Few Observations from covid wards

Hydroxychloroquin is useful in prophylaxis of covid.

It’s found that Those who are on Hydroxychloroquin either don’t get covid or even if they get the disease runs a milder course in them.

Proper PPE kit is must in covid ward .Also poper Donning & Doffing is required. Good infection control protocol should be in place.

High chances of contracting covid if one has regular outdoor Work but Covid is contracted even if one has stay put indoor & follows 99% precautions. That 1% lapse is sometimes enough to catch covid.

It easily catches those 70 & above even if they are at home.

Diabetes is common comorbidity

Overweight & obesity is a risk factor in running a moderate to severe course of covid

Hypothyroidism is another common comorbidity

Covid runs a milder course in individuals who have lived a healthy lifestyle like balanced diet,yoga,regular cardiac exercise.

Covid incidence is higher in lower socioeconomic class

The reason may the overcrowded living conditions, sharing of toilets,inadequate hygiene precautions.But the recovery rate in this group is good as compared to higher socioeconomic class may be they have cross immunity because of greater incidence of malaria , dengue & other viral infections

Covid runs a moderate to severe course in higher socioeconomic class as obesity,Diabetes,

Hypertension,Hypothyroidism & Cardiac disorders is common & they have stressful life ( because of overwork )

Severe Addictions like smoking & alcohol is adverse factor.

Loss of only taste or smell sensation is one of the presentation in some. Possibly in those who have Healthy lifestyle & good immunity.In them diseases doesn’t run a further course .

Fever is a common symptom Often the history of fever is only for a day or two.In few patients it can be prolonged .In few patients it can be high grade.

Loss of appetite is bothersome

Severe weakness is common

Bodyache ,low back pain is also observed in some.

Happy hypoxia is a very peculiar

Sign. Patients have 88 – 90 saturation but are stable at rest on bed but moment they exert for say toilet they feel shortness of breath .

Dry non ptoductive cough is a symptom.Some have only throat irritation.

High sugar in not previously diagnosed diabetics is common

Diabetes becomes difficult to manage as covid causes sugar to rese & these patients

are on steroids

These patients remain bed bound in hospital as one is not allowed to move out of room , still DVT is uncommon in them.

one reason is quite a few are on Low molecular Weight Heparin &

other is lack of ACE 2,receptors in lower limb vasculature.

Lung thrombosis & exaggerated immune response to the virus is the cause of Covid pneumonia .

Pulmonary embolism is common

In those who have moderate to severe disease .,CTPA should be done in indicated patients.

High D – Dimer in multiple thousands is poor prognostic sign .

Positive attitude of patient is very important in recovery .

Oxygen is the mainstay in treatment as hypoxia is common in majority of patients .

Pulse oxymeter is a vital tool on rounds

Auscultation, palpation, Percussion have become redundant atleast of now.

CRP is one of the best guide

IL 6 is another guide in whom

disease appear to run a moderate to severe course .

Tocilizumab is the saviour in cytokines storm But timing of using Tocilizumab is Vital .

PCT should be done prior to Tocilizumab .

The secondary bacterial & fungal infection after Tocilizumab becomes a headache

It becomes a challenge to come out of it.

Those poor patients in whom Tocilizumab can’t be used & maintained on IV steroids though take longer time come out of covid.

But in few cases who require NIV

Tocilizumab is must.

Remdesvir is good & possibly

helps to get patients out of danger but objective tally will give final answer.Liver function have to be monitored .

NIV is found to be superior to Invasive ventilation .

Mortality is very high who require Invasive ventilation

Those who require invasive ventilation are difficult to wean out.They require prolonged ventilatory support. Some times especially the elderly even if they are weaned off & extubated they require reintubation in a day or two as they suddenly start gasping .

Sudden cardiac arrest in critical patients is another worrying thing

Possibly arrhythmia due to myocarditis .

Renal involvement is seen but not common .

Low albumin is another finding

Tocilizumab also causes low albumin .

Fabiflu is new entrant

It can be be used if patients presents early. Patients are presenting early as there is greater awareness ,easy accecibility of test & availability of antigen test .

Elevation in uric acid level is possible but it’s not a big issue

If Fabiflu proves it’s worth

It may in future can be used like Tamiflu on OPD basis & good number of patients will be treated on OPD basis .

Whether Lopinavir Ritonavir combination is superior or not is

a dialemma.

One reason for poor prognosis can be lack of adequate antibody response in some patients

Plasma therapy can help these patients .

CT scan is useful in early diagnosis.,Some patients are first diagnosed on CT scan & then the

Covid test is done which comes positive .Ground glass opacities are seen on HRCT chest

CT scan also helps in knowing the stage of the disease.

Patients with 70 – 80 % involvement of lungs have on CT scan have bad prognosis .

Patients with extensive lung involvement heal by fibrosis.

Surprisingly fibrosis sets in early

These patients with fibrosis continue to have hypoxia. Some at rest,some on exertion.They require home oxygen therapy.

Spirometry , Respiratory physiotherapy.

The vaccine may change the scenario.

Covid is going to stay, there is no point in hiding . Take all precautions & live life with new normal.

– Dr.Jaiprakash Pednekar

jbpednekar@gmail.com

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