With input from Dr Monica Vasudev

1569: HCFI Round Table Expert Zoom Meeting on “Consequences of COVID situation today”

17^th April, 2021, 11am-12noon

Participants: Dr KK Aggarwal, Dr AK Agarwal, Dr Suneela Garg, Dr Mahesh Verma, Dr Ashok Gupta, Dr Girdhar Gyani, Dr Anita Chakravarti, Dr Jayakrishnan Alapet, Dr DR Rai,

Dr Vinod Kumar, Dr Haresh Kapadiya, Dr Meenakshi Soni, Ms Balbir Verma, Mr Bejon Misra,

Dr KK Kalra, Dr Anil Kumar, Dr S Sharma

Consensus Statement of HCFI Expert Round Table

• Sutra 1:In view of the controversy of vaccine clots, consider low-dose (75mg) aspirin before vaccination in all women (hormone bearing or on HRT), if no contraindication.
• Sutra 2:Consider low-dose (75mg) aspirin in comorbid or high risk people with suspected or silent/confirmed vascular blockages, if no contraindication, before, during and after COVID or COVID vaccine.
• Sutra3: If not contraindicated, in high risk or comorbid COVID-confirmed or suspected persons, starting early low dose steroids (prednisolone 40mg) and blood thinners (aspirin or warfarin or NOACs) may not harm and may prevent complications. Steroids are needed for 10 days and blood thinners are needed for at least 4 weeks.
• Sutra 4:COVID inflammation is at its peak by Day 3; pneumonia also starts developing by Day 3. This is the time for CT scan also. CRP is at its peak by Day 3 (Th1 response).
• Sutra 5:If inflammation is not targeted by Day 5, it may lead to Th17 response, which is neutrophil recruitment leading to thromboinflammation.
• Sutra 6:You must control inflammation by Day 3 and thromboinflammation by Day 5.
• Sutra 7:Steroids must be started before Day 3 and anticoagulant must be started before Day 5.
• Sutra 8:CRP should be less than 5 by Day 5; if this target is missed, CRP should be less than 10 by Day 10. After that, the situation is bad.
• Sutra 9:Budesonide/fluticasone with salmeterol inhaler may be considered to be given in all COVID patients with lower respiratory symptoms, if not on oral steroids.
• Sutra 10:All diabetics when given oral steroids (not inhaled steroids) will have high postprandial blood sugar and will need sublingual oral antidiabetic drug in addition or insulin (0.3 units/kg/day in divided doses).
• The earliest marker of inflammation is CRP. It increases in 4 hours, peaks in 36 hours and crashes in 17 hours. CRP qualitative strip test like diabetes costs Rs 10 and glucometer like tests cost Rs 60. The market cost has increased from Rs 150 to Rs 1000 because of shortage. Qualitative test only tells if CRP is less than or more than 6.
• Sutra 11:In this COVID time, train people to do self test CRP at home and aim at making it negative.
• Day 1 is the first day of symptom or the day of diagnosis.
• Overdiagnose, over treat and overprevent in the present scenario.
• Sutra 12:Do CRP, CBC first and then PCR to prevent CPR.
• If CRP is positive, steroids, aspirin and anticoagulant on Day 1.
• Sutra 13:In view of the very high rates of vaccine and infection, high risk individuals should consider taking the second dose as soon as permissible to prevent post-vaccine COVID.
• Everybody should get at least one dose of the vaccine in the present circumstances.
• Sutra 14:Post-vaccine COVID: Wait for 8-12 weeks before taking the vaccine after testing negative.
• Sutra 15:Post-vaccine cough and throat pain cannot be due to vaccine; rule out COVID in such patients.
• Post-vaccine COVID can be primary infection or breakthrough infection (after 14 days of vaccine): more contagious, lower Ct value, early incubation period, high fever, lungs are often spared, very high CRP, cough and cold/GI symptoms, children are also affected and as spreaders, R0 value is high.
• Pattern: Very high CRP by Day 1-3, rising D-dimer by Day 2-3, falling platelets by Day 4-5 and then resolving (in most cases).
• CRP is a surrogate marker for IL-6 and fibrinogen.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA