Covid19 was declared a pandemic in the first quarter of 2020. Everyone’s lives changed. We, the doctors who were looked down upon by the public, suddenly found ourselves in the midst of a revolution wherein we began to take the role of leading the healthcare battlefields from the frontlines. We knew our limitations and scarily enough, the implications of jumping into the fray without the protective gear (PPE).
Being doctors ourselves, both my wife and myself knew that it was dangerous to venture outside the safety of our home. We had been taking precautions from the time that lockdown was declared. We were also taking HCQ prophylaxis, however being a gynaecologist, my wife had to attend to a few emergency surgeries and that was when the inevitable happened. The following is the set of events that will showcase the tough battle that she faced against her invisible tormentor – “`Covid19“`
• _On day 1:_
She had fever up to 100 F with a feeling of malaise.
• _Till day 3:_
A spike of fever up to 100 F continued. Since she was feeling better on taking Paracetamol, we felt it was a case of a simple viral infection.
• _On day 4:_
A fever spike went up to 101.7 F. She also complained of total anosmia along with severe fatigue which led us to suspect the silent killer – Covid19. We decided to self quarantine her.
While being in self-quarantine, she took HCQ 200 mg BD (to complete 5 days course) and Tab Ivermectin 12 mg BD (2 days course) along with 1000 mg Vitamin C and 100 mg Zinc.
• _On day 6:_
Fever spike went up to 103 F. We decided to get her tested by RT PCR. Since the fever was increasing and being in the high risk category (age factor, though no comorbidities), our friend and Infectious Diseases Specialist – Dr. Tanu Singhal – advised us to admit her. We followed the same and got her admitted at Fortis Mulund (Covid Ward). Her CBC was having leukopenia TC 3400 with lymphocyte 37%, CRP 15( normal less than 10 ) LDH and d Dimer slightly raised , so she was put on IV methyl prednisolone and low dose Inj Clexan . Her CT scan on admission showed minimal changes in the lung.
• _On day 6 to 10:_
Fever disappeared from the time she got admitted and she was generally feeling much better. Her repeat CBC remained same and CRP came down to 8 and so discharge was planned on next day.
• _On day 11:_
They repeated CRP before planning to discharge but it had increased to 16 and so was advised to be there for one more day.
• _On day 12:_
Repeat CRP test indicated that it had increased to 81 even though clinically she was feeling fine. So repeat CT done was done, which showed moderate changes and groundglassing. In the late afternoon the SaO2 on 3 min walking went down to 90. She was immediately put on O2 – 2 to 3 lits – by nasal prongs and was advised proning. At night She was also shifted to ICU to start Inj Remdesivir (the pros of which outweighed the con – which was a slight effect on the liver which was easily reversible). There was also a strong suspicion of the start of a cytokine storm thereby contemplating to put her on Inj Tocilizumab (which can suppress immunity leading to increase in viral replication and also increase the chance of secondary bacterial infection by 20%). To avoid all of these, she was put on Inj Remdesivir and Inj Meropenam.
• _On day 13:_
CRP shot up to 222 and though other reports like IL6 , d Dimer were awaited , because she was desaturating without wasting much time Inj Tocilizumab 600 mg (@ 8 mg per kg) was administered at once. After some time, the IL6 report came – which was, as suspected, high. All throughout this, Inj Methylprednisolone and Inj Clexan along with HFMO(highflow O2 @ 60 lit per min. fiO2 of 0.6%) and proning continued. (HFMO is better because of less dead spacing compared to intubation and mechanical ventilation.) In the meantime, it was noticed that the sugar levels had also shot up to 250. To counter this, Inj insulin was added. After all these it was noted that P/F ratio was remaining at 100 (which otherwise is expected to be 150 or more) and She was finding it difficult to remain in prone position for longer duration, and so intubation was contemplated. Having a fear of intubation, she somehow managed to remain in prone position for longer durations and P/F ratio started improving after 24 hrs of Inj Tocilizumab and High flow O2 with proning.
Totally after 10 days of admission which included five days of Inj Remdesivir, 3 days after single dose of Inj Tocilizumab , 5 days of highflow O2, 10 days of Inj methylprednisolone and Inj Clexan , she showed improvement in oxygen saturation levels, and also improved clinically and radiologically. She was shifted to ward for 3 days under observation wherein the external O2 and injectables were stopped. Ultimately she was discharged after spending 15 days in the hospital with advise of proning, respiratory exercises with spirometer and rest.
I am forever grateful to Dr Rahul Pandit, Dr Anita Mathews, Dr Kirti Sabnis and all the frontline health workers of Fortis Mulund.
Of course other than the timely advise (to get admitted) from Dr Tanu Singhal, God’s blessings and prayers of all of my friends, family and extended family of IAP helped her speedy recovery and gave me the strength from time to time. Thanks to all of you. I am happy to be a small part of this huge family and will remain obliged to you all, throughout my life.🙏🙏🙏
Dr Bakul Jayant Parekh
National President IAP