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With input from Dr Monica Vasudev
1065: Minutes of Virtual Meeting of CMAAO NMAs on “Asian countries update – Formula of Six”
22nd August, 2020, Saturday, 9.30am-10.30am
Participants: Member NMAs
Dr KK Aggarwal, President CMAAO, Dr Yeh Woei Chong, Singapore Chair CMAAO, Dr Marthanda Pillai, Member World Medical Council, Dr Alvin Yee-Shing Chan, Hong Kong, Dr Marie Uzawa Urabe, Japan, Dr Md Jamaluddin Chowdhury, Bangladesh, Dr Prakash Budhathoky, Nepal, Dr Subramaniam Muniandy, Malaysia
Invitees: Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia, Dr S Sharma, Editor IJCP Group
Key points from the discussion: Six things to remember in COVID-19
If you do not have Covid-19, ask yourself
- “Am I at risk”? Age, sex (males more at risk), am I vaccinated (flu, pneumonia, MMR, BCG), do I have any comorbid condition, am I immunocompromised, is my profession high risk e.g. healthcare worker dealing with microdroplets.
- “Is my environment at risk”? My room, my office, travel, kitchen, drawing and dining table, toilet – are they well ventilated or not.
- “Am I prepared”? Who will be my treating doctor, which hospital if I need admission, do I have stand-by oxygen, first aid box, notification (who should I notify), which lab for home test?
- “What do I do if I get it”? Do I need to isolate/quarantine/inform contacts, interpretation of rapid antigen test or RTPCR; start observing for symptoms; start treatment for Day 1.
- Observation days:1-6 days (watch for hypoxia complications), Day 9 (allowed to meet family), Day 14 (no quarantine), Day 28 (consider plasma donation), Day 40, Day 90.
- 0-9 days:Nutrition, 6MWT, cohort isolation, blood tests, tele consult, treatment.
- 9-90 days:Observe (for post-Covid symptoms), appeal, plasma donation, antibodies, antigen Ct value, nutrition.
Six things to do to tackle Covid-19
- During first 6 days (6am, 6pm) 6MWT, 6 parameters, 6 feet distance (ideal).
- 6 parameters:Shortness of breath, cough or difficulty talking, SpO2, increase in temperature, distance, and heart rate.
- 6 tests on Day 1:CBC with ESR, CRP, LDH, ferritin, d-dimer, IL-6.
- Six instruments at home: SpO2 monitor, peak expiry flow rate (PEFR), BP, thermometer, glucometer, smell, and taste.
- Six gene targets:E, N, S, RdRp, ORF 1a, ORF 1b; gene targets may remain in the body for about 120 days.
- Reception(whosoever visits my home): Jaggery (taste), rose (smell), wash feet/hands, namaste (greet), ask to sit a higher place (no face to face meeting).
- Decontaminate: 6 g bleaching powder in 900 ml water to make 0.1% solution.
- 6 Treatment options:Oxygen, plasma, steroids, heparin, antibiotics, antiviral.
Six things for prevention
- Contact time in last 48 hours, contact distance (was it less than 6 feet [ideal]), was the area cross ventilated, was the person wearing a mask and was the person coughing/sneezing.
- Appeals (ask for): Prevent, test, home (quarantine), cohort (two covid-positive persons can stay in isolation together), day 9, day 14 (stop quarantine, shift to monitoring).
- 6 ways to clean and sanitize:Soap, sanitizer, disinfectant, UV, ozone, air purifier
- 6 tastes: Astringent, bitter, pungent, sweet, sour, salt. In Covid-19, salt and bitter tastes are retained, while the rest are lost.
- Mistakes: Missing first case in your family, first cluster in your colony, first spread, misinterpreting antigen / antibody test, missing Days 1-3 (pneumonia develops on Day 3).
- 6 supplements: Vitamin C, D, B12, iron, zinc, thymosin alpha.
Six things about the virus
- Six different behaviours:Viral, bacterial, HIV-like, it causes immune-inflammation (antigen triggered), thrombo-inflammation and cytokine storm
- Six strains:L strain (original strain in Wuhan), strains S, V, G, GR, and GH.
- New definition:Acute manageable thrombo-immunoinflammatory disease with post-viral state
- The CDC has recommended maintaining a distance of 2 m (6 feet), while WHO has recommended maintaining a distance of 1 m (3 feet) as 2 m distancing may be difficult in developing countries.
- The third wave in Hong Kong is coming down from 114 new cases in a day in July to 18 cases per day now. Hong Kong will launch en masse population screening program to identify silent carriers; screening will be voluntary. Should the rules about social gatherings be relaxed is a dilemma because of apprehension of another wave of the infection, which might exhaust the resources.
- The first sero survey (done between June 27 and July 10) in Delhi showed 22.8% seroprevalence; the second sero survey (done in the first week of August) shows a seroprevalence of 28.3% (males 28.3%, females 32.2%, <18 years 35%, 18-49 years 29%, >50 years 31%).
- Seroprevalence is 51.5% in Pune; in Mumbai, it is 57% in slums and 16% in residential societies
- A study in Bangladesh conducted by the Institute of Epidemiology, Disease Control and Research and the International Centre for Diarrhoeal Disease Research, Bangladesh in Dhaka (RTPCR) has shown 9% of population in Dhaka has the infection.
- Nepal is testing for Covid-19 with Gene Xpert test for emergency cases; it has 100% specificity, but sensitivity is around 50%. RT PCR is the gold standard.
- Singapore is reaching the tail end of the outbreak in dormitories; community cases in the last week have been 0-2 in a day. Challenge is the next wave of infection, opening up of economy. Singapore is looking to open up travel to selected destinations.
- Malaysia has detected D614g strain of the virus (mutation of SARS-CoV-2 virus) in a cluster of cases, which has been termed as the “Sivaganga cluster”. The index case belongs to Sivaganga in Tamil Nadu.
- In Australia, all travel within the country has been stopped. Cases are coming under control in Victoria.
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA