With inputs from Dr Monica Vasudev
India
healthysoch
New Delhi, June 25, 2020
Round Table Expert Zoom Meeting on “Mortality reduction in Covid-19” – 20th 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.
Author: Dr K K Aggarwal, President CMAAO
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