Concluded Case

CORONA VIRUS

Hello everyone, Here are some important facts about COVID-19. From Clinical presentations to treatment. Please check it out and feel free to add more points. CLINICAL PRESENTATION: In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were: •Fever in 88% •Fatigue in 38% •Dry cough in 67% •Myalgias in 14.9% •Dyspnea in 18.7% Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients breathing difficulty developed after a median of five days of illness. Acute respiratory distress syndrome developed in 3.4% of patients. Other symptoms •Headache •Sore throat •Rhinorrhea •Gastrointestinal symptoms About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have the severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours). Critical illness (respiratory failure septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases. INCUBATION PERIOD: The exact incubation period is not known. It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure. THE SPECTRUM OF ILLNESS SEVERITY: Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly population or in patients with underlying medical problems. As per the report from the Chinese center for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity. • Mild illness was reported in 81% of patients. • Severe illness (Hypoxemia, >50% lung involvement on imaging within 24 to 48 hours) in 14%. • Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5 percent. • Overall case fatality rate was between 2.3 to 5%. AGE AFFECTED: • Mostly middle-aged (>30 years) and elderly. • Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild. **The 4th version of Belgian guidance for COVID 19 is published on19th March 2020. It is one of the most precise guidelines published yet. Some points from that: 1. Chloroquine is found to have good efficacy in vitro and it reduces the duration of viral shedding. But the drug has a narrow therapeutic window and cardiac toxicity is the most limiting side effect. 2. Hydroxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study. 3. Azithromycin may have a viral suppressive effect, but this needs to be proved as it was noticed accidentally in 6 patients of Gautret’ study. But I think it is a good choice for coverage of bacterial pneumonia. 4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond. 5. Remdesivir is promising but the studies are ongoing. Also, availability is a key issue. 6. Corticosteroids are not recommended as a systemic adjunctive treatment. 7. Paracetamol is the first-line analgesic and antipyretic over NSAIDs which are used with caution. 8. No need to stop ACEIs/ARBs in non-hospitalized patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalized patients. 9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19.

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Certains aspects may be discussed 1.Hydroxy chloroquine- side effects are over emphasized- because its dose in prophylaxis is 400 mg B.D Ist day and then 400 mg O.D weekly for 7 weeks.for health care workers For contacts it is 400 mg B.D Ist day and then weekly for 3 weeks . For COVID- 19 patients it is used only in symptomatic patients with severe disease I.e respiratory rate >30 , PO2 -<93%, PaO2/ FiO2 - <300 with dose of 400 mg B.D 1st day and then 400 mg O.D for 4 days . I think with dose - the so called cardio toxicity is minimal As you know we have been using HCQS 200 mg B.D for Rheumatoid arthritis for more than 6 months even up to 1- 2 years and we have seen very few cases of cardiac side effects . 2.Incubation period is 1- 14 days - but few cases are reported to be positive even after 14 days , although earlier they were negative. 3.Few cases in China have now reported recurrence- although it was thought that it gives immunity after once is cured . 4.Now - of late in an Australian study it has been found that increased temperature may not effect the course of disease as earlier predicted that in coming summer the disease will disappear. 5.Now - more evidence is coming that by the end of june the pandemic will be nearly at the fag end but it may recur in November and this recurrence may be a regular phenomenon in coming years. 6.With passage of time we will be more wiser regarding the COVID 19 - particularly when the mutations occur THANKS
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Certains aspects may be discussed 1.Hydroxy chloroquine- side effects are over emphasized- because its dose in prophylaxis is 400 mg B.D Ist day and then 400 mg O.D weekly for 7 weeks.for health care workers For contacts it is 400 mg B.D Ist day and then weekly for 3 weeks . For COVID- 19 patients it is used only in symptomatic patients with severe disease I.e respiratory rate >30 , PO2 -<93%, PaO2/ FiO2 - <300 with dose of 400 mg B.D 1st day and then 400 mg O.D for 4 days . I think with dose - the so called cardio toxicity is minimal As you know we have been using HCQS 200 mg B.D for Rheumatoid arthritis for more than 6 months even up to 1- 2 years and we have seen very few cases of cardiac side effects . 2.Incubation period is 1- 14 days - but few cases are reported to be positive even after 14 days , although earlier they were negative. 3.Few cases in China have now reported recurrence- although it was thought that it gives immunity after once is cured . 4.Now - of late in an Australian study it has been found that increased temperature may not effect the course of disease as earlier predicted that in coming summer the disease will disappear. 5.Now - more evidence is coming that by the end of june the pandemic will be nearly at the fag end but it may recur in November and this recurrence may be a regular phenomenon in coming years. 6.With passage of time we will be more wiser regarding the COVID 19 - particularly when the mutations occur THANKS
Dear sir, there is no foolproof evidence for treatment of Covid19 with HCQ and or Azithromycin as per the panelists in webinar I attended yesterday. Also need of ecg before initing HCQ and subsequent continuation is not as easy as thought of
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Nice review of COVID. We need to know travel history or contact of COVID case ... But now we are noticing cases without symptoms and without travel or contact history... Good learning overall. Thank you for sharing. Specially illustration pictures.
Great & useful info sir . But Continuous blood transfusions, Plasmapheresis, Iron chelating agents, Free radical scavengers should also be added in the treatment protocol ASAP to avoid Lung toxicity and Pulmonary thrombosis.
How the immunity of the person can be made strong? Prophylactic measures like Isolation ,social dispensing and hand hygiene and Resporatory system hygiene should be highlighten.
1. What are the other organs likely to be most affected after lung in patient with moderate to severe Covid 19? 2. What's role of Vitamin C and Zinc as Immuno Booster?
Informative and useful post. But everything from age,incubation period, treatment part is changing rapidly from country to country and person to person.
Thanks Dr Vipin Bihari Jain
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Great important information cardiac monitoring and iron chelation.obtund the cytokine effect and modify inflammatory response
Presentation is very clear and informative. Treatment part is easy to remember. Very useful and nice
Oxygen therapy of to maintain spo2 Above 94% should help to reduce hypoxemia & work of breathing
Very elaborative and practically useful clinical feedback from wuhan study.very helpful.
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