Covid 19 update

Hope all of you are staying safe ,while trying to save the community.

NSAIDs should not be used .

No steroids (unless COPD/Asthma patients requiring absolutely )

Ok to continue ACEI/ARB,no need to stop them for suspicious or confirmed covid cases .

Look for troponin elevation in COVID 19 ,which generally signifies myocarditis with electric potential of impending arrhythmias.

Most common cause of death is ARDS/MOD followed by myocarditis with sudden cardiac arrhythmias.

CT chest w/o contrast picks up ground glass infiltrates bilaterally ,which has high sensitivity for covid ,while we are waiting for Nasopharyngeal swab test results which is more specific .

Chloroquine has used as 500 mg bid for 10 days for treatment .

Hydroxy chloroquine was used in post exposure /ICU level patients ,used only if corrected QT is <450 msec.

Neither chloroquine nor hydroxychloroquine are adviced/used as prophylaxis and no study has been done so far .

Also China did not use macrolides ,hence we don’t know the benefit of it yet.

Monoclonal Ab to IL6 is used as treatment with benefit .

N acetyl cysteine use in BAL has been beneficial.

Use of Pulmizyme in broch is under trial

The strain pattern of USA is 16% different from Wuhan strain ,Italian strain is 16% different than Wuhan (but seems to be more virulent )

Indian strain 17% different but seems to be less virulent strain .

Kaletra has been proven of no benfit.

Remdisivir is under randomized controlled trial and the results are promising .

Hyperimmune IG will be available in 6 months .

Convalescent sera from infected patients could be available in 3 months .

Ok to use N95 mask for 8 hours and could be reused after oven sterilization for 25 minutes in 280degree Fahrenheit.

Ok to clean the face shield with alcohol wipes between patient encounters and use it for a day.

Both face shield and N 95 respirator should be carried in a paper bag.

Adviced to add a surgical mask on top of N95 mask .

Patients with abnormal CT chest requiring intubation are 50 -60 percent , those needing ECMO in addition are 10 -20%.

There’s are no reports of reinfection ,but there could be relapses .

Daily labs with worsening lymphopenia,lactemia and raising IL6 and CRP are noted to be bad prognostic markers ,while worsening transaminases were observed to be more so from drugs than the disease progression itself .

Hope this is helpful .

Stay safe all.

Let’s battle this together .

Prayers !

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