Commentary: Winter weather in Kashmir poses new challenges in the fight against COVID-19

Arka Chakraborty and Kasturi Guha

 

Winters in Jammu and Kashmir are always the harshest, and yet the most beautiful in the Indian subcontinent. A 40-day-long (approximately) ‘Chillai Kalan’ (harshest days of winter) begins in the Valley from 21 December, followed by a 20-day-long (approx.) ‘Chilai Khurd’ (small cold) after which the winter finally comes to an end with the 10-day-long (approx.) ‘Chillai Bacha’ (baby cold). The beautiful and in some ways unique winter, however, brings with it a whole host of problems for people, one of them being annual health issues, both big and small. With the threat of COVID-19 still looming large, this winter the flu season is likely to get worse, researchers warn.

A list of health problems triggered by the cold weather in Kashmir

1. Common Cold: The common cold is a viral infection that occurs in both children and adults and can subside in 2-4 days. However, a long-lasting common cold might need medical attention. The symptoms are headache, burning sensation in eyes, chest congestion, sore throat, runny nose and low-grade fever.
2. Hypothermia: With prolonged exposure to cold temperature, an individual’s ability to generate body heat may become less than the rate of heat escaping his/her body. This physical state is called hypothermia or abnormally low body temperature. This condition affects the brain, making the victim unable to think clearly or move well. The most likely victims of this condition are the elderly with inadequate clothing or housing and infants. The symptoms for adults are: shivering, exhaustion, confusion, memory loss, slurred speech and drowsiness. The symptoms in infants are bright red, cold skin and very low energy.
3. Frostbite: Frostbite is an injury in a part of the body caused by freezing. Frostbite causes affected areas to lose feeling and colour, resulting in numbness. The chances of frostbite become high with people with reduced blood circulation and people who are not properly dressed for the extreme cold weather.
4. Flu: Flu is a type of respiratory infection spread by various strands of the influenza virus. Every year, around 25% of J&K’s populace is infected by the flu. In each 2-3 years, there is a spike in the flu which can infect twice as many people as the usual number. Flu can affect people for 1-2 weeks but have the potential of developing into complications that are harder to cure.

The flu is a contagious disease which can spread (i) from person to person through airborne respiratory droplets injected into the air when an infected person coughs or sneezes and (ii) from an inanimate surface containing the influenza virus to a person through touch.

Various types of influenza viruses can produce various types of flu that are dangerous to humans in various degrees. Among these, the type A influenza virus is the most dangerous. Various strands of the same type can affect various species. Sometimes, strands affecting two different species can combine and produce a new strand that can create epidemics (ex. The Avian flu and the Swine flu).  

Symptoms of the flu include- headaches, chills, cough (initial), fever, loss of appetite, muscle ache (advanced) and nausea, vomiting, diarrhea (more common in children than adults).

The most common complications that can arise out of the flu are secondary bacterial infections of the sinuses or lungs (pneumonia).

5. Pneumonia: This is an inflammatory condition of the lungs primarily affecting small air sacs known as the alveoli. Symptoms include productive or dry cough, fever, chest pain and difficulty breathing as well as the production or green, yellow or brown sputum.
6. Bronchiolitis: Bronchiolitis is an infection of the respiratory tract caused by the Respiratory Syncytial Virus (RSv). Initially, the symptoms resemble those of the common cold or flu. However, as the infection progresses, the symptoms become more severe. The symptoms are, as follows: nasal congestion, low to high-grade fever, cough, difficulty in breathing, wheezing and dehydration.
7. Strep Throat: This is a more intense form of a sore throat caused by a bacterial infection, common among children. The symptoms include sore throat, pain in throat, difficulty in swallowing, fever, headache, swollen lymph nodes, nausea and vomiting.
8. Norovirus: Also known as the winter vomiting bug, the norovirus is an infectious virus that can affect people of all ages throughout the year, but becomes more common during the winter. Symptoms are, as follows: nausea, vomiting, diarrhea, stomach pain, fever and chills.
9. Kangri Cancer: This rather unique form of skin disease gets its name from the earthen pot ‘Kangri’ that Kashmiris, until recent years, used in high quantities in the winter months to generate heat. Extended exposure of unprotected skin to this heat results in Kangri cancer, a skin disease that can prove to be fatal in most cases. Recent changes in lifestyle and the replacement of Kangri with electronic heating appliances have drastically reduced this disease in the valley, but there are still about 5-10 cases recorded every year, mostly from the remote regions. The elderly without adequate clothing to protect themselves from the direct heat of the Kangri are most susceptible to this deadly disease.
10. Joint pain: Joint pain is a fairly common winter phenomenon that affects mostly the elderly but can and does affect people of all ages. This condition influences and heavily impairs a person’s lifestyle is not the only kind of pain that increases during winter: muscular pains, backaches, headaches, neck pain, nerve pain, fibromyalgia also increase during this time.
11. Novel coronavirus or COVID-19: This is a new disease that has caused a worldwide pandemic, killing millions. The coronavirus disease 2019 is a contagious respiratory and vascular disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Also known as 2019-nCoV acute respiratory disease, the disease can be asymptomatic or symptomatic. In the case of the latter, the symptoms are- fever, cough, fatigue, shortness of breath, loss of taste, or smell. As of now, no vaccine for this has reached the public, so preventive measures are currently the only way to combat this disease.

These are some of the many diseases that can strike the Valley this winter.

The uniqueness of a potential health crisis in winter 2020-2021

Every year the people of Kashmir have to deal with an array of ailments as the mercury plunges throughout the winter months. The reason behind this, according to Dr. Masood Hussain, is the direct effect that the changing temperature has on the body. As soon as temperatures start to drop, the process of being accustomed to the new weather begins which lowers the body’s immunity system. This makes the body more vulnerable to viruses and bacteria.

However, the unprecedented health crisis that the novel coronavirus or COVID-19 pandemic has posed to the world is most likely going to present an equally unprecedented challenge to J&K’s health infrastructure. Experts across the world have predicted a second wave of coronavirus triggered by the winter and Kashmir faces the same danger. Citing a study done at the University of Sydney, Dr. Nisar-ul-Hassan, President of the Doctors’ Association Kashmir (DAK) and an influenza expert, opined that the upsurge in the pandemic during winter will be caused by principally the loss of humidity which will allow infectious droplets produced from an infected person’s mouth due to talking or sneezing to survive longer, thereby increasing their exposure to people. The Sydney study estimates that every 1% drop in humidity could result in 6% rise in the number of COVID-19 cases. As coronavirus is a respiratory virus, like others of its kind it is also more likely to thrive during cold weather conditions. Winter is also the time when people tend to stay indoors where there is little ventilation which increases the chances of infection.

The flu is a common disease in Kashmir which experiences a great upsurge every year. This disease and COVID-19 have remarkably similar symptoms. One medical professional has expressed the concern that as flu strikes Kashmir this year, doctors might face difficulty in differentiating between the two diseases which can very well lead to disaster.

Preventive measures to be taken to avoid illness

Every illness mentioned above is unique and it goes without saying that, when contracted, professional medical attention is highly advisable. That said, prevention is always better than cure. Here are a few general guidelines to reduce the chances of getting infected this winter.

1. Drink sufficient liquids: Drinking a sufficient amount of liquids during winter is advisable to stay hydrated, fight winter weight gain, improve skin quality and immune system. However, common favourites like tea and coffee should not be preferred as these tend to draw water away from the body. Rather, a daily intake of the equivalent of eight glasses of water is advised.
2. Regular exercise: A daily 20-minute regimen of physical activity helps in maintaining healthy body weight, keeping optimum physical mobility and keeping a healthy blood circulation level. This also has the added advantage of reducing and preventing joint pain.
3. A minimum of eight hours of sleep: Sleep deprivation can result in the damaging of the immune system and reduced energy levels. Therefore, a minimum of eight hours of sleep is recommended. A healthy sleep schedule also helps in managing one’s hunger level and retaining memory.
4. Regular Handwashing: Regularly washing one’s hands is the best way to avoid communicable diseases like the flu and COVID-19. Therefore, washing one’s hands before eating or touching one’s face is of utmost importance, especially this winter,
5. Wearing face masks: Wearing face masks, like washing one’s hands, is one of the most simple yet effective ways of combating communicable diseases like the flu and the COVID-19 virus. Therefore, like the rest of the year, wearing masks in public and maintaining social distancing are of primary importance. The fact that the peak of the corona infection has apparently passed should not be the cause of complacency.
6. Dietary adjustments: What we choose to eat will contribute greatly to determining our bodies’ responses to natural adversities. Therefore, it is high time to start monitoring our dietary habits. Omega 3 fatty acid commonly found in fish, plant seeds and nuts help to lower levels of joint pains, stiffness and depression. Soluble fiber found in apples, fruits and nuts help in decreasing inflammation, boosting immune system function, reduce cholesterol levels in the body and gives protection against diabetes. Plenty of green and orange vegetables should also be consumed to get healthy nutrients, sugars and fats.
7. Child care: As children, especially those below 5 years of age, are most vulnerable to winter-related ailments and their complications. Therefore, children must be specially cared for in this situation. Dr. Masood Hussain opines that children’s chests must be covered and they should be given warm drinks in order to avoid pneumonia. Child specialist Dr. Gavinder Jit Singh, however, advises parents not to ‘overheat’ their children by making them wear just sweaters and warm clothes.
8. Limit exposure: As prolonged exposure to cold temperatures can lead to various kinds of ailments mentioned above, according to a cold-weather advisory issued by DH Baramulla, individuals should cover themselves with warm, dry, loose-fitting clothes. However, as sweating can drain body heat quickly, it is advised that one remove extra layers of clothing whenever it becomes too warm for them. Staying indoors while keeping adequate ventilation is advised. Homeless people during winters should be granted shelter.
9. Keep emergency supplies at hand: Emergency supplies should be kept close both in home and office situations to cope with fluctuating winter temperatures.
10. Avoid Exertion: As exertion of the body during winter places a heavy strain on the heart, Moreover, a lot of energy during winter is used to keep the body warm. Therefore, the exertion of the body by doing heavy outdoor chores should be avoided. If unavoidable, these should be done while wearing warm clothes and work should be done slowly.
11. Avoid Wind Chill: Windchill is the temperature the body feels when the air temperature is combined with the wind speed. As the wind speed increases, cool air can take away body heat from exposed skin pretty quickly. Therefore, avoiding wind chill is highly advised.
12. Ayurvedic methods to stay healthy during winter: According to Ayurveda, there are three major body types depending on the condition of three biological humors or doshas– vata. Pitta and kapha. Winter is the season when kapha accumulates. It is also in winter when our digestive power i.e. agni increases. Eating too lightly, therefore, might result in body tissues breaking down and vata getting out of control. Therefore, the dietary advice mentioned in the Ayurveda are mainly vata-reducing measures. Warm and nourishing foods, dairy products, almonds, nuts and soaked fruits should be favoured. Raw foods, salads, all kinds of cabbage and dry foods should be reduced. Warm drinks should be preferred over ice-cold drinks. Regular sipping of hot water simmered for about 15 minutes is highly recommended. Along with regular exercise, morning oil massage and evening warm foot baths are recommended for controlling vata.

The role of housing infrastructure in aggravating/reducing winter diseases

The increase in COVID-19 cases has called into question the rationality of Kashmiri housing infrastructure and social behavior. An unplanned, damp house can very well aggravate the chances for people living in it to get infected. Sameer Maither, director of New Delhi-based research and advisory firm Greentech Knowledge Solutions opines that houses should be heated with minimum use of air conditioners and a well-insulated house can provide for that natural heating, Windows should be strategically located to bring in solar energy. Windows should be double-glazed to provide insulation and should be tightly fitted to prevent cold air from coming inside. Houses and hospitals should be well-ventilated to reduce the chances of infection.

Saleem Beg, regional head of Indian National Trust for Art and Cultural Heritage (INTACH) calls for judicial adoption of traditional, organically designed housing infrastructure to realize a healthier living environment.

Conclusion

The Union Territory administration has said that it is taking the warnings, issued by the experts, very seriously and are prepared to face the COVID surge this winter, However, the healthcare infrastructure of J&K has a number of weaknesses, the principal being the lack of adequate private hospitals. According to the Indian Public Health Standards (IPHS) norms, J&K still requires 69 community Health Centres, 222 Primary Health Centres and 1396 sub-centers. DAK President Dr. Nisal-ul-Hassan agrees that the hospitals should be prepared for a COVID upsurge by increasing the number of beds, specialised facilities and ventilation. While it remains to be seen how the administration handles this new winter challenge, it is undeniable that the general populace has to behave responsibly in order to keep themselves out of harm’s way. Hygienic practices as well as adherence to COVID-specific guidelines might prove to be the strongest weapons against winter ailments, both familiar and novel. Popularizing these practices is the responsibility of both the government and educated and socially responsible citizens.

 

References

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Know what flu is and if you need a vaccine shot before winter sets in Kashmir

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