Dr Shashank Joshi, head of the covid response team in Mumbai, has coined the word covidology for the learning gems from corona experience. He is the man responsible for increasing the doubling time in mumbai to 28 days ( national average is 15 days) thus flattening the curve in Mumbai.
In his discussion with Dr K K Aggarwal of Delhi covid team the following gems were picked up by me today.
Sharing with you.
1. Loss of smell and taste ( to sweet and salty only. Khatta taste remains) occurs in 30–32% of patients and in current times is as accurate as a covid RT PCR test to diagnose covid infection.
This is associated with excellent survival and fast recovery so don’t make a patient waste money on tests. Just quarantine, treat oral drugs and monitor spo2.
2. ZERO LYMHOCYTE SYNDROME. This is observed by Dr Shashank in Mumbai. Whenever zero or less than 5% lymhocyte count, means AIDS like response to the virus so antiretroviral drugs Lopinavir and Ritonavir used for aggressive treatment.
3. NEWER DRUGS LEARNING IN COVID. When antivirus drugs fell short and prolonged QT prevented use of Azithromycin and hcqs combination, the following combinations proved effective in Mumbai
(A). Tab Ivermectin 12 mg once a day for 5 days or Tab Nizonide 500 mg BD for 5 days. In combination with
(B) Doxycycline 100 mg BD for 5 days.
( C) Tab vitamin C 1000 mg daily for 28 days.
(D) Tab vitamin D 60 k units od for 3 days.
(E) Tab Zinc 100 mg daily.
4. If CRP more than 100 or fall in spo2 after a 6 minutes walk, methylprednisolone 40 mg BD, IV or oral, saved a lot of patients from ventilator in Mumbai.
5. Inhaled steroid added on 7th day helped in reducing dyspnea in Mumbai and being published.
6. As covid produces an inflammatory response paracetamol is not effective in reducing fever or myalgia. Indomethacin, Naproxen, Meftal and Nimesulide– in that order, helped best even reducing need for steroids in moderate to severe cases.
7. Since thymus gland is active, children below 10 years never get a severe disease and recovery is fast.
8. Fever can last upto 21 days. However patient is non infective to others after 10th day even if covid test is positive ( shows covid particles) as virus does not replicate after 10 days. Fever is positive due to post infective inflammation. However after 14 days look for a secondary infection and treat with second antibiotic if procalcitonin positive or CRP rises even if leucocytes not increased.
9. Sleeping for 8 hours daily during the infection was found to be associated with faster response due to slowed viral replication hence prescribe sedatives for sleeping and reducing anxiety.
10. In patients with moderate to severe disease prescribe atorvastatin 10 mg and Aspirin 75 mg even on discharge to reduce thrombotic and cardiac events. 24% patients have echo change of cardiac involvement.t
11. Low molecular weight heparin is standard of care in hospitalized critical cases.
12. In the Mumbai study highest specificity was with loss of smell and taste. Next was HRCT finding of ground glass appearance.
13 pharyngeal swab for RT PCR is best done on days 5–10 of infection.
14. In people living in flats chance of family members getting infection is 40—50% . In Bungalows or spacious houses 5—10% chances of transmission to family members. Density infects.
15. In 1918 Spanish flu led to mass scale implementation of burkha in Muslim and ghoonghat in Hindu communities. Now covid is leading to face mask— probably part of our lives for atleast a year more.
Dr Anil Dhingra.