We caught Dr Sunil Gunness, cardiologist and head of the Cardiac Centre, between two consultations – or perhaps two heart surgeries. We met him at the Cardiac Centre, his pride and joy, an oasis in the middle of the desert of health care. He was more interested in talking about cardiology, the unit where he operates and the latest technology he hopes to introduce in the coming months – a revolutionary machine likely to save loads of lives. We took the opportunity to get his ideas on the topic we are more interested in – the coronavirus. And, as it happens, his interests and ours are rather related.

We first listened to him talk about the Extracorporeal Membrane Oxygenation (ECMO). Although we frankly were only mildly interested initially, his passionate way of talking about it intrigued us. And after listening to him, he managed to convince us that it is worth talking about. He even took the time to show us a video where a patient’s life had actually been saved – in the middle of the streets of Paris – through the ECMO.

OK. Tell us how this toy works. (A question we knew we would come to regret.)

It is a kit you can use in any hospital. It goes in the femoral vein and takes the place of the heart in pumping oxygen to the organs.

Don’t we have something similar in our hospitals already?

We have an intra-aortic balloon pump, but this is cumbersome and is just in the Intensive Care Unit. It cannot be taken out. We put it in for five or seven days until the heart is better but, with the ECMO, the heart can be put on hold for weeks and this can be performed anywhere.

Is your staff trained to use the ECMO?

We are going to send a team to be trained in Italy and, at the same time, a group from Italy will come to help us set it up. It should be operational by the end of March. We have been thinking about this for quite some time now. There have been many models and versions and we opted for one that can be used in our place. We don’t want something difficult to use, but a simple one that can save lives.

In what situations can the ECMO be used?

It can be any situation – a road accident, heart failure or any other situation where the heart needs a rest.

(We saw an opening to talk about what we had come to talk about: the coronavirus.)

So, if you had this machine today, and you had to deal with a case of the coronavirus, you would use it until the patient starts breathing normally again, wouldn’t you?

Exactly! That was what I was thinking.

(The rest was rather easy. As soon as we became engrossed in the topic of the coronavirus, there was no shortage of emotions.)

How does the coronavirus get one’s heart to stop? How does the disease go from a respiratory problem to death in some cases?

The coronavirus first attacks the respiratory system, and can lead to acute respiratory failure. When oxygen is not getting to the major organs, such as the heart, it can lead to failure and sudden death. Cardiac patients are more vulnerable. When there is less oxygen, there is increased likelihood of heart failure. Besides, some of them are on medication, which lowers their immune system and can cause the coronavirus to be more active and create more problems. It is a very aggressive virus.

Is it more aggressive than other viruses we have survived, like Ebola, for example?

Yes, it seems to be more aggressive. Two things are important to understand: one is how fast this virus will get into the body and attack the cells. The second is the incubation period. With the coronavirus, you get into respiratory distress very quickly. And the incubation period is very long. With the flu, for example, it’s four to five days. For the coronavirus, it seems the incubation period can be as long as 14 days. This means that, before you know the patient has been infected, they will have been in contact with hundreds of people and caused a lot of damage. So, one has to be extremely careful.

How can one be careful? Are masks effective?

Yes, because the virus doesn’t go through urine or blood, nor is it sexually transmitted. So, what you want to do is avoid contact and breathing in the droplets coming out of the mouth of an infected person when coughing. Without being alarmist, you should also avoid contact as much as possible. Social kissing and shaking hands are rather risky these days. And you should also avoid crowded places.

Like airports and aeroplanes? Is a plane a good place for the propagation of the virus?

Yes. It’s closed, people cough, you cannot open doors or windows and the temperature is lowered. All the ingredients for propagation are present. So, people should wear masks. In an ideal situation, it is the people coughing who should wear a mask, scarf or cloth over their mouths, not the others.

Should people restrict travelling?

Yes, if they can avoid travelling to countries where the virus has been detected, it would be a good thing. The virus is everywhere. The World Health Organization (WHO) has said it’s not an emergency as yet and it does not recommend travel restrictions but, if one can avoid travelling for, say, a holiday, it’s much better until the virus fades out.

How is that going to happen since there is no cure or vaccine and we don’t know how many people are infected?

I think it will be like it was for the severe acute respiratory syndrome (SARS) where cases start diminishing until they just stop. That’s the way it’s happened before and that’s the way the coronavirus is likely to go too.

How about food? Is there anything likely to help reduce the risk of catching the virus?

I personally think one should avoid eating meat during this period and eat as many vegetables as possible.

What is the connection?

If you eat meat that’s not well-cooked or you don’t know where it’s coming from, then that could be a problem. The virus started with eating meat.

It was bat meat, wasn’t it? Not any meat, surely?

It was probably bat meat but I also heard it was snake meat and many other types of meat. Undercooked or not well cooked meat is risky anyway. We have to avoid adventures. This virus started from animal to animal and then from animal to human, just as the Ebola virus did. Maybe we should learn from this. (Here, Dr. Gunness embarked on another one of his favourite subjects). Just imagine if we were all vegetarians. I am sure we would not have all these viruses. People now like to eat raw meat. I don’t think this is a good idea. Vegetables are safer.

With the amount of pesticides and other poisons in local produce, are they really much safer?

I agree with you. This is something we must take care of. I hope the ministries concerned take this seriously and impose the European standards, with controls and regular testing. Pesticides have been linked to cancer and that’s 100 per cent certain. Just like the big countries, we must start having standards. Another thing is to wash your hands and wash fruits and vegetables carefully. The virus can stay on fruit and vegetables for up to four hours, so you have to wash them carefully and peel them before eating. But I agree that food hygiene and strict control of the amount of pesticides in the food are needed. I was happy to hear that you can now get a food handler certificate by following a programme, and a few places around the island are already taking part in it. I would advise that this becomes mandatory. If you don’t have a certificate, you should not be allowed to handle food. I think that’s very important. Now that we have a system, we must use it.

There have been conflicting reports coming out of Wuhan – a mix of scaremongering and some false reassurances. Which do you believe? The people falling in the streets and dying instantly or the fact that the virus is well-contained and only 132 people have died so far?

I believe that some of those videos showing people falling and dying are completely fake. If I saw an old man having difficulty breathing and then collapsing, I could believe it. But when I see a video of a young man walking and then suddenly collapsing, I think that’s a show. Most of the time, the people falling and conspicuously dying are young and healthy-looking and, when they fall, they don’t seem to be in any respiratory distress. So, that looks more like acting. Now coming to the Chinese government, I don’t think they know precisely how many cases there are.

Couldn’t they be underplaying the severity of the virus for economic and social reasons?

Of course, they could be underplaying it. But I appreciate their bold decision to quarantine Wuhan. I also saw videos where they are constructing more quarantine rooms and a hospital is being built. We should learn from this.

Many international news channels are talking about a pandemic. Are we there yet?

The coronavirus has not reached pandemic proportions yet. At this stage, there are only sporadic cases. It is not a pandemic just yet.

Aren’t we heading in that direction?

In Mauritius, we have been lucky. We fought malaria back in 1978. Since that time, we have had an organisation in the Ministry of Health which is doing an excellent job monitoring the airport and the seaport. Three weeks ago, they were already on alert and started being more vigilant. They already have this well-organised structure and they are following WHO guidelines. They are doing the best they can. But then, even with the best, some cases can slip through.

Do you believe in the number of people affected in the world, which some estimate at 100,000?

I don’t think we have reached that number yet but, considering the virulence of the virus, we can easily get there. Also, very little is known about the virus at this stage. I was reading that, in Paris and China, they are doing a lot of research, and it’s going very fast. Let’s hope their work can steer us into safety.

(We avoided the attempt to go and talk about the ECMO again! We promised, however, to talk about it in more detail when it is fully operational sometime in March. By then, hopefully, the coronavirus will be something of the past.)

For more views and in-depth analysis of current issues, Weekly magazine (Price: Rs 25) or subscribe to Weekly for Rs110 a month. (Free delivery to your doorstep). Email us on: weekly@lexpress.mu