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

June 25, 2020

With inputs from Dr Monica Vasudev

India

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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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