Friday, July 31, 2020




Dr K Aggarwal

President CMAAO

With inputs from Dr Monica Vasudev


1031: Trained Dogs Can Identify COVID-19 Infections?

After some training, dogs may be able to sniff out and identify people who are infected with the coronavirus, according to a study published in the journal BMC Infectious Diseases.


Eight dogs, which are part of the German Armed Forces, were trained for a week to detect the virus in samples of saliva. Then they were given more than 1,000 infected and non-infected samples and were able to detect 94% of cases. They correctly identified 157 positive samples and 792 negative samples but missed 30 positive samples and gave false positives for 33 samples.


The study was a small pilot project tested by the German Armed Forces, the University of Veterinary Medicine in Hannover and the Hanover Medical School.


Dogs are able to detect a specific smell of the metabolic changes that occur in those patients.


Trained dogs could be sent to airports, borders and sporting events to detect infections.


Within the medical field, dogs have been trained to detect cancer, malaria, and other bacterial and viral infections. [Medscape]


1034: Study details cardiovascular effects of COVID-19

As per a study published in JAMA Cardiology, cardiac inflammatory involvement is frequent among patients who have recently recovered from COVID-19 infection, regardless of pre-existing conditions. In a cohort of 100 German patients recently recovered from infection, cardiovascular magnetic resonance (CMR) revealed cardiac involvement in 78% and ongoing myocardial inflammation in 60%.

Cardiac involvement occurred irrespective of infection severity, overall course of COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms.

The prospective observational study included patients who recovered from COVID-19 between April and June 2020. All patients included were at least 2 weeks out from being diagnosed with COVID-19, had resolution of respiratory symptoms, and had negative results on a swab test at the end of the isolation period.

Of the patients, 53 were male, with a median age of 49 years. The median time interval between COVID-19 diagnosis and CMR was 71 days. Of the patients, 67 recovered at home, while 33 required hospitalisation. Pre-existing conditions included hypertension, diabetes, and known coronary artery disease, but no previously known heart failure or cardiomyopathy was reported. Pre-existing conditions were similar between patients who recovered at home and patients who were hospitalised.

At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (≥3 pg/mL) in 71 patients and significantly elevated (≥13.9 pg/mL) in 5 patients. In addition, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, higher left ventricle mass, and raised native T1 and T2 compared with both control groups.

The most prevalent abnormality on CMR was myocardial inflammation, defined as abnormal native T1 and T2 measures, which was detected in 73 and 60 patients, respectively, followed by regional scar and pericardial enhancement, which was detected in 32 and 22 patients, respectively. Findings on classic parameters, such as volumes and ejection fractions, were mildly abnormal. 

There was a small but significant difference in native T1 mapping between patients who recovered at home versus patients who were hospitalised (median, 1122 ms vs 1143 ms; P = .02), but not for native T2 ,hsTnT, or N-terminal pro-b-type natriuretic peptide levels. Nonetheless, none of these measures were correlated with time from COVID-19 diagnosis.

Levels of hsTnT were significantly correlated with native T1 mapping (P < .001) and native T2 mapping (P = .03). There was also a cross-correlation between native T1 and T2 (P < .001). Additionally, the authors noted a significant correlation of hsTnT with native T1 (P < .001) and left ventricle mass (P < .001). The associations of hsTnT with mapping measures remained significant despite controlling for the presence of comorbidities (overall or separately) or treatment received for COVID-19 infection.

Unlike these previous studies, the findings reveal that significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation, with no significant trend toward reduction of imaging or serological findings during the recovery period. [DG alert]











Wednesday, July 29, 2020

168 CMAAO CORONA FACTS and MYTH COVID Paradigm shifts in COVID 19

168 CMAAO CORONA FACTS and MYTH COVID  Paradigm shifts in COVID 19

Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev

1029:  Update on Covid-19

IMA-CMAAO Webinar on “Paradigm shifts in COVID-19”

25th July, 2020


Dr RV Asokan, Hony Secretary General IMA
Dr Ramesh K Datta, Hony Finance Secretary IMA
Dr Jayakrishnan Alapet
Dr Brijendra Prakash
Dr Sanchita Sharma


Dr KK Aggarwal
Padma Shri Awardee
President CMAAO & HCFI

Dr KK Aggarwal elaborated on the paradigm shifts in the management of Covid-19 from the month of March to July, based on his experiences of patients with Covid-19.

Key points from the discussion

  • Covid-19 was first considered to be a viral pneumonia, but now it is known as a mysterious virus, which is predictable unpredictable.
  • It spares joints and larynx, so no joint involvement or hoarseness of voice; also, no lymph nodes involvement.
  • Covid-19 was earlier believed to be non-inflammatory, but we now know that it is predominantly an inflammatory disease.
  • Earlier, it was thought that the patient could become critical on any day of the illness; now we know that Days 3-6 are the days to watch.
  • Social distancing has changed to physical distancing.
  • From macrodroplets (surface to human transmission) earlier, we now talk of microdroplets (crowded ill ventilated rooms) today.
  • Surface to human transmission was the most important route of transmission; now it has become less important (heat and humidity)
  • The shift from no masking to mandatory masking in public has become the norm.
  • From simple masks, we have moved to N95 masks for all high risk patients (COPD, asthmatics)
  • Masking only when going out, now adds masking also at home.
  • Distancing of 3 feet has changed to 6 feet; with microdroplets, this distance is now 9 feet.
  • We started the pandemic with very high mortality (10%); now mortality is around 0.3%.
  • Institutional care has shifted to home care
  • In the early days, no treatments were available; but individualized treatment is now available. If inflammatory parameters are raised, then give steroids, if d-dimers are high, give anticoagulant, if early presentation, give antiviral etc.
  • From mandatory ventilation, the concept has changed to noninvasive ventilation.

  • Children to grandparents; now children are no risk for transmission to adults or other children.
  • Menstruation reduces severity of illness.
  • We have shifted to no steroids to early low dose steroids.
  • Hydroxychloroquine (HCQ) for all to no HCQ for mild cases.
  • Late discharge – earlier patients were kept for 30-40 days; now patients are discharged early (Day 6) if no complications, to home quarantine
  • Thinking of death to thinking recovery
  • No pooled test to pooled test
  • We have now understood that after 9 days of illness, the virus is non-culturable and the person is non-infectious, the presentation is post-Covid sequelae due to persistent inflammation, or hypercoagulable state. Before 9 days, it is covid.
  • No Ct value to Ct value of RTPCR to find out if cohort isolation can be done; low Ct value means high viral load.
  • Testing has moved from antigen RTPCR to rapid antigen and now antibodies testing (total vs IgG)
  • Isolation to cohort isolation (multiple infected persons in a family can stay together)
  • Isolation and now isolation/quarantine/monitoring
  • From no oxygen at home to oxygen at home
  • Closed camps/OPDs to open sunlight camps – microdroplets are killed in sunlight
  • Earlier testing was done only for symptomatic persons, but now liberal testing
  • A mandatory government prescription has now become non-mandatory
  • When it first began in Wuhan, China, it was pulmonary COVID and CT diagnosis was a must; but now it is also recognized as non-pulmonary COVID, involving GIT, CNS.
  • Typically, fever at the time of presentation; now no fever presentation
  • Asymptomatic persons are really not asymptomatic; they may have some atypical symptoms such as diarrhea, sore throat etc.
  • High grade fever, which is classically associated with viral illness to low grade (100oF) exertional persistent fever, due to persistent inflammatory process
  • The six minute walk test (6MWT) was meant for only COPD, heart failure patients, but it is now mandatory from Day 3-6. If the patient desaturates by 5% on walking, this is indicative of pneumonia with thrombosis. This is an emergency.
  • Transmission from joint families to nuclear families
  • No toilet transmission, now toilets are recognized as a covid chamber
  • Contact time from 30/10 minutes to 15/5 minutes in closed areas
  • Testing till Ag negative to no testing to confirm when Ag will become negative
  • Fear to no or less fear
  • Mortality is two times that of the government figures reported
  • For every 1 tested people, there are 20 untested; for every 20 Covid patients, there are 80 patients with corona-like illness.
  • Stigma to less stigma
  • Low mortality to high mortality amongst doctors
  • Ignorance to knowledge
  • Engineering (AII rooms) to social engineering (test for 5 parameters when screening - – temperature (low grade, does not respond to paracetamol), SpO2 (happy hypoxia), loss of smell, loss of taste (give jaggery – first taste to go is sweet taste) and hand grip strength)
  • New loss of smell and taste has been seen in 20-30% of patients; the disease is mild in nature.
  • We now know that plasma therapy is effective if given early.

Tuesday, July 28, 2020


Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev

1019: Kim Jong-un, North Korea’s leader, placed Kaesong City, near the country’s border with the South, under lockdown and declared a national emergency after acknowledging that his country might have its first case of the coronavirus.  A North Korean who defected to South Korea three years ago but secretly crossed back into Kaesong City last week was “suspected to have been infected with the vicious virus,” the North’s official Korean Central News Agency said on Sunday. Until now, North Korea, one of the world’s most isolated countries, has said that it has no cases of Covid-19, although outside experts have questioned the claim.

1020: Vietnam, which had gone 100 days without a case of locally transmitted coronavirus, said on Saturday that a 57-year-old man in the central city of Danang had tested positive for the virus. A second man has since tested positive. How they were infected remained a mystery.
Vietnam, will evacuate tens of thousands of tourists from Danang after four residents there tested positive this weekend.

1021: President Jair Bolsonaro of Brazil said on Saturday that he no longer had the coronavirus, appearing to have experienced only mild symptoms from a scourge he has repeatedly downplayed. More than 86,000 people in Brazil have died from the virus.

1022: Australia on Sunday reported its highest one-day death toll — 10 people, all in the state of Victoria.

1023: France will do COVOD 19 testing free for all

1024:  Biocon suffered a setback on Sunday with the Union health ministry announcing that the firm’s itolizumab drug has not been included in national treatment protocol for Covid-19 patients. Less than two weeks ago, the Drug Controller General of India had given permission for the drug’s use on moderate to severe coronavirus patients, leading to a surge in the company’s share price.

1025: Hong Kong is shutting down all dine-in restaurant service and limiting public gatherings to two people after it recorded more than 100 new cases for the sixth day in a row.

1026: President Trump’s national security adviser, Robert O’Brien, has tested positive for the coronavirus, making him the most senior White House official known to have contracted the virus.

1027:  Japan takes masks to a new level:  In Japan, where masks were widespread even before the pandemic, there has been a big push to innovate. Inventors have dreamed up masks with motorized air purifiers, Bluetooth speakers and even sanitizers that kill germs. In South Korea, the electronics giant LG has created a mask powered with fans that make it easier to breathe. One company is trying to build a mask with a translator. Masks were first used in epidemics in the early 20th century, when Wu Lien-teh, a doctor of Chinese descent, began promoting simple gauze masks to battle an outbreak of pneumonic plague. During the 1918 flu, the practice went global.

1028: perinatal transmission of COVID-19 unlikely if precautions taken: Mothers positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at delivery are unlikely to transmit the infection to their infants during the perinatal period provided proper precautions are undertaken, a study in The Lancet Child & Adolescent Health has found. "This is the largest cohort of neonates born to mothers positive for SARS-CoV-2 at the time of delivery, with prospective follow-up up to 1 month of life," Christine M Salvatore, Departments of Pediatrics, Weill Cornell Medicine, New York Presbyterian—Komansky Children's Hospital, New York, NY, and colleagues noted.

Monday, July 27, 2020

166 CMAAO CORONA FACTS and MYTH COVID Illness in Bangladesh

166 CMAAO CORONA FACTS and MYTH  COVID Illness in Bangladesh

Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev

1018: Minutes of Virtual Meeting of CMAAO NMAs on “CMAAO view on COVID-19 in Bangladesh”

25th July, 2020, Saturday



Member NMAs

Dr KK Aggarwal, President CMAAO
Dr Yeh Woei Chong, Singapore Chair CMAAO
Dr Marie Uzawa Urabe, Japan
Dr Ashraf Nizami, Pakistan
Dr Sajjad Qaisar, Pakistan
Dr Md Jamaluddin Chowdhury, Bangladesh


Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia
Dr S Sharma, Editor IJCP Group

Dr Md Jamaluddin Chowdhury from the Bangladesh Medical Association presented data on the situation of COVID-19 in Bangladesh. This was followed by a discussion among the participating NMAs on COVID-19 status in Bangladesh.

COVID-19 Situation in Bangladesh- Health Perspective
Dr Md Jamaluddin Chowdhury
Bangladesh Medical Association

  • Bangladesh is the most densely populated country of the world with a population density of 1116/sq km.
  • The first case of Covid in the country was detected on 8th March.
  • So far, Bangladesh has done more than one million tests; the number of tests conducted per million is 6629.
  • Bangladesh allows private facilities to conduct Corona test by their own RT PCR machine.
  • However, the number of tests has reduced; the reason for this decline is not known, the cost of the test may have been a factor.
  • Bangladesh has not started antigen test yet. Also, antibody testing has not been started for surveillance.
  • No. of confirmed cases is 218658; no. of deaths confirmed due to Covid-19 is 2836.
  • No of total deaths (documented or undocumented) indicate the total number of infected cases.
  • Analysis of one month data from 25th June to 24th July shows that the number of deaths (confirmed) is not so high and ranges between 35 and 50. But there may be some undocumented cases.
  • The number of critical cases is reducing; the number of ICU beds dedicated for Covid-19 cases is 201; of these 133 are occupied.
  • Initially there was a shortage of high flow nasal cannula; also initially private hospitals and clinics were not providing any service. Now they are given service, both diagnostic and curative.
  • Hydroxychloroquine is not being used for patients; ivermectin is also not advised in the national guideline, but the patients are taking the drug randomly.
  • An ongoing trial is investigating the efficacy of combination of ivermectin and doxycycline for treatment of Covid-19 patients with the approval of Bangladesh Medical Research Council.
  • Health care workers who have treated patients infected with Covid-19 have faced social stigma from local people.
  • The number of doctors infected is 2229; the number of doctors deceased is 68.
  • Supply of PPE is now satisfactory. Initially there was question about its quality.
  • Contact tracing is going on but it is insufficient due to shortage of employees or volunteers.
  • Wearing mask has recently been made compulsory by law.
  • A 45-day lockdown was ordered in the country, but was not observed strictly. At present, no significant lockdown program is on implementation.
  • Most of the confirmed cases are in the age group 21-40 years.
  • The number of cases in females is 29% vs 71% in males.
  • The number of deaths in females is 23% vs 77% in males.

Other key points from the discussion

  • Countries in South Asia (India, Bangladesh, Pakistan, Sri Lanka, Nepal) should have similar data.
  • Mortality in Bangladesh is 1.2-1.3%; mortality in Delhi is now 0.3%; a sero-surveillance study in Delhi has shown that 22.8% have developed antibodies. Because the mortality is low, people are not accepting the lockdown guidelines.
  • Mortality in our countries should be 0.1-0.3%; the virus is not so deadly here.
  • Less than 1% needs ventilators; rest can be managed at home, nursing homes and smaller hospitals as long as there is facility for HFNC.
  • Start early anticoagulant (LMWH); treat with tenecteplase if no improvement despite LMWH.
  • All patients should identify Day zero. Measure SpO2 on Day 3-6. If there is exertional dyspnea, this means there is pneumonia + clot; give antiviral + LMWH + steroids, all should recover.
  • We need to build up AII rooms similar to countries like China, Hong Kong, Singapore, South Korea.
  • Hydroxychloroquine has no role if steroids are given; role of antibiotics is to prevent secondary infection.
  • Start pool test; if positive then presume that all in family are infected. Singapore allows pooled test with 64 samples at a time; Kerala allows 20 samples and ICMR allows 5 samples.
  • A lockdown now is not the answer.
  • In India, doctors are on duty for 7 days; they are not allowed to go home; they stay in a hotel for 5 days and are allowed to go home only if they test negative.
  • Asymptomatic people are not actually asymptomatic. They may be missing atypical symptoms such as headache, single diarrhea, sore throat, nasal obstruction etc. Even a single symptom can be Covid positive.
  • Public should strictly follow the SOPs in their workplace.
  • Undue interference by law has created confusion. The Supreme Court of India has given a decision that petitions against policy decisions regarding Covid-19 will not be entertained.
  • Pakistan Medical Association has demanded home isolation with proper monitoring of the patients (by GPs/Family Practitioners), if the person has the capacity or resources to be isolated.
  • In Singapore, enforcing of stay at home orders is done by security people, while medically, if people have illness, they are shifted out to a facility.
  • Issues about stigmatization, ethics and interference in professional autonomy are very real. We have to be on alert about these.

Sunday, July 26, 2020



Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev

1009: Can the Virus Disrupt the Endocrine System?

Through its effects on angiotensin-converting enzyme 2 (ACE2), researchers from Louisiana State University say that SARS-CoV-2 may disrupt various endocrine functions throughout the body.

1010: Potential Treatments, but Hard to Test
Dipyridamole a cheap, FDA-approved drug typically prescribed with blood thinners to prevent strokes, could help patients with COVID-19.

1011: Researchers at Johns Hopkins wanted to test another cheap generic drug — alpha-blocker prazosin, which prevents inflammatory surges.

1012: Oral petechial lesions observed in a small number of COVID-19 patients in addition to skin rash exanthem, is a new symptom of the virus. Madrid researchers examined the oral cavity of 21 patients with the virus who also had a skin rash, and published their findings in a research letter in JAMA Dermatology.  The presence of enanthem in a patient with a skin rash is a useful finding that suggests a viral aetiology rather than a drug reaction.

1012: Test to Guide Steroid Treatment: Hospitalized COVID-19 patients with high levels of inflammation may benefit significantly from dexamethasone and other steroids. Researchers at Albert Einstein College of Medicine and Montefiore Health System in the Bronx, New York, concluded that patients with low levels of inflammation may experience a significantly higher risk for severe outcomes with steroid use. They also found that a C-reactive protein test can help physicians decide which patients are likely to benefit.

1013: Combination Therapy Quells Cytokine Storm: In a new study, the combination of high-dose methylprednisolone and tocilizumab was associated with faster respiratory recovery, lower likelihood of mechanical ventilation, and fewer in-hospital deaths among COVID-19 patients experiencing a hyperinflammatory state known as a cytokine storm compared with those who received supportive care alone. Researchers compared patients who received the treatments with historic controls and found that participants in the treatment group were 79% more likely to achieve at least a two-stage improvement in respiratory status.

1014: Bleeding complications linked to antithrombotic strategy used in non‐critically ill COVID-19 patients: Findings from a study in the Journal of Thrombosis and Haemostasis dispute the currently adopted strategy of giving weight-adjusted doses of anticoagulants to non-critically ill patients with COVID-19 in the absence of thromboembolic complications. Researchers led by Raffaele Pesavento, MD, Department of Medicine, University of Padua, Padua, Italy, noted that "the increasing awareness that low-dose anticoagulants may be ineffective for prevention of thrombotic complications in the course of COVID-19, including the development of micro-thrombosis in the lung vessels, has induced several clinicians to consider the use of sub-therapeutic or even therapeutic doses of antithrombotic agents in all admitted patients, challenging their hemorrhagic potential. The results of our retrospective cohort study do not support this strategy."

"As (sub)-therapeutic doses of antithrombotic drugs failed to reduce the risk of fatal or non-fatal thrombotic complications while simultaneously increasing the haemorrhagic risk, their use in patients with non-critically ill COVID-19 should be discouraged," the authors said.
SOURCE: Journal of Thrombosis and Haemostasis

1015: Clinical improvement of severe COVID-19 pneumonia in a pregnant patient after caesarean delivery:  A case of COVID-19 in a pregnant patient with severe respiratory compromise, whose clinical status significantly improved after caesarean delivery was described in BMJ Case Reports.
A 35-year-old gravida 10 para 7 at 29 3/7 weeks gestation presented to the labour and delivery unit with a 2-week history of cough and fever. The patient also reported dyspnoea that worsened with ambulation, myalgias and dysuria. On the day of presentation, she became increasingly hypoxic, requiring 8 L/min of oxygen via nasal cannula. A COVID-19 nasopharyngeal PCR test on admission was positive and her laboratory results were significant for lymphopenia and elevated LDH, D-dimer and C reactive protein (CRP). Additionally, her chest X-ray findings were consistent with COVID-19, with extensive patchy airspace opacities in the middle and lower lung fields. 
In the SICU, the patient’s condition worsened on hospital day 2 with increasingly elevated oxygen requirements. On hospital day 3, she received tocilizumab 400 mg intravenously. Nonetheless, her respiratory status continued to worsen, and by hospital day 5, she required 15 L/min of oxygen through a Venturi mask with desaturation of her SpO2 to the low 80th percentile on ambulation.
Despite worsening respiratory status, the patient’s acute phase reactants “remarkably” improved, where her CRP down-trended from 179 mg/L at admission to 7.4 mg/L by day 5. Throughout her hospitalisation in the SICU from hospital days 2 to 9, the patient remained afebrile but was visibly tachypneic with increased work of breathing. Meanwhile, her D-dimer level continued to rise, peaking at 3037 ng/mL. 
Because the patient remained dependent on 15 L/min of oxygen and showed signs of clinical worsening with potential imminent need for intubation, an interdisciplinary team agreed on proceeding with caesarean delivery with neuraxial anaesthesia for expedited delivery, and possible intraoperative intubation if the patient was unable to tolerate prolonged supine position. 
The patient eventually underwent an uncomplicated primary caesarean delivery at 30 5/7 weeks gestation with spinal anaesthesia on hospital day 10, while being maintained on 15 L/min of oxygen during the procedure and she did not require intubation. A male neonate was delivered and his chest X-ray on day of life 3 showed no evidence of pulmonary disease, and COVID-19 nasopharyngeal PCR testing collected 2 hours after delivery and on day of life 3 were negative.
The patient’s clinical status rapidly improved postoperatively, where she had a SpO2 to the low 90th percentile on room air at 2 hours post-caesarean, which improved to 100% on 15 L/min of oxygen in the recovery room, and her cough and work of breathing significantly improved. Her oxygen requirements gradually decreased, and by postoperative day 2, she was weaned to 4 L/min of oxygen via nasal cannula. 
The patient remained on therapeutic enoxaparin postpartum until she was stable enough to obtain a CT angiogram, given the continued concern for a concomitant pulmonary embolism. Her CT angiogram was negative for pulmonary embolism, but consistent with COVID-19 infection, showing extensive bilateral patchy ground glass infiltrates and small consolidations. Meanwhile, COVID-19 nasopharyngeal PCR tests continued to be positive on postoperative days 7, 8 and 9. Nonetheless, the patient was discharged on postoperative day 9 as she was symptomatically improved, saturating well on room air and meeting all postoperative milestones. Eventually, her COVID-19 test was negative on postoperative day 14.
In cases of severe respiratory distress from COVID-19 pneumonia, patients may experience a reversal in poor respiratory status after the physiological changes of pregnancy are removed.
This is the first case to describe the use of tocilizumab for COVID-19 infection in a pregnant patient.
Tocilizumab exposure during pregnancy has mostly been studied in patients with severe rheumatologic diseases.
SOURCE: BMJ Case Reports

1016: Antibody levels in patients with mild COVID-19, appear to drop by half within 36 days. The research was conducted by F. Javier Ibarrondo, PhD, and colleagues and was published online on July 21 in a letter to the editor of The New England Journal of Medicine. Ibarrondo is associate researcher at the David Geffen School of Medicine at University of California, Los Angeles (UCLA). (The original letter incorrectly calculated the half-life at 73 days.)

1017: Although acute kidney injury is seen in a substantial minority of patients with severe COVID-19, no evidence of the presence of SARS-CoV-2 was found in kidney biopsies from a small series of such patients, according to researchers.

Kidney biopsy research shows that the kidney injury from COVID-19 virus happens due to complications of the disease and is not because of direct viral infection of the kidney. [Journal of the American Society of Nephrology]

Saturday, July 25, 2020



Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev


Chronic COVID or POST COVID illness

COVID-19 can mean weeks' long illness, even in young adults and those without chronic conditions who have mild disease and are treated in outpatient settings, according to survey results in today's Morbidity and Mortality Weekly Report from the Centres for Disease Control and Prevention (CDC).

In a multistate telephone survey of symptomatic adults who tested positive for SARS-CoV-2, 35% had not returned to their usual state of wellness when they were interviewed 2 to 3 weeks after testing.

Delayed recovery (symptoms of fatigue, cough, and shortness of breath) was evident in nearly a quarter of 18- to 34-year-olds and a third of 35- to 49-year-olds who were not sick enough to require hospitalization.

This is post Covid state
1.    On 9th day virus is non infectious
2.    Is post Covid persistent inflammation or immunologic reactions
3.    Like arthritis in chikungunya
4.    Like post herpetic neuralgia
5.    Like post viral syndrome, CFS etc
6.    Is quite common and presents in India more with low grade fever and obstruction in throat. It can also present with SOB, exertional tachycardia and below knee pains.