134 CMAAO CORONA FACTS and MYTH BUSTER Mortality Reduction
Dr K K Aggarwal
With inputs from Dr Monica Vasudev
956: Round Table Expert Zoom Meeting on “Mortality reduction in Covid-19”
20th June, 2020
Dr KK Aggarwal
Dr Ashok Gupta
Dr Suneela Garg
Dr Alex Thomas
Dr DR Rai
Dr JA Jayalal
Dr Jayakrishnan Alapet
Dr PN Arora
Mrs Upasana Arora
Ms Meenakshi Datta Ghosh
Dr K Kalra
Ms Ira Gupta
Dr Sanchita Sharma
Key points from the discussion
- Mortality due to Covid-19 differs in different countries, although there are no answers as to why. The answer may lie in different clinical presentation.
- Careful treatment and educated patients may reduce mortality to less than 0.2%.
- We must learn from our experiences. Lessons learnt over the course of the pandemic may reduce mortality.
- Presentation may vary in different patients; hypoxia (silent) for 4-6 hours increases mortality. We must learn to recognize the symptoms.
- Day 1 symptom is not fever, cough or shortness of breath; nonspecific symptoms such as headache, muscle pain, diarrhea, nausea, pain in the legs below knees may be seen on Day 1, which may be missed.
- Patients who have loss of taste and smell usually recover.
- A person who has diarrhea may be a superspreader.
- Fever may last as long as 3 weeks and does not respond to paracetamol. It responds to naproxen, indomethacin, mefenamic acid and nimesulide.
- LMWH on Day 1 in all patients who have comorbid conditions; this may reduce mortality due to thrombosis.
- Use of steroid (injectable) may reduce hypoxia.
- Every ER should have an Airborne Infections Isolation (AII) room; this should be a part of SOP. If no AII room, then every ER should have air purifier with at least 10 exchanges per hour.
- Many patients come late to the hospital when the disease has become severe; patients do not know at what stage they should reach the hospital.
- The new order of Delhi Government, which abolished home quarantine, is a retrograde step. This will overburden the hospitals.
- Capacity building in healthcare workers is not optimal.
- SOPs should be displayed prominently in every hospital, restaurants etc.
- Alternatives to central oxygen supply in hospitals such as oxygen cylinders, ambu bag should be in place in case the central oxygen pressure falls.
- Data of all Covid patients in the country - clinical presentation, treatment - should be analyzed and made available for learning.
- Pulse oximeters, oxygen concentrators should be accessible to communities (primary care, residential societies).
- There is a lack of awareness about proper home quarantine. Putting patients in home quarantine without monitoring may be detrimental and may increase mortality.
- Tamil Nadu follows the PALM regime (Prone position, Absolute bed rest, Low molecular weight heparin, Methyl prednisolone 1 mg/kg in moderate to severe cases).
- Health is the right of the patient. There is no clarity about advisories. Patients should know how to proceed.
- Various videos circulating in the media have created fear. People may hide their illness because of fear and stigma.