With input from Dr Monica Vasudev

1276:   Minutes of Virtual Meeting of CMAAO NMAs on “Lessons learned from COVID-19 in 2020”

26^th December, 2020, Saturday, 9.30am-10.30am

Participants: Member NMAs: Dr KK Aggarwal, President CMAAO, Dr Marthanda Pillai, India, Member World Medical Council, Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association, Dr Marie Uzawa Urabe, Japan Medical Association, Dr Prakash Budhathoky, Treasurer, Nepal Medical Association

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

Key points from the discussion

• The pandemic has taught us the significance of cell and plant physiology.
• It has taught us the anatomy of the thymus, the structure of the virus and the behavior of the virus.
• We are shifting back from closed to open environment.
• It has introduced a new terminology “inflammatory lifestyle”.
• There are two types of blood clots – white clots and red clots. COVID-19 has helped to understand the difference between the two.
• Rising CRP on Day 4 is a sign of continuing inflammation.
• Overtreatment can lead to mutations.
• The pandemic has taught us risk triage to reduce mortality.
• In dengue, SGOT levels are more than SGPT, but now may also be due to coronavirus infection.
• This pandemic has brought back conservative approaches. Streptokinase (STK) is back.
• There are two types of fever: Viral fever due to IL-6 (thermoregulatory dysfunction) and pyroptosis fever due to IL-1β.
• Negative symptoms: Lymph node enlargement (other than mesenteric lymph nodes), effusions, joint involvement, hoarseness of voice rule out coronavirus infection.
• Rising D-dimer, reducing platelets and reducing LDL are markers of thrombosis.
• COVID-19 has highlighted the importance of postprandial sugar. In these patients, postprandial sugar will increase first.
• Fever more than 101, CRP>10 and ground glass opacities on CT scan are markers of pneumonia.
• CRP is a marker of inflammation.
• Bring CRP to less than 1 before, during and after the infection.
• ESR is not important in the acute phase. It is important for recovery.
• This pandemic has taught us the importance of subclinical diseases (thyroiditis, myocarditis).
• Ct value on RT PCR is useful. The Ct value for the new UK variant is lower.
• It has redefined contact as cumulative exposure time and not one time exposure.
• It has taught us the advantages of prone ventilation/sleeping.
• Typhoid antigen can be false positive in COVID-19.
• A person who has tested negative on RT PCR may still have acute thrombotic events after 1-2 weeks due to delayed immunological reaction.
• Persons with proven re-infection do not have neutralizing antibodies.
• Cellular immunity tests (T cell tests) are now coming in the US.
• We now know that faster development of vaccines is possible.
• Isolation, quarantine and monitoring became familiar terms.
• We learnt the significance of correct, consistent and continuous use of facemasks.
• Face to face interactions have the risk of spread of the virus.
• We learnt the importance of bitter and astringent foods in diet.
• Loss of smell and taste are important symptoms of COVID-19.
• Other systemic locations aside from lungs are involved: Eyes, skin, GI, heart, blood, liver.
• Left eye conjunctivitis in this time is corona unless proved otherwise.
• Various terms like emergency use authorization, vaccine hesitancy, consortium, broader good came to be known.
• Adult vaccination, vaccination priorities, vaccine storage temperature (-70 degree vs 2 degree) became the points of discussion.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA