With input from Dr Monica Vasudev

1277:   HCFI Round Table Expert Zoom Meeting on “Round up Activities Year 2020”

2^nd January, 2021, 11am-12pm

Participants: Dr KK Aggarwal, Dr JA Jayalal, Dr Shashank Joshi, Dr Jayakrishnan Alapet, Dr Girdhar Gyani, Dr Anita Chakravarti, Dr Ashok Gupta, Dr Atul Kochhar, Dr DR Rai, Dr Balbir Verma, Dr Girija Krishnan, Dr UK Priyadarshi, Mr Bejon Misra, Ms Upasana Arora, Dr KK Kalra, Ms Ira Gupta, Dr S Sharma

Consensus Statement of HCFI Expert Round Table

• The pandemic has taught us one marker “C-reactive protein”. Bring your CRP to less than 1 before (prevent), during (treat) and after (follow-up) COVID.
• For the first time, contact has been defined as cumulative exposure time and not one time exposure.
• Terms like isolation, quarantine and monitoring were talked about again. Isolation may be the answer for eradication of disease like MDR TB, streptococcal sore throat, measles.
• Foods which are bitter and astringent are anti-inflammatory.
• We learnt the importance of correct, consistent and continuous use of facemasks.
• From cough etiquettes, we have also come to realize the significance of washroom etiquettes as washrooms are a source of aerosols.
• Importance of SpO2 monitoring and 6 minute walk test (6MWT) was highlighted. 6MWT will now be extensively used in asthma, COPD, ILD, respiratory failure and heart failure. SpO2 monitoring will make home management simpler.
• We are going back from closed environment to an open environment (Nightingale wards) in hospitals.
• Face to face interactions have the risk of spread of the virus; shift from handshake to Namaste.
• There are two types of fever: the IL-6 fever, which resets the biological clock; another fever is the cytokine fever. The cut-off is 101. The two types of fever need to be differentiated.
• A viral disease can also have subclinical presentations – thyroiditis, myocarditis, cholecystitis, appendicitis, etc.
• Five systemic locations, aside from lung (primary location) - eyes, skin, GI, heart, blood, liver - are also the sites of inflammation.
• COVID-19 has primary symptoms and symptoms due to thrombosis.
• Left eye conjunctivitis in this time is corona, unless proved otherwise.
• If fever with relative bradycardia, think of COVID-19. Typhoid antigen can be false positive in this time.
• Negative symptoms of lymph node enlargement (other than mesenteric lymph nodes), effusions, joint involvement, hoarseness of voice rule out coronavirus infection.
• CRP is a surrogate marker of IL-6 and fibrinogen and D-dimer. It rises in 4 hours, doubles every 8 hours, reaches its peak in 36 hours and crashes in 17 hours.
• ESR is not important in the acute phase. It is important for recovery.
• Ferritin is not as reliable in India as many would already have low baseline ferritin because of anemia.
• Rising D-dimer, decreasing platelets and decreasing LDL are markers of severe thrombosis.
• Fever more than 101, CRP>10 and ground glass opacities on CT scan are markers of pneumonia.
• Postprandial sugar will rise in COVID-19; fasting blood sugar may be normal.
• If Ct value on RT PCR is less than 30 and the person has returned from UK, check for the new UK variant.
• Start antiviral drugs before day 3. If started late, mutations may result.
• For the first time, we have come to know that acute pulmonary fibrosis is reversible in the first month in 70% of corona patients.
• Look for corona, if SGPT is more than SGOT. Up till now, this was a finding in dengue.
• Rising CRP on Day 4 is a sign of continuing inflammation.
• Start early and hit hard in thromboinflammation.
• Bring CRP to baseline by Day 4.
• It has taught us risk triage to reduce mortality.
• Pyroptosis pathways – NLRP3 pathway and nuclear factor NF-κB pathway – have become more important now than IL-6.
• Conservative approaches, e.g., streptokinase (STK) are back.
• Non-S antibodies with high CRP, these are binding antibodies.
• It is possible to have rapid clearances; it is possible to develop a vaccine in one year. This is possible if data is simultaneously analyzed by regulators.
• It is possible to have emergency use authorization (EUA) after phase 2 trials of a vaccine.
• For the first time, children are a last priority for vaccination.
• The pandemic has taught us the significance of cell and plant physiology.
• It has taught us to revisit the anatomy of the thymus, the structure of the virus and the behavior of the virus.
• It has introduced new terminologies “proinflammatory lifestyle”, “prothrombotic lifestyle” or “non-inflammatory lifestyle”.
• It told us the types of cell death, the importance of self vs. non-self and neutralizing vs. binding antibodies.
• It taught us about virus spreading behaviors and also about negative pressure rooms.
• There is a need to emphasize the need for increasing budget allocations for health infrastructures.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA