With inputs from Dr Monica Vasudev

956: Round Table Expert Zoom Meeting on “Mortality reduction in Covid-19”

20^th June, 2020

11am-12pm

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; however, there are no answers as to why. The answer may lie in different clinical presentation.
• Careful treatment and educated patients may reduce mortality to less than 0.2%.
• We must learn from our experiences. Lessons learnt over the course of the pandemic may reduce mortality.
• 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 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.
• Use of steroid (injectable) may reduce hypoxia.
• Every ER should have an Airborne Infection Isolation (AII) room; this should be a part of SOP. If no AII room, then every ER should have air purifier with at least 10 air 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, restaurants, 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 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.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA