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New Delhi, May 15: A group of doctors from the AIIMS, Raipur has recommended restrictions on the use of mobile phones in healthcare institutions amid the COVID-19 pandemic, warning that such devices can be a potential carrier of the virus and lead to infection among healthcare workers.

In a commentary published in the BMJ Global Health journal, the doctors stated that mobile phone surfaces are a peculiar 'high-risk' surface, which can directly come in contact with the face or mouth, even if hands are properly washed and one study indicates that some healthcare workers use phones every 15 minutes to two hours.

Though there have been many significant guidelines from various health organisations like the WHO and CDC focusing on prevention and control of disease, the commentary highlighted "there is no mention of or focus on mobile phones in these guidelines, including the WHO infection control and prevention guidelines, which recommends the use of handwashing".

In healthcare facilities, phones are used to communicate with other health care workers, look up recent medical guidelines, research drug interactions, understand adverse events and side effects, conduct telemedicine appointments and track patients among others, stated the document.

The document has been authored by Dr Vineet Kumar Pathak, Dr Sunil Kumar Panigrahi, Dr M Mohan Kumar, Dr Utsav Raj and Dr Karpaga Priya P from the Department of Community and Family Medicine.

"In their tendency to come in direct contact with the face, nose or eyes in healthcare settings, mobile phones are perhaps second only to masks, caps or goggles," the authors said.

"However, they are neither disposable nor washable like these other three, thus warranting disinfection. Mobile phones can effectively negate hand hygiene... There is growing evidence that mobile phones are a potential vector for pathogenic organisms," they said.

It is the need of the hour to address proper hygienic use of mobile phones in healthcare settings. In a study in India, almost 100 per cent of health workers of a tertiary care hospital used mobile phones in the hospital, but only 10 per cent of them had at any time wiped their mobile phones clean, the commentary published on April 22 said.

"The safest thing to do is to consider your phone as an extension of your hand, so remember you are transferring whatever is on your phone to your hand," Dr Pathak said.

Amidst the ongoing pandemic, two biggest mobile phone companies have uploaded their user support guidelines, saying that 70 pc isopropyl alcohol or Clorox Disinfecting Wipes can be used to gently wipe the exterior surface of phones in switched-off mode.

However, in doing so, the use of bleach or entry of moisture through any of the openings must be avoided, and any harsh chemical may damage the oleophobic screen, leading to damage in the touch screen sensitivity of the phone, the article stated.

Mobile phones are one of the most highly touched surfaces according to the Centers for Disease Control and Prevention (CDC), along with counters, tabletops, doorknobs, bathroom fixtures, toilets, keyboards, tablets and bedside tables.

The doctors recommended restriction on mobile phone usage in healthcare settings like hospital wards, ICUs and operation theatres, while advocating the use of headphones to prevent contact with the face while talking.

There should be no sharing of mobile phones, headphones or headsets of any kind. In addition, where available, the use of interdepartmental intercom facility may be promoted.

"Although hand hygiene and mobile phone use by a person are not mutually exclusive, it is high time to acknowledge the potential role of mobile phones in disease transmission cascade and to take evidence-based appropriate actions. This is especially important, given the ongoing COVID-19 pandemic," the authors said.

They said it is necessary for government agencies and the WHO to generate public awareness and to formulate suitable information, education and communication material on mobile phone hygiene, especially in healthcare settings.

AIIMS, New Delhi, Resident Doctors' Association (RDA) General Secretary, Dr Srinivas Rajkumar T said even outside health care settings, people should pay special attention to the usage of mobile phones as they carry them to all places.

"Phone and computer peripherals like keyboard, mouse, etc. should be covered with transparent plastic covers which can be cleaned without interfering with their function. Cleaning hands by soap or alcohol-based hand sanitizer before and after contact with phone and between contact with other surfaces can decrease the risk of potential transmission.

"Using a handsfree headset, dedicated operator/assistant per ward handling the communication via common line in hospitals while on duty can enable communication without compromising safety," Dr Srinivas said.

From March through May, around 1 crore migrant workers fled India’s megacities, afraid to be unemployed, hungry and far from family during the world’s biggest anti-Covid-19 lockdown.

Now, as Asia’s third-largest economy slowly reopens, the effects of that massive relocation are rippling across the country. Urban industries don’t have enough workers to get back to capacity, and rural states worry that without the flow of remittances from the city, already poor families will be even worse off -- and a bigger strain on state coffers.

Meanwhile, migrant workers aren’t expected to return to the cities as long as the virus is spreading and work is uncertain. States are rolling out stimulus programs, but India’s economy is hurtling for its first contraction in more than 40 years, and without enough jobs, a volatile political climate gets more so.

“This will be a huge economic shock, especially for households of short-term, cyclical migrants, who tend to come from vulnerable, poor and low-caste and tribal backgrounds,” said Varun Aggarwal, a founder of India Migration Now, a research and advocacy group based in Mumbai.

In the first 15 days of India’s lockdown, domestic remittances dropped by 90%, according to Rishi Gupta, chief executive officer of Mumbai-based Fino Paytech Ltd., which operates the country’s biggest payments bank.

By the end of May, remittances were back to around 1750 rupees ($23), about half the pre-Covid average. Gupta’s not sure how soon it’ll fully recover. “Migrants are in no hurry to come back,” Gupta said. “They’re saying that they’re not thinking of going back at all.”

If workers stay in their home states long term, policymakers will have more than remittances to worry about. If consumption falls and the new surplus of labor drives wages down, Agarwal said, “there will also be a second-order shock to the local economy. Overall, not looking good.”

India announced a $277 billion stimulus package in May and followed it up with a $7 billion program aimed at creating jobs for 125 days for migrants in villages across 116 districts. Separately, local authorities are also looking for solutions.

Officials in Bihar have identified 2,500 acres of land that could be made available to investors, said Sushil Modi, deputy chief minister of Bihar, a state in east India. “We can use this crisis as an opportunity to speed up reforms,” he said.

The investors haven’t materialised yet, and in the meanwhile, state governments are relying on the national cash-for-work program that guarantees 100 days worth of wages per household.

Skilled workers don’t want to do manual labor offered through the program, and even if they did, says Amitabh Kundu of RIS, many think of it as beneath their station. “There will be an increase in social tensions,” he predicts. “Caste may again start playing a role. It’s absolute chaos.”

For skilled workers, initiatives vary:

* Uttar Pradesh, which received 3.2 million people, is compiling lists of skilled workers who need employment and trying to place them with local manufacturing and real estate industry associations. So far, the government says, it’s placed 300,000 people with construction and real estate firms.

* Bihar has placed returners in state-run infrastructure projects and hired others to stitch uniforms and make furniture for government-run schools, even as they waited in quarantine centres, said Pratyay Amrit, head of the state’s disaster management department.

* The eastern state of Odisha announced an urban wage employment program aimed at putting as many as 450,000 day labourers to work through September. Some 25,000 people have been employed, so far, under the scheme, G. Mathivathanan, principal secretary for housing and urban development said.

Attracting Investments

It’s not clear any of this will be enough to make a dent, says Ravi Srivastava, professor at New Delhi-based Institute of Human Development, adding that the states don’t have much of a track record on economic development.

“It was the failure of these states to improve governance and put development plans in place that led to the out-migration in the first place,” he said.

But officials and workers’ rights advocates see opportunity. Uttar Pradesh has established liaisons to encourage companies from the US, Japan and South Korea to establish manufacturing in the state. There and in Madhya Pradesh and Rajasthan, the government has made labour laws more friendly to employers, making it easier to hire and fire workers.

Modi, the minister from Bihar, said the migration may also give workers--historically a disenfranchised group--new power, particularly as urban centres struggle. “The way industries treated workers during the lockdown -- didn’t pay them, the living conditions were poor -- now these industries will realize the value of this force,” Modi said.

“In the days to come, labour will emerge as a force that can’t be ignored anymore,” he added. “That’s the new normal. We will work out how to ensure dignity, rights to our people who are going to work in other states.”

Bihar is due for elections by November, a vote that could be an early test of the mass migration’s political consequences. The state is currently governed by a coalition that includes Prime Minister Narendra Modi’s Bharatiya Janata Party. Amitabh Kundu, a fellow at the Research and Information System for Developing Countries, a New Delhi-based government think-tank, said migrant workers are likely to be angry voters.

“Chief ministers are telling these migrants that they will not have to go back for work,” he said. “But their capacity to do something miraculous in the next four to five months is doubtful. If they can retain even one-fourth of the migrants, I would call it a success.”

The Ministry of Health and Family Welfare has prepared a draft for guidelines for home quarantine, as well as for the use of masks by public, in view of coronavirus.

What to do in Home Quarantine?

The government says, for those taking refuge to home quarantine should stay in a well-ventilated single-room preferably with an attached or separate toilet. It adds that if another family member needs to stay in the same room, it's advisable to maintain a distance of at least 1 metre between the two.

The government advised, coronavirus patients to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household as their immune system may be low. The health minister also suggested to restrict the patient's movement within the house. "Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc, said the guideline.

It also instructed the corona virus infected person to avoid sharing household items like dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with others at home. The guideline also demanded that even though home quarantine, the patient should wear a surgical mask at all times. "The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused, it added.

"Masks used by patients/ caregivers/ close contacts during home care should be disinfected using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial," instructs the government.

Even for family members of a patient, the health ministry clearly instructs to use disposable gloves when cleaning the surfaces or handling soiled linen. No visitors, under any circumstances will be allowed, said the guideline.

"In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined (for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab testing," states the draft.

How to wear & dump masks?

There is a specific and elaborate do's and don'ts also released by the ministry. For those unsure in which mask to choose, it says, "Medical masks of different sizes and shapes are available in the market. The common ones are flat pleated masks of woven fabric which covers the nose and mouth and affixed behind the head with straps/ elastic fasteners. There are also conical or duck bill shaped masks with valves (or without valves) that fit in the contour of face over the nose and mouth, but are costlier."

However, the ministry warns, medical masks should not be used by healthy persons who are not having any symptoms "because it creates a false sense of security". Instead, it suggests to refrain from touching face, mouth, nose and eyes as well as washing hands regularly with soap for 20 seconds each time.

However, when a person develops a cough or fever, the suspected patient needs to switch to medical masks. "Use of medical three layer masks when ill, will prevent your infection from spreading to others. However you also need to wash your hands frequently to avoid spreading infection to others," read the guideline.

Even if one is not tested positive but showing symptoms, they are advised to wear masks while visiting a healthcare facility. "Close family contacts of such suspect/confirmed cases undergoing home care should also use Triple layer medical mask," it warns.

The ministry has also given point by point guideline on how to use a mask like to make sure that they are facing down while unfolding or for that matter to ensure there are no gaps on either side of the mask.

It even warns, "Fit flexible nose piece (a metallic strip that can easily be located) over nose-bridge" to ensure no one else are infected. The government also warns against simple dumping of the masks once used. Instead one should disinfect "using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1 per cent) and then disposed of either by burning or deep burial," says the Health Ministry.

COVID-19 emerged in early December 2019 in China's Wuhan province and has now spread to over 100 countries. As on March 9, 2020, India has reported 42 cases mostly among those who had travelled from affected countries.

However the government says, "It causes a minor illness in majority of patients with symptoms of fever and or cough. A small proportion of such persons may progress to severe disease with difficulty in breathing."