Hyderabad: Senior gastroenterologist and chairman of Asian Institute of Gastroenterology (AIG), Hyderabad, Dr D Nageshwar Reddy has urged people not to press the panic button if they test positive for Covid-19. There is a patterned response of patients with Covid-19 and that’s why we are able to respond quickly and that is a big reason why the mortality rate is coming down, Dr Reddy said.
The Padma Bhushan recipient, renowned for his research in the field of gastroenterology, Dr Reddy points out that there is enough information and evidence available on Covid-19, which is helping doctors to enable patients fight Covid-19 and eventually get cured. In an interaction with Telangana Today, Dr Reddy urges people to be wise and take simple precautions like wearing masks all the time when outside, maintain physical distancing and hand hygiene to avoid getting infected.
The senior doctor urges people not to get overly worried or depressed because there is an end to the ongoing Covid wave not only in Telangana but across India. “Don’t stigmatise people who test positive. Covid-19 is like any other infection and can be cured. Best is to take precautions to avoid getting infected in the first place,” he says.
During February and March, most of our knowledge about Covid-19 came from China through research papers published at that time. However, in the last three months, we have got extensive experience with the virus. We now have enough clinical and research experience and information on Covid-19 from India too.
SARS-CoV-2 not mutating in India
Initially we thought mutations can occur in SARS-CoV-2 and it will be difficult to control either with the vaccine or with medications. Fortunately, significant mutations in the virus are not happening and we still have hope that if a good vaccine comes, it can control the situation.
Clinical features and treatment of patients
One of the other important aspects of Covid that we have learnt about are clinical features and treatment modalities of positive patients. Many people are asymptomatic and in India it is much more because of many reasons. Close to 65 per cent of patients in India are asymptomatic and they do not have any problems and another 20 to 30 per cent are symptomatic.
Different stages of disease
Among symptomatic patients, there are three stages. Patients with mild and moderate symptoms like fever, cough and mild changes in the chest CT scan fall under the first stage.
Such mild and moderate patients must be put immediately on one antiviral drug Remdesivir. If you start this drug quickly, patients in this stage will recover.
Second stage is the severe stage where we have fever and cough but in addition to that, patients also need oxygen supplementation. The normal oxygen saturation using pulse oximeters should be above 95 per cent. But, if oxygen saturation is below 95 per cent and CT scan shows some changes, then patients have entered the second stage, which is severe in nature. Usually, this stage occurs in the second week.
Why patients enter into severe stage
We know that the severe stage does not occur due to the SARS-Cov-2 virus but occurs because the human body is fighting against the virus and in the process is releasing all sorts of cytokines, which are actually warriors against the virus. Unfortunately, sometimes warriors (in this case cytokines) can turn against the host itself and turn against the body. There is no point in administering antiviral drug Remdesivir in the severe stage.
How to treat it
In the severe stage, we do not administer anti-viral drugs but administer medicines that are aimed at suppressing body immunity, which is quite opposite to the treatment modality among moderate cases.
Initially, we used to administer a steroid Methylprednisolone with good results. Later some good studies coming out of London indicated that Dexamethasone steroid also provides excellent results. At this moment, we can use either Methylprednisolone or Dexamethasone to suppress the body immunity.
Complications in severe stage
The common mistake that most people are making is instead of coming to healthcare facilities in the first stage itself, when symptoms are mild or moderate, they reach us in the second stage. At this stage, some people respond to steroids while others don’t.
In the second stage, if patients do not respond to steroids, we have a more powerful agent called Tocilizumab, which acts against a cytokine called IL6. Many cytokines are secreted by the body to fight the virus and the most important cytokine is IL6.
Sometimes, severe Covid patients produce very high levels of IL6 levels in the body, which is dangerous. Therefore in such patients, monitoring the IL6 levels is very important and when the levels are high, they must be administered with Tocilizumab. Even when patients come in the second stage, with the help of steroids and Tocilizumab, we are able to control the disease and 98 per cent of such severe patients do recover.
Patients on ventilators
Covid patients when they come to us in the last critical stage, have to be put on mechanical ventilators and we are not able to do much. At this stage, it is only luck and only 50 per cent of such patients are being saved. So, we should not wait for the patients to go into ventilators before using steroids or Tocilizumab. So my suggestion to the people is that they must quickly see a doctor and if there is a drop in oxygen saturation, come to the hospital immediately.
Patients developing heart ailments
The SARS-CoV-2 virus also impacts blood vessels and the human heart. For some reason, few Covid positive patients are developing severe cardiac problems. They are developing heart rhythm issues like cardiac arrhythmia and even heart attack too. The virus is also producing extensive thrombosis i.e. clotting in the blood vessels, which could cause thrombosis in lungs and brains, causing patients to go into a critical stage. Before they go into the critical stage where ventilation is required, we should utilise antiviral agents, steroids and even Tocilizumab and enable them to recover.
Infrastructure changes in AIG
These viruses are very dangerous and can’t be dealt by regular hospitals. That’s why we had to create a new virology department. Moreover, we also need a separate containment area for positive patients so that non-Covid patients do not have to mix with positive cases. The isolation area should be accessible from a different route to the patients.
Protective equipment and non-Covid patients
In the last two months or so, we have gained extensive knowledge on protection equipment against Covid-19. There are various grades of protective equipment but all of them have been standardised and have become very scientific. We are also able to continue to provide services to our non-Covid patients at our Somajiguda facility while a Covid facility was set up in AIG, Gachibowli.
Morale of healthcare workers
This is a very difficult area because motivation should not be just monetary but you must be willing to engage with the healthcare workers especially nurses because they have to work in the heavy PPE suits and some of them could go into depression when patients are very serious. We have set up a separate HR wing to deal with such issues.
Where Covid-19 is heading?
It is difficult to answer. The only thing we can say is based on the experience that we have gained about Covid-19 in the last few months. The cases of Covid-19 right now are on the rise but at some point of time the curve flattens. In our country, flattening of the outbreak may occur in the later part of September or October.
Flattening may occur for various reasons including a certain section of the population in the community developing immunity and the virus itself through several generations becomes less virulent. However, we should be very careful because even if SARS-CoV-2 flattens, chances are there that mini-spikes in cases may occur in the future. An effective vaccine is the need of the hour.
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