CMAAO CORONA FACTS and MYTH BUSTER 85

CMAAO CORONA FACTS and MYTH BUSTER 85

Dr K K Aggarwal

President Confederation of Medical Associations of Asia and Oceania, HCFI, Past National President IMA, Chief Editor Medtalks

With inputs from Dr Monica Vasudeva

791: Why sudden deaths after cure

In one of the countries amongst 200 people who was suffering from coronavirus 20 died days after discharge. In the post-mortem it was found that the active virus was still present in their body.  We all know that virus can remain active in the nasal cavity for upto 28 days and in the stools for 3 months. Once the RT PCR is negative, it does not mean that the virus has gone as RT PCR can have 33% false negative in the first test and 15 to 20 % false negative with the second test. Also if the second sample is not a lower respiratory tract sample the false negative rates are higher.

Therefore the dictum is  that positive cases undergoes  14 days of isolation followed by 14 daus of quarantine and another 14 days of monitoring.

10% of these cases develop heart involvement and these are the cases which can have sudden death even after discharge. The classical example is the Italian doctor who died after discharge because of a heart attack in Jaipur.

False dawn’ recovery haunts virus survivors who fall sick again

After a month Mirabai Nicholson-McKellar the 35-year-old filmmaker who was infected with the coronavirus, developed shortness of breath followed by chest pains. A visit to the emergency room and a second test for Covid-19 gave another positive result. Just three days earlier, she’d been cleared by health authorities in Australia’s New South Wales state and was allowed to end her home quarantine after going 72 hours without symptoms.

Her experience adds to a growing number of reports of patients appearing to have a reactivation of symptoms, testing positive again, or even potentially being reinfected. Such incidents don’t align with the generally accepted understanding of how virus infections work and spread. This is called false-dawn phenomenon.

Why symptoms seem to re-emerge in some people, and whether they experience reinfection or if the virus persists for weeks. One possibility is that Covid-19 causes blood clots that may cause potentially dangerous complications unless treated with anticoagulant medications, said Edwin J.R. van Beek, chair of clinical radiology at the University of Edinburgh’s Queens Medical Research Institute.

 South Korean researchers also offered some clues this week when they reported that so-called nucleic acid tests might be positive based on the detection of dead viral particles that could give the false impression that a patient is still infectious when they’re not.

793: Why people are leaving from one state to another

When we talked to people who are leaving Delhi to go to their native places they said they know that the restriction of lockdown are easing down but to maintain a social distance of 3 feet they will have to vacate their residence where they are sharing a single room with 10 other people and also the place where they work social distancing will not be possible unless they lay off 30 to 40% of the people. Therefore, the only answer for dam is to go back from Delhi

794: is it ok to raise cess on alcohol

Delhi government decision of putting cess on alcohol and extra GST of petrol and kerosene is not understandable. The reason given is to maintain social distancing and recover the losses they must increase the cess so that less people buy. But this would mean that all sectors of the society which have lost money in the lockdown are free to increase their charges. If private medical establishments were adding PPE charges, I could have understood but not the government.

Putting an extra GST and increasing the charges of petrol and diesel does not make any sense and will not be taken up in a good paste by the community as all over the world the charfes are going down.

795: India in top 5

The number of new cases in India in last one day were approximately 4000. With this India comes in the top 5 countries having largest number of cases on a single day. USA tops the list with 24000, Russia is second with 10000 and Brazil third with 7000 cases. India share this number with UK, both with approximately 4000 new cases in one day.

796:  Sudden rise a concern

Sudden rise of cases at the end of the lockdown is a matter of concern. On an average it takes 5.2 days for symptoms to manifest. This would mean these cases have acquired the infection atleast five days before the lockdown was eased out. The actual rise if any, because of the lock down release will be evident only after another five to seven days.

797:  India is missing the cases

Time to Death is 14 days

Death Rate = Number of deaths today/ Number of cases 14 days back

Deaths on 4^th May 1566, number of cases on 20^th 1239: death rate 6%

15% of serious patients will die

Number of deaths on a given day x 85 = number of serious patients 14 days before 

Number of deaths 100 today would mean 666 serious cases 14 days before

On 20^th we should have had 666 serious cases

For every 100 cases 15% would be serious cases

No of actual expected cases on 20^th:  4440

Actual cases: 1239

Cases Missed: 3201 > 75%

>90% of people are symptomatic within 2 weeks of infection, with fatalities occurring on average 2 weeks after that

	Daily new cases	New Deaths	Total cases	Total Deaths
20	1239	42	18539	559
21	1251	40	20080	592
22	1500	43	21370	681
23	1456	45	23039	721
24	1638	48	24447	780
25	1617	54	26283	825
26	1668	53	27890	881
27	1680	61	29451	939
28	1724	66	31324	1008
29	1804	71	33062	1079
30	1978	75	34863	1154
1	2212	81	37257	1223
2	2547	79	39699	1323
3	3062	68	42505	1391
4	3932	175	46437	1566

798: WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF

A bit of death is the unavoidable price of economic revitalization. Georgia’s Republican governor, Brian Kemp, has already reopened his state, despite a severe outbreak. The lockdowns can’t last forever.

799: COVID Dermatology

Two case reports published simultaneously in JAMA Dermatology prompted an accompanying editorial calling for dermatologists to actively participate in the characterization and management of skin complications associated with COVID-19 infection.

800:  CDC 10 Clinical Tips on COVID-19 for Healthcare Providers Involved in Patient Care

Treatment and Prophylaxis

1.     The NIH has developed guidance on treatment, which will be regularly updated as new evidence on the safety and efficacy of drugs and therapeutics emerges from clinical trials and research publications.

2.     There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to COVID-19.

Symptoms and Diagnosis

3.     Non-respiratory symptoms of COVID-19 – such as gastrointestinal (e.g., nausea, diarrhea) or neurologic symptoms (e.g., anosmia, ageusia, headache) – might appear before fever and lower respiratory tract symptoms (e.g., cough and shortness of breath).

4.     Children with COVID-19 may have fever and cough at symptom onset as often as adult patients. Although most children with COVID-19 have not had severe illness, clinicians should maintain a high index of suspicion for SARS-CoV-2 infection in children, particularly infants and children with underlying conditions.

5.     CT scans should not be used to screen for COVID-19 or as a first-line test to diagnose COVID-19. CT should be used sparingly, reserved for hospitalized, symptomatic patients with specific clinical indications for CT.

Co-Infections

6.     Patients can be infected with more than one virus at the same time. Coinfections with other respiratory viruses in people with COVID-19 have been reported. Therefore, identifying infection with one respiratory virus does not exclude SARS-CoV-2 virus infection.

7.     Several patients with COVID-19 have been reported presenting with concurrent community-acquired bacterial pneumonia. Decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection (community-acquired or hospital-acquired), illness severity, and antimicrobial stewardship issues.

Severe Illness

8.     Clinicians should be aware of the potential for some patients to rapidly deteriorate one week after illness onset.

9.     The median time to acute respiratory distress syndrome (ARDS) ranges from 8 to 12 days.

10. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels, elevated lactate dehydrogenase, high CRP, and high ferritin levels may be associated with greater illness severity