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With inputs from Dr Monica Vasudev
956: Round Table Expert Zoom Meeting on “Mortality reduction in Covid-19”
20th June, 2020
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