This article deals with allotted topic in three parts; Learnings as COVID patient; as a healthcare provider and some general learnings.
I am a surgeon with an office type surgical suite with 3 recovery beds on the ground floor. My chamber is in the basement which also has the patient reception along with a dressing and treatment room. All our staff had been instructed to wear masks and face shields, I used to remove my mask whenever alone as it was uncomfortable and a possible reason for breathlessness considering the high quantity of sanitizers in the atmosphere. I am nondiabetic, non-hypertensive with ideal body weight. I got the infection from a patients’ relative who had been allowed entry after checking for absence of fever. He spent the first few minutes to explain a false personal complaint of backache, and then started asking about his wife and son who did have the same and were denied entry. As a result, a good 15 minutes was spent in a closed room with an asymptomatic person. Three days later, he telephoned to inquire further about his wife who had been described to have pneumonia on a Chest X Ray. By this time, I had started coughing along with a feeling of mild breathlessness i.e. only on climbing 3 flights of stairs. I got the RT-PCR test done on 2nd June and was reported positive 2 days later. My staff nurse, who also had symptoms, tested negative.
I home quarantined. Since my wife was the only some other person in the house, we decided that there was no need for separate rooms though we did keep the mask on along with general hygiene measures. I was already on HCQS and AYUSH care (Item 8f below). I started Ivermectin 12 mg for 3 days and Aspirin (75 mg) plus Clopidagerol (75 mg) as anticoagulant along with steam inhalation for sore throat. The sore throat got converted to a full-blown URI, but I never had fever and my SpO2 levels never dropped. Fatigue became severe. On 10th June i.e. 12 days from the onset of symptoms, I miraculously recovered after a good nights’ sleep. I was given an official discharge from home quarantine on 20th June. Interestingly the same day, my local area was declared a containment zone so I could restart formal activities only on 20th July i.e. 7 weeks after onset. One interesting symptom, not specifically described anywhere as far as I know, was a burning sensation in my feet experienced whenever both my feet touched each other, for example sitting cross legged under a fan. I wondered if it could be due to aspirin as I noticed this problem after I started medication. However, this symptom as well as the cough persisted for two months despite stopping all drugs by day 15. I have shifted my chamber on to the ground floor and do not use the AC there. Faster air circulation in the operation theatre as well as the entire basement has been ensured through exhausts. We are working to capacity with confidence that a recurrence is now unlikely. We start with the personal experience of undergoing an episode of COVID. Some general observations and possible conclusions. These are in no particular order.
- Since there was zero immunity for a variation of the flu obvious mutation, there is little chance for anyone to escape an episode.
- Despite the initial occurrence from China, incidence has been lower in South East Asia as a whole. These are the same countries which had undergone SARS and H1N1 etc.
- Person in underdeveloped regions have shown better resistance. Even if the symptoms occurred – countries with higher level of testing show higher rates, the death rate is far lower. It could be due to a lower average age of the population or better immunity.
- Most cases are mild or even asymptomatic but do contribute to spread of the pandemic. The viral load at the time of initial infection is important
- Contact in closed environments makes spread more likely
- The complete lockdown has had definite socio- economic ill-effects, but India was spared the initial spread of the virus which devastated large parts of Europe and New York. We did get time to prepare better. However, the time for preparations was not well utilized.
- Even when Corona cases increased later there has been concomitant fall in mortality due to other reasons. A fall the number of road accidents – a cause for an average 1.5 lakh mortalities per year[i] and lower pollution levels helped. Our case rate has risen 20-25 times from the month of May, but death rates rose from 200 average to 1000 per day![ii]The chalta hai attitude of Indians has to some extent been replaced by an inculcation of discipline. We constantly wear masks, our streets are cleaner, garbage disposal is the norm. Road traffic is more orderly.
- We all realized that our lifestyle was highly polluting. Work from home is possible in many vocations. Telehealth and online meetings got a big boost, not with standing a webinar pandemic. Ability to conduct webinars on the fly has also created many self- styled experts on every topic (Maybe this author is one of them!)
- Now we all understand that the pathogenic factors contributing to mortality in Corona virus infections have been indirect. These are in the form of Intravascular Thrombosis and cytokine storm, a common ground for the wide variety of presentations. Whether the lung lesions are only indirectly related to either pulmonary embolus or cytokine storm remains to be a matter of debate. Prevention of these is important.
- A clear treatment plan has emerged – which is. Investigate early and to the hilt
- Prevention of spread to others through masks and hand washing is especially important from the patients’ side
- Asymptomatic people are more likely to spread than those with symptoms
- Monitoring of fever and SpO2 levels is important with relevant rules of home quarantine
- Hydroxy-Chloroquine (HCQS) had been recommended initially for prevention as well as treatment, but now the focus has shifted to Ivermectin. A triple therapy (Ivermectin + Doxycycline + Zinc) has been shown as a possible method to free Australia of COVID[iii]
- It is important to build up the Immune system.
- an AYUSH ministry note recommends warm Medicated water (kahwa) with Basil (tulsi -4 parts), Cinnamon (dalchini – 2 parts), Dry ginger powder (soonthi- 2 parts) and black pepper seeds (kali mirch – 1 part) 3-4 times a day
- Yoga (deep breathing – make sure intermittently to reduce your breathing time to
iii. Vitamins B, C, D (Sunshine) and essential minerals especially Zinc
- Need for blood thinners
- Need for early use of steroids rather than when the cytokine storm is full blown
- Similarly, use of plasma and other anti-viral drugs may possibly benefit before the auto- immune reaction has been triggered
- The rush for ventilatory support in the initial months had been inappropriate. It offers little benefit to the patient[iv] and a cause for harm in the form of permanent lung and even nerve damage[v], Also, ventilators and ICUs may contribute to high aerosol related spread of the virus. In the interim many healthcare workers suffered. Better PPE kits helped diminish the ill effect. Mortality is higher in doctors running their own clinics as well as those in government facilities – probably the protection there is less[vi].
- Full PPE kits are only required for high risk environments like when testing or confronting a patient with an open mouth, ICUs, and operation theatres. Spread by fomites and food etc. has been overrated.
- Role of sanitizers needs to be downgraded. Fires have occurred due to high alcohol content in the ambient atmosphere. Hand washing is far more important despite being less convenient
- The bad side of humanity has also come to the fore Many products bought in a hurry to prevent Covid – read sanitizers, masks, PPEs, Digital thermometers have had quality issues
- The role of unproved remedies especially expensive anti-viral drugs is not only doubtful, but also a harbinger of how the corporate and pharma sectors try to push products by less than ideal methods There has been a rush to publish and create evidence– even high-quality journals like Lancet have fallen prey[vii].
- Frequent changes of stance by WHO and many others including governments raise deep suspicion
Covid by itself does not signal the end of the world. It is something which needs to be endured. It has shown that nature remains supreme, whatever euphemism may be used in place of nature – God for example! We can survive and build a better world.