A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Outbreaks rarely begin with dramatic scenes or obvious warning signs. More often, they start quietly, a traveler returning home with a fever, a strange laboratory result, or a clinician sensing that something about a patient’s illness does not quite fit. Before the public even hears the name of a virus, epidemiologists and public health teams are already tracing patterns, reviewing histories, and searching for clues.

The recent hantavirus cases linked to travel in South America have once again highlighted how infections move silently through the spaces we often overlook between environmental disruption and human movement, between fragile ecosystems and overwhelmed healthcare systems. Reports suggest that several travelers associated with the expedition cruise ship MV Hondius, which visited regions including Patagonia, later developed suspected or confirmed hantavirus infections. Health authorities across multiple countries have since initiated surveillance, contact tracing, traveler monitoring, and precautionary advisories while investigations continue.

Hantavirus And Virus Spillovers

Understandably, news like this creates anxiety. For many people, the phrase “Emerging Virus” immediately brings back memories of COVID-19, overwhelmed hospitals, lockdowns, and uncertainty. But before fear spreads faster than facts, it is worth understanding what outbreaks like these are actually telling us.

Hantaviruses are not new. They have circulated in nature for decades, primarily among rodents. Humans are typically infected after inhaling aerosolized particles from rodent urine, saliva, or droppings, especially in enclosed or poorly ventilated areas such as cabins, storage spaces, campsites, or abandoned buildings. Unlike influenza or SARS-CoV-2, most hantaviruses do not spread efficiently between humans. However, certain strains, particularly the Andes virus found in South America, have demonstrated limited person-to-person transmission under specific conditions, which explains why health authorities are treating the current situation carefully.

This is not a moment for panic, but it is absolutely a moment for attention. One of the most unsettling realities about infectious diseases is how predictable the larger pattern has become. Years ago, while reading David Quammen's Spillover, I was struck by the idea that pandemics are not random interruptions to civilization, but ecological consequences of how humans live.

Deforestation, urban expansion, habitat destruction, climate shifts, wildlife intrusion, and increasing global travel all create opportunities for pathogens to cross into human populations. Viruses are not aggressively hunting us down in the dramatic way headlines often imply. More often, humans repeatedly place themselves in situations where spillover becomes easier.

The current hantavirus outbreak is therefore not just about one ship or one cluster of infections. It is also about changing rodent habitats, ecological imbalance, global mobility, and healthcare systems still recovering from years of strain after COVID-19. In today’s interconnected world, an infection emerging in one region can become an international public health concern within days.

Subtle Early Warning Signs

In infectious disease work, outbreaks often resemble cracks appearing in a wall long before collapse becomes visible. The outbreak itself is usually only the surface sign of deeper vulnerabilities underneath delayed surveillance, uneven diagnostics, exhausted healthcare workers, misinformation, political hesitation, ecological disruption, and public anxiety.

Laboratories frequently speak about signals. A single unusual test result may mean very little, or it may represent the earliest sign of a much larger problem quietly unfolding. The difficulty is that outbreaks rarely announce themselves clearly at the beginning. They whisper first.

A cluster of unexplained fevers. An unusual exposure history. A severe pneumonia case that does not behave as expected. A clinician calling the lab simply because something about a patient “Does not feel right.”

Symptoms People Should Watch For

For the public, awareness matters far more than panic. Early hantavirus symptoms can resemble many viral illnesses and may include fever, severe body aches, chills, headache, fatigue, nausea, vomiting, abdominal pain, and dizziness. In some patients, particularly those who develop hantavirus pulmonary syndrome, symptoms can rapidly progress to cough, chest tightness, breathlessness, and severe respiratory distress.

In critical cases, fluid accumulation in the lungs can become life-threatening and require intensive care. Anyone with recent travel to affected regions, rodent exposure, or unexplained febrile illness should seek medical evaluation early rather than dismiss symptoms or self-medicate.

At the same time, modern outbreaks involve more than viruses alone. Misinformation now spreads with remarkable speed during every emerging infectious event.

The Menace Of Misinformation

Social media quickly fills with recycled videos, conspiracy theories, fabricated warnings, miracle cures, and fear-driven speculation. Public trust can fracture rapidly when noise becomes louder than evidence. This is why reliable information from organizations such as the World Health Organization (WHO), National Centre for Disease Control (NCDC), Indian Council of Medical Research (ICMR), other national public health agencies, and verified infectious disease experts remains essential.

Countries like India understand this deeply because outbreaks carry memory. From Nipah and H1N1 to dengue surges, scrub typhus seasons, and COVID-19, healthcare systems have repeatedly faced waves of fear and exhaustion. Yet behind every containment effort are professionals whose work often remains invisible- doctors caring for critically ill patients while making difficult clinical decisions, microbiologists validating results late into the night, infection prevention teams tracing contacts, epidemiologists connecting patterns across regions, laboratory technicians processing endless samples, sanitation workers disinfecting dangerous spaces, and nurses continuing through exhaustion while reassuring frightened patients and staff. Public health survives not only through science but through human endurance.

Infectious diseases also force a certain humility upon modern medicine. Scientific progress has been extraordinary, yet microscopic organisms continue to reshape economies, politics, healthcare systems, and human behavior across the globe. Technology alone does not guarantee preparedness. Scientific capability must coexist with trust, equity, communication, and systems thinking.

As the world watches the hantavirus situation unfold, both panic and complacency should be avoided. Alarmism distorts understanding, but indifference delays action. Emerging infections are now part of the reality of a planet experiencing ecological and climatic strain. More spillovers will happen. More outbreaks will emerge. The important question is not whether humanity can eliminate every microbial threat. It cannot.

The Real Question Going Forward

The more important question is whether we can build systems capable of listening earlier, responding faster, communicating honestly, and protecting both people and ecosystems more responsibly. Because outbreaks rarely begin on the day the first case is confirmed. They begin much earlier, somewhere between a disturbed habitat, a rodent nest, a warming climate, a delayed diagnosis, an exhausted healthcare worker, and a society still learning how fragile the balance between humans and microbes truly is.

You open Instagram for "just five minutes". Forty-five minutes later, you look up — and you have forgotten why you picked up your phone in the first place.

If this sounds disturbingly familiar, you are not alone. Across India, neurologists are seeing something deeply concerning: a generation of young, otherwise healthy individuals who are struggling to recall names, lose their train of thought mid-sentence, and find sustained focus nearly impossible. Informally, it's being called "brain rot" — and it is no longer a meme. It is a medical reality.

"The brain is not designed for 300 micro-decisions per hour. When you doom-scroll, you are not relaxing — you are exhausting your prefrontal cortex."

Reels, shorts, and endless social media feeds are engineered to exploit the brain's dopamine reward system. Every swipe delivers a micro-burst of novelty. The hippocampus — our memory consolidation center — requires periods of quiet and depth to encode information properly.

Constant digital stimulation denies it that window. The result is shallow processing: we end up consuming huge amounts of content but actually retain very little of it. Over time, this rewires the brain's attention architecture and makes it difficult to focus on anything that does not provide instant gratification.

The concern is particularly acute for India's youth. Studies suggest Indian teenagers and young adults spend upwards of five to seven hours daily on screens — a figure that has accelerated dramatically post-pandemic. In my clinical practice, I am seeing a rising number of patients in their 20s and 30s presenting with complaints that were once associated with middle age: difficulty concentrating, poor short-term memory, mental fatigue, and disrupted sleep. Investigations reveal no structural pathology. The culprit, almost invariably, is digital overconsumption.

What Can You Do?

The good news: the brain is neuroplastic. Damage from digital overuse is largely reversible if addressed early. Begin with intentional digital detox windows — no screens for the first hour after waking and the last hour before sleep.

Practice deep reading, even fifteen minutes daily; it actively rebuilds attention span. Physical exercise, particularly aerobic activity, promotes neurogenesis in the hippocampus. And critically, reclaim boredom — allow your mind unstructured rest, because that is precisely when memory consolidation and creative thinking occur.

Doom-scrolling is not a harmless habit. It is a slow erosion of your cognitive sharpness. The algorithm does not care about your memory. You must. Protect your attention — it is the foundation of everything your brain does.

While salt is often blamed for high blood pressure, it is not the only factor contributing to those numbers. Many people carefully reduce salt intake yet continue to struggle with hypertension because several hidden causes often go unnoticed.

Understanding these triggers can help people take better control of their heart health before complications arise.

One major but overlooked reason is chronic stress. When the body stays under constant mental pressure, stress hormones like cortisol and adrenaline rise repeatedly. This causes blood vessels to tighten and the heart to work harder, gradually increasing blood pressure over time. Poor sleep also plays a significant role. People who sleep less than six hours regularly or suffer from conditions like sleep apnea may experience uncontrolled hypertension despite following a healthy diet.

Hormonal imbalance is another hidden culprit. Disorders of the thyroid or adrenal glands, as well as conditions like PCOS, can affect blood pressure regulation. In some individuals, high blood pressure may actually begin because of hormonal changes rather than lifestyle alone. This is why persistent hypertension should never be ignored or treated casually at home.

Certain medications can also cause a silent increase in blood pressure. Frequent use of painkillers, steroids, nasal decongestants, birth control pills, or even some herbal supplements may contribute to rising readings. Excessive caffeine, smoking, alcohol consumption, and a sedentary lifestyle further add to the risk.

Weight gain around the abdomen is particularly harmful because it increases resistance in blood vessels and affects how the body handles insulin. Similarly, unmanaged diabetes and high cholesterol damage arteries over time, making it harder for blood to flow normally.

Another commonly missed factor is dehydration. When the body lacks enough water, sodium concentration rises, forcing the heart to pump harder. Even low potassium intake from poor dietary habits can disturb the body’s blood pressure balance.

Why Regular Monitoring Is Important

High blood pressure is often called a “silent killer” because symptoms may not appear until serious complications develop.

Regular health check-ups, monitoring blood pressure at home, staying physically active, sleeping well, and identifying underlying medical conditions are equally important as reducing salt intake.

Managing hypertension requires looking at the complete picture, not just the salt shaker on the dining table.