>Does temperature play a role in inhibiting the virus?</strong></p>.<p>I don’t really anticipate a peak during monsoon. Within six weeks all countries have peaked for cases as well as deaths and this could be ours. We are unlikely to reach a greater peak since there is a seasonal variation in flu which is maximum during the transition from summer to winter or vice versa. We are fortunate that Covid-19 entered India when winter was about to end. Temperature plays a role in Covid-19 deaths which have been attributed to arteriovenous thrombosis — small blood vessels being thrombosed in the lungs (affecting oxygenation) and multiple organs. According to the 17th edition of <span class="italic">Bailey & Love Textbook of Surgery</span>, arteriovenous thrombosis was virtually unknown in Singapore and the tropics but more prevalent with the appearance of snow and ice. There is a seasonal variation even in the anti-phospholipid antibody which rises during winter and has a direct relation with thrombosis anywhere. Covid-19 increased it further. The baseline of this antibody is low in India due to summer or proximity to equator. The rise is unlikely to have a great effect. Only a small percentage would go higher for it to become life-threatening. As we get deeper into summer, I am hopeful the deaths would reduce.</p>.<p class="Question"><strong>Do we have to live with Covid-19 permanently?</strong></p>.<p>Indians are probably exposed to a lot many viruses and possess innate herd immunity. Asymptomatic individuals would allow herd immunity to be achieved over a period of time. Rule of the thumb — do not talk to someone without a mask, nor will you talk to anyone without your mask on. This virus will evolve into herd immunity and cease to threaten us. A second wave is most unlikely and I feel, by the end of June to mid-July, things should get quite normal.</p>.<p class="Question"><strong>What precautions must cancer patients take in the months ahead?</strong></p>.<p>Cancer can be fatal if treatment is delayed. If a tumour is allowed to grow by 2 centimetres, it can increase the death rate by 20%, the doubling time being between 100-120 days. Why add to the country’s death rate?</p>.<p>Seek your treatment quickly so the chances of cancer reappearing is minimised.</p>.<p>Take the universally applicable precautions (same as above).</p>.<p>Those undergoing chemotherapy have low immunity and are at greater risk and must take even greater precautions — wear a mask, don’t talk to anyone without a mask, no interaction should last for more than ten minutes, maintain social distancing in public transport and maintain exceptional hand hygiene.</p>.<p>Six weeks after radiation and chemotherapy are over, the immune status would be back to normal.</p>.<p>There is some evidence that the old Ayurvedic remedy of storing water overnight in clean copper vessels, pouring it into a glass and drinking it with a lemon rind every morning, fights infections.</p>.<p>Drinking warm liquids, steam inhalations for running nose and warm water gargles prevents the throat’s temperature.</p>
<p>Dr Rajendra A Badwe is one of the world’s foremost cancer surgeons and research pioneers. The Director of Mumbai’s Tata Memorial Centre, India’s leading cancer institute, shares an optimistic perspective on the pandemic and offers advice for cancer patients for life after lockdown. India, he believes stands on a rock as compared to western nations.</p>.<p class="Question"><strong>How hopeful and afraid should we be at this point of time?</strong></p>.<p>Nobody fears a cold, cough or a running nose until they kill. In Wuhan, Iran, Europe and the US, the number of deaths hold significance rather than the number of cases revealed by the number of tests performed. One must consider the number of deaths per million population rather than per million patients. If out of say 5,000 that are diagnosed in a day or two, around 3,500 recover, it’s almost 95% without ventilators. We should hence take it in the right stride and try to continue our business maintaining all the precautions we are currently taking like masks, social distancing, thorough hand washing and never touching your own face (like during conjunctivitis). A small amount of exposure will allow<br />immunity to develop in society and we shall overcome it. The lockdown has achieved its goal. Along with precautions, there should be curbs on mass gatherings, eateries, and schools. However, if we stop treating other diseases, we will lose many more lives. A balance must be maintained.</p>.<p class="Question"><strong>Does temperature play a role in inhibiting the virus?</strong></p>.<p>I don’t really anticipate a peak during monsoon. Within six weeks all countries have peaked for cases as well as deaths and this could be ours. We are unlikely to reach a greater peak since there is a seasonal variation in flu which is maximum during the transition from summer to winter or vice versa. We are fortunate that Covid-19 entered India when winter was about to end. Temperature plays a role in Covid-19 deaths which have been attributed to arteriovenous thrombosis — small blood vessels being thrombosed in the lungs (affecting oxygenation) and multiple organs. According to the 17th edition of <span class="italic">Bailey & Love Textbook of Surgery</span>, arteriovenous thrombosis was virtually unknown in Singapore and the tropics but more prevalent with the appearance of snow and ice. There is a seasonal variation even in the anti-phospholipid antibody which rises during winter and has a direct relation with thrombosis anywhere. Covid-19 increased it further. The baseline of this antibody is low in India due to summer or proximity to equator. The rise is unlikely to have a great effect. Only a small percentage would go higher for it to become life-threatening. As we get deeper into summer, I am hopeful the deaths would reduce.</p>.<p class="Question"><strong>Do we have to live with Covid-19 permanently?</strong></p>.<p>Indians are probably exposed to a lot many viruses and possess innate herd immunity. Asymptomatic individuals would allow herd immunity to be achieved over a period of time. Rule of the thumb — do not talk to someone without a mask, nor will you talk to anyone without your mask on. This virus will evolve into herd immunity and cease to threaten us. A second wave is most unlikely and I feel, by the end of June to mid-July, things should get quite normal.</p>.<p class="Question"><strong>What precautions must cancer patients take in the months ahead?</strong></p>.<p>Cancer can be fatal if treatment is delayed. If a tumour is allowed to grow by 2 centimetres, it can increase the death rate by 20%, the doubling time being between 100-120 days. Why add to the country’s death rate?</p>.<p>Seek your treatment quickly so the chances of cancer reappearing is minimised.</p>.<p>Take the universally applicable precautions (same as above).</p>.<p>Those undergoing chemotherapy have low immunity and are at greater risk and must take even greater precautions — wear a mask, don’t talk to anyone without a mask, no interaction should last for more than ten minutes, maintain social distancing in public transport and maintain exceptional hand hygiene.</p>.<p>Six weeks after radiation and chemotherapy are over, the immune status would be back to normal.</p>.<p>There is some evidence that the old Ayurvedic remedy of storing water overnight in clean copper vessels, pouring it into a glass and drinking it with a lemon rind every morning, fights infections.</p>.<p>Drinking warm liquids, steam inhalations for running nose and warm water gargles prevents the throat’s temperature.</p>