CMAAO CORONA FACTS and MYTH BUSTER Mortality Reduction : Dr K K Aggarwal

With inputs from Dr Monica Vasudev

India

healthysoch

New Delhi, June 25, 2020

Round Table Expert Zoom Meeting on “Mortality reduction in Covid-19” – 20^th June 2020, 11 am-12 pm

Participants :

Dr KK Aggarwal

Dr Ashok Gupta

Dr Suneela Garg

Dr Alex Thomas

Dr DR Rai

Dr JA Jayalal

Dr Jayakrishnan Alapet

Dr PN Arora

Mrs Upasana Arora

Ms Meenakshi Datta Ghosh

Dr K Kalra

Ms Ira Gupta

Dr Sanchita Sharma

Key points from the discussion :

Mortality due to Covid-19 differs in different countries, although there are no answers as to why. The answer may lie in different clinical presentations.
Careful treatment and educated patients may reduce mortality to less than 0.2%.
We must learn from our experiences. Lessons learned over the course of the pandemic may reduce mortality.
The presentation may vary in different patients; hypoxia (silent) for 4-6 hours increases mortality. We must learn to recognize the symptoms.
Day 1 symptom is not fever, cough or shortness of breath; nonspecific symptoms such as headache, muscle pain, diarrhea, nausea, pain in the legs below knees may be seen on Day 1, which may be missed.
Patients who have a loss of taste and smell usually recover.
A person who has diarrhea may be a superspreader.
Fever may last as long as 3 weeks and does not respond to paracetamol. It responds to naproxen, indomethacin, mefenamic acid, and nimesulide.
LMWH on Day 1 in all patients who have comorbid conditions; this may reduce mortality due to thrombosis.
The use of steroids (injectable) may reduce hypoxia.
Every ER should have an Airborne Infections Isolation (AII) room; this should be a part of SOP. If no AII room, then every ER should have an air purifier with at least 10 exchanges per hour.
Many patients come late to the hospital when the disease has become severe; patients do not know at what stage they should reach the hospital.
The new order of Delhi Government, which abolished home quarantine, is a retrograde step. This will overburden the hospitals.
Capacity building in healthcare workers is not optimal.
SOPs should be displayed prominently in every hospital, restaurant, etc.
Alternatives to central oxygen supply in hospitals such as oxygen cylinders, Ambu bag should be in place in case the central oxygen pressure falls.
Data of all COVID-19 patients in the country – clinical presentation, treatment – should be analyzed and made available for learning.
Pulse oximeters, oxygen concentrators should be accessible to communities (primary care, residential societies).
There is a lack of awareness about proper home quarantine. Putting patients in-home quarantine without monitoring may be detrimental and may increase mortality.
Tamil Nadu follows the PALM regime (Prone position, Absolute bed rest, Low molecular weight heparin, Methylprednisolone 1 mg/kg in moderate to severe cases).
Health is the right of the patient. There is no clarity about advisories. Patients should know how to proceed.
Various videos circulating in the media have created fear. People may hide their illness because of fear and stigma.