200 CMAAO CORONA FACTS and MYTH COVID: Non COVID phase
Dr K Aggarwal
With input from Dr Monica Vasudev
1071: Minutes of Virtual Meeting of CMAAO NMAs on “Covid-19 Update”
29th August, 2020, Saturday
Dr KK Aggarwal, President CMAAO
Dr Marthanda Pillai, Member World Medical Council
Dr Alvin Yee-Shing Chan, Hong Kong
Dr Prakash Budhathoky, Nepal
Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia
Dr S Sharma, Editor IJCP Group
Key points from the discussion
- Three acute phase reactants– CRP, ESR and IL-6. In a resource-limited country, of the three, choose CRP. It is indicator of intensity of inflammation. CRP cannot rise without increase in IL-6. Raised CRP, presume that the d-dimer is high.
- We do not know how China which has a higher population density than India has managed to control the disease. Mortality is 3 per million; new cases are 9.
- Antigens of various diseases such as typhoid, malaria, chikungunya, and dengue are false positive in Covid-19.
- “All overseas players and support staff underwent two COVID-19 RT-PCR tests before flying in to the UAE and could fly only if the tests are negative. If not, then the same 14-day quarantine period and two negative tests to be able to fly to the UAE. The players and support staff will be tested on Day 1, Day 3 and Day 6 of their quarantine in the UAE and after clearing that, they will be tested every fifth day during the 53-day event.” Instead of three tests, pooled testing of the teams can be done daily.
- Giving oxygen without anticoagulation has no significance. You have to give aspirin/anticoagulation. For cases under home care, rivoraxaban (10 mg prophylaxis) can be given in place of LMWH; it is cheaper, can be taken by the patient, onset of action is 10 hours.
- According to TOI report, 87,000 healthcare workers in India are infected with Covid; there have been 573 deaths; 74% cases and over 86% deaths are from six states: Maharashtra, Tamil Nadu, Delhi, West Bengal, Gujarat and Karnataka. The number projected seems to be very high and needs to be checked.
- Doctors have high viral load so have higher chances of developing hypercoagulable state. Should prophylactic anticoagulation be started on right on Day 1 of the illness for doctors/HCWs?
- There are three phases of the illness: Covid (1-9 days, infectious phase), post-Covid (after 9 days, non-infectious, persistent inflammation) and non-Covid (after 3 months). After 3 months, the patient should be treated as non-Covid, instead of post-Covid. This has medicolegal issues
- In Hong Kong, the third wave is partly controlled. There have been less than 20 cases per day for the last week or more. One-third of confirmed cases have no known source of origin; so the chain of spread of infection is not known. Universal community testing scheme will start from 1st September to find out silent carriers. The Hong Kong government has agreed to expand to high risk group tracing and testing even with universal testing. With opening up of economy, better monitoring of industries so that there will not be a fourth wave. The third wave began with 9 cases with mutated virus strain (d614g). At that time, sailors coming to Hong Kong had been exempted from testing and quarantine; also restrictions of social distancing were relaxed. This created the third wave.
- Reinfection: A person from Spain positive in March and became negative reached Hong Kong and tested positive again in July. This raises a question whether this virus can re-infect. It was a mutated virus with 24 gene differences. It formed antibodies quickly, caused no symptoms and not serious and disappeared early. We need to be vigilant about this. People in post-Covid phase getting recurrent corona-like illness may be getting re-infection with a different strain.
- Another case of re-infection reported in the US; a young person who had severe symptoms and required oxygen and assisted breathing in the second infection.
- A study from Mumbai has reconfirmed the US study that antibodies do not last for more than 3 months.
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