CMAAO Corona Facts and Myth COVID Paradigm shifts in COVID 19

“IMA-CMAAO Webinar on “Paradigm shifts in COVID-19” – 25^th July, 2020, 4-5pm”

India

healthy soch

New Delhi, July 29, 2020:

Participants

Dr RV Asokan, Hony Secretary General IMA

Dr Ramesh K Datta, Hony Finance Secretary IMA

Dr Jayakrishnan Alapet

Dr Brijendra Prakash

Dr Sanchita Sharma

Faculty

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 (100^oF) 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.