135 CMAAO CORONA FACTS and MYTH BUSTER Mortality Reduction in CMAAO countries

135 CMAAO CORONA FACTS and MYTH BUSTER Mortality Reduction in CMAAO countries

Dr K K Aggarwal

President CMAAO

With inputs from Dr Monica Vasudev

957: Minutes of Virtual Meeting of CMAAO NMAs on “Can mortality in Covid-19 patients be reduced?”

20^th June, 2020, Saturday

9.30am-10.30am

Participants

Member NMAs

Dr KK Aggarwal, President CMAAO

Dr Yeh Woei Chong, Singapore Chair CMAAO

Dr Ravi Naidu, Past President CMAAO, Malaysia

Dr Rajan Sharma, National President, IMA

Dr N Gnanabaskaran, President Malaysian Medical Association

Dr Marthanda Pillai, Member World Medical Council

Dr Marie Uzawa Urabe, Japan

Dr Md Jamaluddin Chowdhary, Bangladesh

Dr Sajjad Qaisar, Pakistan

Invitees

Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia

Dr Sanchita Sharma, Editor IJCP Group

• In high density population, transmission rate is high (40%); if low density, then chances of transmission are low (<5%).
• Mortality in most Asian countries is not as high as in Europe, US.
• Doctors should work on reducing mortality, while the government should work on prevention of infection.
• Mortality should be an exception and not the rule (exceptions are patients with fulminant disease – severe AMI, stroke, encephalitis).
• Mortality is high, if signals are missed.

India Update

• Deaths are 9 per million population
• Situation differs from state to state; Delhi, Mumbai are epicenters
• Delhi has abolished home quarantine; as per new policy, all positive cases will be placed in mandatory institutional quarantine for at least 5 days. Patients will only be allowed to leave the quarantine centre if there are no symptoms.
• Cost of Covid-19 testing in Delhi has been reduced to Rs 2400 from Rs 4500.
• Cost of Covid-19 treatment in private hospitals has been capped for 60% of isolation beds and ICU beds.
• To create more beds, two railway stations in Delhi have been totally converted to Covid facilities.
• Testing has been increased; this will help detect asymptomatic carriers and potential superspreaders
• In Kerala, only the very sick patients are hospitalized in tertiary centers; other positive cases are in peripheral hospitals/hotels; home quarantine is practiced with HCW visit/teleconsultation. People participation, better health infrastructure, more testing have contributed to low mortality (≤1%)
  
• Observations from Delhi & Mumbai, India

• About 20% of people have loss of taste and smell; recovery is a rule in these patients.
• If patient has diarrhea, the virus is more contagious and the patient may be a superspreader.
• Fever may last as long as 3 weeks and does not respond to paracetamol. It responds to indomethacin, naproxen, mefenamic acid and nimesulide.
• People with persistent respiratory symptoms respond immediately to inhaled corticosteroids (ICS).
• If low lymphocyte count, there is better response to ritonavir + lopinavir combination.
• Mortality can be reduced, if LMWH is given on the day hypoxia is detected (continued till recovered), short course of steroids (3 doses of IV/oral prednisolone/dexamethasone), remdesivir if available, continuing aspirin and statin for 3 months after discharge.
• Patients who develop cytokine storm may not recover.

Bangladesh Update

• There is alarming spread of infection.
• Till now home quarantine is allowed but this is increasing chances of infection.
• Death rate is less; deaths are 8 per million population.

Pakistan Update

• 15 deaths per million population
• Total cases: 748 per million population
• Total tests: 4581 per million population
• Around 50,000 patients are in isolation
• Many people are not following precautionary measures (social distancing, masks; they do not consult a doctors, if they develop symptoms)

Australia & New Zealand Update

• The state of Victoria has had fresh new cases every day for 5-6 days with opening of schools, restaurants etc.  There is high alert for a second wave. Testing has increased.
• Other states have had virtually no new cases in the last two days.
• Borders have not been opened except in the states of Victoria and New South Wales.
• New Zealand had few cases last week after 2-3 weeks of no new cases.

Malaysia update

• There are 8530 cases and 121 deaths; 807 have been discharged
• The movement control order (MCO) has been reduced; industries have started opening up,      though cinemas, pubs, swimming pools are still closed.
• Clusters are starting in foreign workers
• There is a concern that the general population may start to relax as Malaysia is doing well.

Singapore Update

• There have been 26 deaths; 40,000 cases (of these only 1800 are community cases, rest are in migrant workers living in the dormitories) and only 26 in ICU
• Most patients are young and fit; statistics show that below 30 years of age, only 0.5% need oxygen and zero percent need ICU care. 
• The system was not allowed to be overwhelmed at any time.
• Social distancing, masking, lockdown, contact tracing, lessons learnt from SARS have helped to reduce mortality.