Monday, August 24, 2020

193 CMAAO CORONA FACTS and MYTH COVID : Formula of six


193 CMAAO CORONA FACTS and MYTH COVID : Formula of six


Dr K Aggarwal

President CMAAO

With input from Dr Monica Vasudev

1065: Minutes of Virtual Meeting of CMAAO NMAs on “Asian countries update – Formula of Six”


22nd August, 2020, Saturday






Member NMAs


Dr KK Aggarwal, President CMAAO

Dr Yeh Woei Chong, Singapore Chair CMAAO

Dr Marthanda Pillai, Member World Medical Council

Dr Alvin Yee-Shing Chan, Hong Kong

Dr Marie Uzawa Urabe, Japan

Dr Md Jamaluddin Chowdhury, Bangladesh

Dr Prakash Budhathoky, Nepal

Dr Subramaniam Muniandy, Malaysia




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

Dr S Sharma, Editor IJCP Group


Key points from the discussion


Six things to remember in COVID-19


If you do not have Covid-19, ask yourself


  • “Am I at risk?”Age, sex (males more at risk), am I vaccinated (flu, pneumonia, MMR, BCG), do I have any comorbid condition, am I immunocompromised, is my profession high risk e.g. healthcare worker dealing with microdroplets.
  • “Is my environment at risk?”My room, my office, travel, kitchen, drawing and dining table, toilet – are they well ventilated or not.
  • “Am I prepared” Who will be my treating doctor, which hospital if I need admission, do I have stand-by oxygen, first aid box, notification (who should I notify), which lab for home test
  • “What do I do if I get it?” Do I need to isolate/quarantine/inform contacts, interpretation of rapid antigen test or RTPCR; start observing for symptoms; start treatment for Day 1
  • Observation days: 1-6 days (watch for hypoxia complications), Day 9 (allowed to meet family), Day 14 (no quarantine), Day 28 (consider plasma donation), Day 40, Day 90
  • 0-9 days: Nutrition, 6MWT, cohort isolation, blood tests, teleconsult, treatment
  • 9-90 days: Observe (for post-Covid symptoms), appeal, plasma donation, antibodies, antigen Ct value, nutrition


Six things to do to tackle Covid-19


  • During first 6 days (6am, 6pm) 6MWT, 6 parameters, 6 feet distance (ideal)
  • 6 parameters: Shortness of breath, cough or difficulty talking, SpO2, increase in temperature, distance and heart rate
  • 6 tests on Day 1: CBC with ESR, CRP, LDH, ferritin, d-dimer, IL-6
  • Six instruments at home: SpO2 monitor, PEFR, BP, thermometer, glucometer, smell and taste
  • Six gene targets: E, N, S, RdRp, ORF 1a, ORF 1b; gene targets may remain in the body for about 120 days
  • Reception (whosoever visits my home): Jaggery (taste), rose (smell), wash feet/hands, namaste (greet), ask to sit a higher place (no face to face meeting)
  • Decontaminate: 6 g bleaching powder in 900 ml water to make 0.1% solution
  • 6 Treatment options: Oxygen, plasma, steroids, heparin, antibiotics, antiviral


Six things for prevention


  • Contact time in last 48 hours, contact distance (was it less than 6 feet [ideal]), was the area cross ventilated, was the person wearing a mask and was the person coughing/sneezing
  • Appeals (ask for): Prevent, test, home (quarantine), cohort (two covid-positive persons can stay in isolation together), day 9, day 14 (stop quarantine, shift to monitoring)
  • 6 ways to clean and sanitize: Soap, sanitizer, disinfectant, UV, ozone, air purifier
  • 6 tastes: Astringent, bitter, pungent, sweet, sour, salt. In Covid-19, salt and bitter tastes are retained, while the rest are lost.
  • Mistakes: Missing first case in your family, first cluster in your colony, first spread, misinterpreting antigen / antibody test, missing Days 1-3 (pneumonia develops on Day 3)
  • 6 supplements: Vitamin C, D, B12, iron, zinc, thymosin alpha


Six things about the virus


  • Six different behaviors: Viral, bacterial, HIV-like, it causes immunoinflammation (antigen triggered), thromboinflammation and cytokine storm
  • Six strains: L strain (original strain in Wuhan), strains S, V, G, GR, and GH.



  • New definition: Acute manageable thrombo immunoinflammatory disease with post-viral state
  • The CDC has recommended maintaining a distance of 2 m (6 feet), while WHO has recommended maintaining a distance of 1 m (3 feet) as 2 m distancing may be difficult in developing countries.
  • The third wave in Hong Kong is coming down from 114 new cases in a day in July to 18 cases per day now. Hong Kong will launch en masse population screening program to identify silent carriers; screening will be voluntary. Should the rules about social gatherings be relaxed is a dilemma because of apprehension of another wave of the infection, which might exhaust the resources.
  • The first sero survey (done between June 27 and July 10) in Delhi showed 22.8% seroprevalence; the second sero survey (done in the first week of August) shows a seroprevalence of 28.3% (males 28.3%, females 32.2%, <18 years 35%, 18-49 years 29%, >50 years 31%).
  • Seroprevalence is 51.5% in Pune; in Mumbai, it is 57% in slums and 16% in residential societies
  • A study in Bangladesh conducted by the Institute of Epidemiology, Disease Control and Research and the International Centre for Diarrhoeal Disease Research, Bangladesh in Dhaka (RTPCR) has shown 9% of population in Dhaka has the infection.
  • Nepal is testing for Covid-19 with Gene Xpert test for emergency cases; it has 100% specificity, but sensitivity is around 50%. RT PCR is the gold standard.
  • Singapore is reaching the tail end of the outbreak in dormitories; community cases in the last week have been 0-2 in a day. Challenge is the next wave of infection, opening up of economy. Singapore is looking to open up travel to selected destinations.
  • Malaysia has detected D614g strain of the virus (mutation of SARS-CoV-2 virus) in a cluster of cases, which has been termed as the “Sivaganga cluster”. The index case belongs to Sivaganga in Tamil Nadu.
  • In Australia, all travel within the country has been stopped. Cases are coming under control in Victoria.





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