With input from Dr Monica Vasudev

1071:  Minutes of Virtual Meeting of CMAAO NMAs on “Covid-19 Update”

29^th August, 2020, Saturday, 9.30am-10.30am

Participants: Member NMAs

Dr KK Aggarwal, President CMAAO, Dr Marthanda Pillai, Member World Medical Council, Dr Alvin Yee-Shing Chan, Hong Kong, Dr Prakash Budhathoky, Nepal

Invitees: Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia, Dr S Sharma, Editor IJCP Group

Key points from the discussion 

• Three acute phase reactants– C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR) and Interleukin-6 (IL-6). In a resource-limited country, CRP is the best choice amongst the three. It is an indicator of intensity of inflammation. CRP cannot rise without increase in IL-6. When CRP is raised, presume that the d-dimer is high.
• We do not know how China with a higher population density than India has managed to control the disease. Mortality is 3 per million; new cases are 9.
• Antigens of various diseases such as typhoid, malaria, chikungunya, and dengue are false positive in Covid-19.
• “All overseas players and support staff underwent two COVID-19 RT-PCR tests before flying into the UAE and could fly only if the tests were negative. If not, then the same 14-day quarantine period and two negative tests was needed to be able to fly to the UAE. The players and support staff will be tested on Day 1, Day 3 and Day 6 of their quarantine in the UAE and after clearing that, they will be tested every fifth day during the 53-day event.” Instead of three tests, pooled testing of the teams can be done daily.
• Oxygen administered without anticoagulation has no significance. Aspirin/anticoagulation must be given. For cases under home care, rivaroxaban (10 mg prophylaxis) can be given in place of Low Molecular Weight Heparin (LMWH); it is cheaper, can be taken by the patient, onset of action is 10 hours.
• According to a Times of India report, 87,000 healthcare workers in India are infected with COVID-19; there have been 573 deaths; 74% cases and over 86% deaths are from six states: Maharashtra, Tamil Nadu, Delhi, West Bengal, Gujarat and Karnataka. The numbers projected seem to be very high and need to be checked.
• Doctors have a high viral load so have higher chances of developing hypercoagulable state. Should prophylactic anticoagulation be initiated on Day 1 of the illness itself for doctors/HCWs?
• There are three phases of the illness: COVID (1-9 days, infectious phase), post-COVID (after 9 days, non-infectious, persistent inflammation) and non-COVID (after 3 months). After 3 months, the patient should be treated as non-COVID, instead of post-COVID. However, this comes laced with medicolegal aspects.
• In Hong Kong, the third wave is partly controlled. There have been less than 20 cases per day for the last week or more. One-third of confirmed cases have no known source of origin; so the chain of spread of infection is not known. Universal community testing scheme will start from 1^stSeptember to find out silent carriers. The Hong Kong government has agreed to expand to high risk group tracing and testing even with universal testing. With opening up of economy, better monitoring of industries is mandatory, to ensure there is no fourth wave. The third wave began with 9 cases with mutated virus strain (d614g). At that time, sailors coming to Hong Kong had been exempted from testing and quarantine; also restrictions of social distancing were relaxed. This created the third wave.
• Reinfection: A person from Spain tested positive in March then became negative reached Hong Kong and tested positive again in July. This raises a question whether this virus can re-infect. It was a mutated virus with 24 gene differences. It formed antibodies quickly, caused no symptoms and no serious manifestations and disappeared early. We need to be vigilant about this. People in post-COVID phase getting recurrent corona-like illness may be getting re-infection with a different strain.
• Another case of re-infection reported in the US; a young person who had severe symptoms and required oxygen and assisted breathing in the second infection.
• A study from Mumbai has reconfirmed the US study that antibodies do not last for more than 3 months.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA