Still, people have not realised the importance of wearing a proper mask

Coming from AFMC, Dr (Major) Rajesh Bhardwaj is a highly experienced and trained ENT specialist with over three decades of experience. He has been associated with various prestigious hospitals in South Delhi including Sitaram Bhartia Institute, Max Med Centre and is currently a practising doctor at Indian Spinal Injuries Centre. In a candid conversation with BK Jha, Executive Editor, Impact Health, Dr Bhardwaj spoke about Response to COVID-19 crisis with special reference to ENT, tobacco menace, deafness, and other critical issues. Excerpts: 

 We are passing through an unprecedented health crisis- Covid-19. Management and treatment of Covid-19 involve a multi-disciplinary approach. Being an ENT specialist, how do you see our response to the disease from ENT point of view?

We have learnt over a period of time that the primary source of infection is through nose and throat. It is observed that before the virus is detected, the infected persons lose their taste and smell. Clinically, this is known as anosmia (loss of taste and smell) and it is very important to create awareness about wearing proper masks to prevent the disease. Western countries did some studies to find out effective of lockdown versus wearing masks in public for protection. It was found that wearing of masks was equally effective or even better than the option of lockdown. If we would have understood the importance of mask initially, lockdown could have been avoided. We need to make people understand that initially, the virus passes through the nose and throat. It is a milder sign as the virus has not gone deep into the body. Hence, primary treatment begins at ENT itself. 

ENT is the gateway for the virus. Do you think we are doing enough for preventing the virus? If not what extra measures we need to take for preventing it?

As you rightly pointed out that ENT is the gateway of the virus. So we need to cover our nose and mouth to safeguard ourselves. The most important measures are to wear a proper mask when we are out. Keep physical distance and wash our hands frequently. These are three very critical steps we need to take seriously as the virus is around us, it has not gone. The government has been emphasising and advisories have been issued. However, still, people have not realised the importance of wearing a proper mask. Both government and community need to work more to make people realise its importance. The government has issued advisory to wear N-95 mask with valve. Actually with Valve mask, while someone is speaking with, there is less chance of transmission, but somebody is coughing or sneezing, he or she is keeping safe but making people around vulnerable. Hence, it is very important to wear the right kind of mask. 

What are the main diseases associated with ENT? Are children more prone to them?

Allergies are a major concern now and they are closely connected with ENT. More than 50 per cent of paediatric problems are related to ENT. There is a very simple reason for that. It is all about immunity. Till two years, children get immunity from their mother’s milk. Till that age child gets immunity from breast milk and remains safe. After that, they are going outside and get exposed to adults and the environment. Here children develop immunity and also get infections which mainly comes from nose and throat. 

Cold and sour throats are main problems and children come up with these ailments to ENT or Paediatrics department. With vaccination, we have protected our children from various diseases. As immunity develops there are fewer chances of getting those diseases such as Pneumonia, loose motion after vaccination. But now because of environmental and other reasons, children are exposed to several allergies which were not there 20 years ago. There are new diseases affecting children. Earlier one out of 10 children was affected by Asthma but now three out of 10 will have some kind of allergies. We have not heard about gluten, wheat, nut or egg allergies 20 years back. But now these new diseases are around. 

Awareness is the key as India faces a high burden of congenital disorders afflicting the children and other ENT related disorders. You have been involved in creating awareness. Do you think more need to be done at community and government levels? 

Apart from that the children’s problems with allergies, Indian are the highest tobacco users in the world. More disturbingly, in India non-smoking forms of tobacco-such Gutkha, Khaini etc are very popular among community level and smoking along with other tobacco products cause cancers of lung, throat, mouth and other life-threatening diseases. Indians are very prone to develop cancers and cardiovascular diseases. Tobacco consumption is a serious concern. The government needs to widen the scope of its advisories. Schools need to be a focal point. What I feel is there is an urgent need to focus on awareness at the school level. Earlier students used to get introduced to smoking at the college level but now students of class 9 or 10 are getting addicted to smoking and other forms of tobacco. This is a serious concern as the majority of the smoking habit is coming from schools. So we have to start a smoking free tobacco campaign in schools. The government needs to adopt all means to discourage consumption of tobacco in the country.

How do you see ENT in our Population Health Management? Do you think all stakeholders including the government have been collaborating to provide quality and affordable care to people suffering from ENT problems?

Invisible disability- Deafness is more serious as compared to blindness. As Helen Keller said that blindness keeps you away from things but deafness keeps you away from people. Hence deafness needs more serious attention. Hearing loss results from several reasons and we need to create awareness of the fact that affected persons should do not ignore your hearing loss or deafness. There are treatments, hence visit doctors. We have a national programme to deal with deafness but it needs to be energised. All stakeholders need to come together to re-energise national initiative such as ‘Shravan Shakti Abhiyan’ which was started for the cause of hearing-impaired people. We hope that the government would consider our recommendations to energise the national programme. 

 What would advice for a healthy life

Only three tips – Eat nutritious food, do regular exercise and have adequate sleep. You do not need anything more to lead a normal, active and healthy life.