The Indian Practitioner

Tanu Singhal ¹

Affiliations
1 Consultant Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IN

Abstract

There is a new public health crisis threatening the world with the emergence of the novel corona virus-19 or COVID-19 in Wuhan, China and its subsequent global spread. It is believed to have originated in bats and transmitted to humans through yet unknown intermediary animals. The disease is transmitted through inhalation or contact with infected droplets and the usual incubation period is 5 days (range 2-14 days). The symptoms are mild in most people but 15-20 % of patients (usually the elderly and those with comorbidities) may suffer from severe disease. The case fatality rate is estimated to range between 2-3 %. Diagnosis is by specific molecular tests in respiratory samples. Treatment is essentially supportive. The role of antiviral agents is being explored. Prevention is by strict contact and droplet precautions in hospitals for suspected and confirmed cases. Home isolation of patients with mild illnesses is recommended.

Keywords

COVID-19, SARS-CoV-2, Pneumonia, Acute Respiratory Distress Syndrome.

Full Text

     

Tanu Singhal ¹

Affiliations
1 Consultant Pediatrics and Infectious Disease Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IN

Abstract

There is a new public health crisis threatening the world with the emergence of the novel coronavirus-19 or COVID-19 in Wuhan, China and its subsequent global spread. It is believed to have originated in bats and transmitted to humans through yet unknown intermediary animals. There have been more than 1 million cases and 50000 deaths till date (3/4/2020). The disease is transmitted through inhalation or contact with infected droplets and the usual incubation period is 5 days (range 2-14 days). The symptoms are mild in most people but 15-20 % of patients (usually the elderly and those with comorbidities) may suffer from severe disease. The case fatality rate is estimated to range between 2-3 %. Diagnosis is by specific molecular tests in respiratory samples. Treatment is essentially supportive. The role of antiviral agents (remdesiwir, lopinavir-ritonavir) and anti inflammatory agents (chloroquine, hydroxychloroquine, tocilizumab) is being explored. Prevention at the community level includes hand hygiene, cough etiquette, social distancing, travel restrictions and even lock downs. Strict infection control measures need to be instituted in hospitals to prevent spread to health care workers and other patients.

Keywords

No Keywords.

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Tanu Singhal ¹

Affiliations
1 Consultant Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IN

Abstract

COVID-19 has caused disruption, damage and death at an unprecedented scale. Knowledge about this disease is constantly evolving. The mode of transmission is believed to be primarily through droplet spread during face to face contact. In addition to the classical symptoms of fever, fatigue and breathlessness, loss of sense of smell and taste, skin manifestations and anorexia/ nausea/ diarrhea are emerging as new symptoms. The virus is now known to cause complications of almost all organ systems including blood vessels, heart, lung, kidney, brain and liver. The pediatric multi system inflammatory syndrome (PIMS) is a well-defined entity. Diagnosis is still by RT PCR in respiratory secretions. Obesity, genetic susceptibility have emerged as additional risk factors for severe disease. Evidence supports use of oxygen, anticoagulation, steroids and remdesivir in treatment of severe COVID-19. Steroids should not be given to non-hypoxic patients. Hydroxychloroquine, lopinavir ritonavir and azithromycin are no longer recommended for treatment. The jury is still out for tocilizumab and convalescent plasma. Patients can now be de-isolated 10-20 days after onset of symptoms for mild and severe disease respectively and demonstration of negative swabs is no longer essential. Vaccine development is underway.

Keywords

COVID-19, SARS-CoV-2, Remdesivir, Glucocorticoids, Tocilizumab, Convalescent plasma, Hydroxychloroquine.

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Tanu Singhal ¹

Affiliations
1 Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IN

Abstract

The term “long COVID” is used to refer to patients who have persisting symptoms for 4 weeks or more after onset of COVID-19. The prevalence of these symptoms is reported to range from 10-80%. The commonest symptoms include fatigue, dyspnoea, chest pain, hair loss, loss of sense of taste and smell, cognitive difficulties, anxiety and depression. Serious complications in this period include thrombo embolic events (stroke, myocardial infarction, limb ischemia and venous thromboembolism), infections, pulmonary fibrosis and multi system inflammatory syndrome. Patients with post COVID-19 symptoms should be first evaluated in primary care and those with serious issues referred to appropriate specialties. The others should be provided with supportive and symptomatic care including respiratory care, nutrition, immunization, mental health support, management of comorbidities and if indicated anticoagulation and treatment of infections. The routine use of steroids, antifibrotics, anticoagulants, anti depressents and antibiotics in these patients should be avoided.

Keywords

Long COVID, Post Acute COVID-19, Chronic COVID-19, Fatigue, Thromboembolism, Dyspnoea, Pulmonary Fibrosis.

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