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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.

UN, May 26: Countries could see a "second peak" of coronavirus cases during the first wave of the pandemic if lockdown restrictions were lifted too soon, the World Health Organization (WHO) has warned.

Mike Ryan, the WHO's head of emergencies, told a briefing on Monday that the world was "right in the middle of the first wave", the BBC reported.

He said because the disease was "still on the way up", countries need to be aware that "the disease can jump up at any time".

"We cannot make assumptions that just because the disease is on the way down now that it's going to keep going down," Ryan said.

There would be a number of months to prepare for a second peak, he added.

The stark warning comes as countries around the world start to gradually ease lockdown restrictions, allowing shops to reopen and larger groups of people to gather.

Experts have said that without a vaccine to give people immunity, infections could increase again when social-distancing measures are relaxed.

Ryan said countries where cases are declining should be using this time to develop effective trace-and-test regimes to "ensure that we continue on a downwards trajectory and we don't have an immediate second peak".

Also on Monday, Tedros Adhanom Ghebreyesus, WHO Director-General, said that a clinical trial of hydroxychloroquine (HCQ) on COVID-19 patients has come to "a temporary pause", while the safety data of the the anti-malaria drug was being reviewed.

According to the WHO chief, The Lancet medical journal on May 22 had published an observational study on HCQ and chloroquine and its effects on COVID-19 patients that have been hospitalized, reports Xinhua news agency.

The authors of the study reported that among patients receiving the drug, when used alone or with a macrolide, they estimated a higher mortality rate.

"The Executive Group of the Solidarity Trial, representing 10 of the participating countries, met on Saturday (May 23) and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally," Tedros said in a virtual press conference.

The developments come as the total number of global COVID-19 cases has increased to 5,508,904, with 346,508 deaths, according to the Johns Hopkins University.

New Delhi, May 26: With India now in the bracket of top 10 nations worst hit by the novel coronavirus, experts have attributed the surge in cases to easing of travel restrictions and movement of migrants besides enhanced testing capacity.

According to AIIMS Director, Randeep Guleria, the present rise in cases has been reported predominantly from hotspot areas but there is a possibility of further rise in the number of COVID-19 cases in the coming few days due to increased travel.

"Those who are asymptomatic or are in presymptomatic stage will pass through screening mechanisms and may reach areas where there have been minimal or less cases," Guleria said.

He said there was a need for more intense surveillance and monitoring in areas where migrants have returned to contain the spread of the disease.

If proper social distancing and hand hygiene is not maintained at a time when people are out on roads, the coronavirus infection will transmit much faster, he said.

Guleria also noted that testing capacity has been significantly ramped up which is reflecting in the increasing number of cases being detected.

Commenting on the partial resumption of rail and road transport services and migrants returning to their native places, Dr Chandrakant S Pandav, former president of the Indian Public Health Association and Indian Association of Preventive and social medicine, said the floodgates have been opened.

"This is a classic case of creating an enabling environment for coronavirus to spread like wildfire. In the coming few days, the number will rise dramatically. While it is true that lockdown cannot go on forever, the opening up should have been in a measured, calibrated and informed manner," he said.

"Travelling leads to spread of the infection. Now, the government will have to ensure even stronger surveillance to curb the infection but if that will be done is something to be observed," he said.

The death toll due to COVID-19 rose to 4,167 and the number of cases climbed to 1, 45,380 in the country, registering an increase of 146 deaths and 6,535 cases since Monday 8 am, according to the Union Health Ministry.

Dr K K Aggarwal, President of the Confederation of Medical Association of Asia and Oceania (CMAAO), and former IMA President, said there will be a further surge in cases in the coming days if migration continues without any proper social distancing.

"Within the next ten days, the cases will cross two lakh. The very fact that number of cases was rising before the end of the third lockdown and continuing during the fourth lockdown means that people are not following physical distancing as required," he said.

"Even in the last week of May when the temperature is very high, the rising number of cases would mean that human-to-human transmission is more important than surface-to-human transmission. Normally in heat the surface-to-human transmission should have reduced the new cases by half which has not happened," Aggarwal said.

However, Professor K Srinath Reddy, president of the Public Health Foundation of India, said an increase in the number of cases reflects both an increase in testing rates and an increase in spread.

"What we need to see is the number of new tests performed per day and the number of new cases that were identified from them. That gives a better idea of the rate of spread than the total number of new cases alone.

"We also have to see if the testing criteria has remained the same between the two periods of comparison.We may open up gradually but will have to continue case detection, contact tracing and follow personal protection measures as vigorously as possible," he added.

A total of 31,26,119 samples have been tested as on May 26, 9 am and 92,528 samples have been tested in the last 24 hours, ICMR officials said.

India is the tenth most affected nation by the pandemic after the US, Russia, UK, Spain, Italy, Brazil, Germany, Turkey and France, as per the John Hopkins University data.

The country has recorded 6,088, 6,654, 6,767 and 6977 cases on May 22, 23, 24 and 25 respectively. Also, the number of RT-PCR tests for detection of COVID-19 in the country crossed the 30-lakh mark on Monday.

The first two phases of the lockdown led to 14-29 lakh COVID-19 cases being averted, while the number of lives saved in that period was between 37,000 and 78,000, the government said last Friday, citing various studies, and asserted that the unprecedented shutdown has paid "rich dividends" in the fight against the pandemic.