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 4th May 1566, number of cases on 20th 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
20th we should have had 666 serious cases
For
every 100 cases 15% would be serious cases
No
of actual expected cases on 20th:
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
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