145 CMAAO CORONA FACTS and MYTH BUSTER Managing COVID 19 Recovery is the rule
Dr K Aggarwal
967: Round Table Expert Zoom Meeting on “Recovery is the rule in Covid-19 and death is an exception”
4th July, 2020
Dr KK Aggarwal
Dr Shashank Joshi
Prof Mahesh Verma
Dr Ashok Gupta
Dr Suneela Garg
Dr JA Jayalal
Dr Jayakrishnan AV
Dr Alex Thomas
Dr Shiv K Harti
Vaidya Sushil Dubey
Mrs Upasana Arora
Dr K Kalra
Ms Ira Gupta
Dr S Sharma
Key points from the discussion
- Timely action
can save lives as most cases are mild; few are moderate and less than 5%
- Death rate is
reducing as we are now able to better manage cases.
- In all patients
who have loss of smell/taste, recovery is the rule and mortality is an
exception. Analysis of 100 patients with loss of smell/taste showed that
none needed oxygen or ventilator or hospitalization. Occurred more often
in males, at any age and recovery is the rule within 4 weeks.
- Recovery if the
rule means that the disease is salvageable at every step. It does not mean
that mortality is zero.
- After 9 days,
the virus becomes non-replicative and after 9 days, the illness is a
- Day 1 is the day
when any of the symptom/s recognized by the CDC/MOHFW guidelines such as
fever, throat irritation, subconjuctival hemorrhage, rash, diarrhea, headache,
calf pain etc.; test may or may not be positive.
inflammation is very common. It can be in the form of persistent
fever/sore throat/bronchitis/diarrhea/cystitis/ exertional tachycardia.
- Doctors have
high viral load because of repeated exposure and they have more hypercoagulable
state. So, if all HCWs are given anticoagulant + short course of steroids,
even in mild cases, recovery is the rule.
- In non-HCW group
of patients, if there are signs of chest congestion on Day 3-4, do an
immediate chest CT scan and give 10-day course of steroids, antiviral and
anticoagulant, then recovery should be the rule and death an exception.
- RT PCR may be
positive for up to 40 days; this does not mean that the virus is
culturable. The virus is culturable for only 9 days, after 9 days, the virus
is present but is non-culturable. This data is available for patients who
are not on ventilator.
- If any illness
is developed during the 9 days, then the post-Covid illness (post-Covid
inflammatory state) may last for up to 6 weeks.
- A delayed
cytokine storm, which occurs between Day 14 and18, has been observed in
Mumbai. A 6-minute walk test is now mandatory at the time of discharge to
look for drop in oxygen saturation. This is a valid marker for delayed
cytokine storm. Give 5-10 days of LMWH/oral anticoagulant and small dose
of statin at the time of discharge, especially to those who have been in
hospital for >28 days and are >55 years age. This can reduce
steroids were given only in serious cases, but now their indication has
also shifted to moderately severe cases. And the time may well come when
steroid may become mandatory in all patients starting from Day 3. Timely
steroids can prevent secondary cytokine crisis.
building not just of HCWs but also RWAs etc. as many patients are in home
care; issues like stigma and discrimination also need to be addressed. The
word “contact” needs to be eliminated as it is a type of stigma.
- Indian vaccine
is a live attenuated vaccine (Bharat Biotech); Moderna vaccine is mRNA
vaccine; all vaccines have different technologies. Three things to be
detected when a vaccine is given: Cellular antibodies, humoral protection
and non-specific immunity building (innate immunity). By 15th
August, we may only be able to tell whether antibodies are produced or
not. Since this is a live attenuated virus, will there be a delayed
response (cytokine crisis), we do not know.
- Isolate for 9
days, quarantine for 5 days and then monitoring with rest for next 2
weeks. Monitoring means that the person is not contagious, but is still
likely to get secondary complications.
- Plasma therapy
is effective if given within first 7 days of illness; plasma should be
donated between 28 and 40 days.