COVID-19 : What You Should Know | Dr. Sujata Chatterjee - Songoti | English

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Tuesday, May 12, 2020

COVID-19 : What You Should Know | Dr. Sujata Chatterjee

Corona Virus is SARS COV 2 Virus causing the disease COVID-19. It is a RNA Virus with crowns on its surface, hence the name CORONA. Formerly it was a virus causing disease in bats, but now after series of mutation, it is affecting humans as well. More mutation has resulted in human to human transmission. 

Dr. Sujata Chatterjee

COVID - 19 is a disease which has the potential to affect the lung tissues and cause pneumonia. The symptoms are like influenza, cold, cough and fever initially and then progresses to shortness of breath, after affecting the lungs. It spreads via droplet and so everyone is advised to wear masks, when they are outside their homes.
Social distancing is a must and there should be at least 3 ft distance with another person outside your home or in hospitals, while seeing patients. Any gathering where there are more than 5 people should be strictly avoided. Visit to temples, churches, mosques, malls, cinema halls are strictly forbidden. All travels must be postponed till further advice.
There are 4 stages of COVID-19.  First there is 1 individual who infects 2 persons R1,who in turn infects 4, R2,who will infect 8. After this stage is the second stage, where infection spreads to the contacts. The third stage is the community spread and lastly the pandemic.  India is at present in the second stage. To arrest the virus at this stage, social distancing, home quarantine and isolation is required.

Dr. Sujata Chatterjee at field

Washing hands with soap and water for 20 secs is advised. Corona virus is insoluble in water, but when soap is added, the outer cytoplasm with the fat layer and the crown disintegrates and dissolves in water. This is why, washing hands with soap and water is essential every 20 minutes. Same thing happens with alcohol. Rubbing hands with hand sanitizers also produce the same effects.
When you sneeze and cough, do it in the inside of your elbow, so that the hands are protected. Healthcare providers are asked to wear the PPE before confronting any suspected case of COVID-19. 
The antimalarial drug Chloroquin and hydroxychloroquin has been found to raise the ph of the target body and thus inhibit the Corona virus from invading the humans. But it has not yet been approved. It should be available only on prescription by a registered medical practitioner. Dose is monitored. Please avoid taking the drug over the counter as combining it with Azithromycin causes increased QT interval and heart problems.
No vaccine is available against this disease as,there is no antibody against the virus in humans, since it was found in animals initially. Vaccines trials go on for more than 12 months to 14 months before their efficacy and safety is proved.
Elderly patients with comorbidities like Diabetes, Hypertension, Cancer and Asthma are more susceptible to COVID-19, as they are immunocompromised. 
We hope that in coming months, we derive a total containment against the virus by social distancing.
[9:47 pm, 07/05/2020] Sujata Client: Initially it was thought that COVID causes influenza  like symptoms leading to pneumonia. Now it is said to affect the hematopoietic tissues and replace iron from haem  and itself combining with haem and producing CO poisoning like symptoms like methhaemoglobinaemia. Also it affects the clotting system and produces thrombus (clots) in the multiple organs, specially lungs. This is a DIC (disseminated intravascular coagulation) like symptom. Those patients taking aspirin may benefit. Patients are also benefitted by the donor plasma. This clotting phenomenon in the multiple organs, leads to multiple organ failure and ultimately sepsis and death.  Recently a vaccine has reached human trials in 3 centers in UK. India is also participating in this vaccine trial. It is called CHARDOX-1 . Germany and China is also participating in this vaccine trials. AIIMS Director Randip Guleria has said that the COVID-19 peak may occur in the month of June-July. Further increase in positive cases may occur in the next 3-4 months, after which the disease curve may flatten and may halt. He insisted that COVID-19 testing and treating centers and Quarantines must be increased. Strict measures should be undertaken in the hotspot zones. Till May 7th 2020, a total of 52,952 COVID positive cases has been reported in the country, out of which, 15,266 patients have been cured and 1783 patients have died. Cumulatively,  13,57,442 tests have been done so far. 

This graph shows that severity of COVID-19 cases,
decreases with the increase in Vit-D levels
People at risk for influenza like symptoms or COVID-19 should take increased amounts of Vit D in their diet. Increase in immunity is essential to fight COVID-19. More exercise, yoga, breathing exercises, walking should be done by the people to increase their immunity and resistance to the disease. Green vegetables with high fiber in diet should be taken. A case study has shown that  a COVID-19 positive patient in the nasopharyngeal swabs had a volvulus in the intestine and was operated for it. The peritoneal fluid had a virus load more than that in the nasopharyngeal swabs. This shows that in an abdominal surgical procedure, there is greater risk of aerosolization of the Corona virus and the OT staff are at high risk of being  infected during an abdominal surgery. So elective abdominal surgery should be conducted, weighing the risk benefit ratio.

There is theory that Herd Immunity may protect the people from getting the disease. But in India, this may not be possible, as millions will probably get the disease and die and the hospital facilities would be overwhelmed. Herd immunity can be explained thus..if 80% people are immune to the virus, 4 out of every 5 people will not get infected, when they encounter a COVID-19 positive patient. In this way, they will not cause any further transmission of the disease. 

At our Fever clinic in the OPD, we ask a patient with fever the following
1. Any associated cough 
2. Sneezing or cold
3. Travel history
4. Contact history
5. Any shortness of breath

We do the following tests
1. Pulse oximetry
2. Breath holding time (BHT)
3. Chest X-ray.. (CXR)

SpO2 less than 94%, BHT less than 10 secs and CXR finding of pneumonia or infection are referred to a COVID-19 centre for testing with RT- PCR (Real time Reverse Transcriptase- Polymerase Chain Reaction). Severe breathlessness persisting is known as SARI, Severe Acute Respiratory Illness, are referred to a COVID hospital for testing and admission for treatment.

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