[PaddleShifter]

We have completed around 17,000 PCR tests in our Govt. laboratory and diagnosed 300+ patients. More than 90% were asymptomatic. We have seen cases where patient was carrying TruNat negative report but when test was done by PCR, it came out positive. I'd not place too much faith on antibody tests right now. Moreover these kits just serve the purpose of surveillance and monitoring. Its a golden opportunity to make money in the market afterall and companies will use it to their full benefit.

Originally Posted by GTO

Would suggest this one to all BHPians. Fits perfectly in the cupholder & the placement makes it always available to you & your passenger. Convenient = after taking toll change back, sanitize your hands. First thing you step in the car, sanitize your hands. After filling fuel, sanitize your hands. This is a permanent fixture in my cars (including the test-drive cars).

Attachment 2034585

Alcohol based hand rubs and sanitizers are at risk of losing their potency when left inside a locked car as the alcohol content may reduce at higher ambient temperature. The time taken for losing potency depends on other factors such as type of bottle (how much and how easily it allows the alcohol to escape). I'd recommend that keeping them in cars should preferably be avoided, especially by those who live in areas that have a high temperature during day time.

Originally Posted by Thad E Ginathom

Are the gels/creams a big fire risk? Using home-made IPA mix at home. Would never use that in a car, as per previous safety discussions here.

Although flammable, the risk is very low in my personal opinion. I have myself kept hand sanitizers in car for 2-3 years (almost a decade ago).

[am1m]

Originally Posted by srvm

Guess what? BBMP did not even bother to test the lady's husband, let alone people in the same floor!

Neither the wife nor the 2 kids have been tested for covid. They've been told that they'll be tested only if they are symptomatic.

Extremely puzzling. Surely it makes sense to test people in the immediate vicinity of a positive case? If they are taking the effort to lockdown areas, why not test as well? Considering all the effort that goes in to checking and monitoring people arriving from other states, even if they aren't showing any symptoms. The effort that goes in to enforcing night and Sunday curfews. Compared to that, what does it take to test a few people who were clearly in close contact to a confirmed positive case?

I'm probably missing something, but I think that is a strange strategy. Does it have to do with the fact that we're officially sticking to our line of 'no community spread' and still following policies based on that? (Even though the reality is pretty obvious.)

Originally Posted by itwasntme

The optimists are saying our glass is half full (and rejoicing), while the pessimists are saying glass is half empty (and hunkering down indoors even more).

You said it man! Even after 6 months of this pandemic making headlines all over the world, almost every bit of news related to it seems to be open to interpretation. Strange for something that is a medical/scientific issue and should be mostly factual and data-driven.

[kavensri]

Originally Posted by Latheesh

We (wife, son, and I) took Vande Bharat flight from Frankfurt to Kochi on Friday. Flight was via Delhi and Bangalore.

My relative (along with his wife and 3 year old son) returned back from Mexico (via Amsterdam) to Mumbai today. His final destination was Bangalore and he had booked his connecting flight to Bangalore as well. But, the authorities at Mumbai did not allow him to continue the journey to Bangalore. He has been put under one week quarantine there.
I had shared the information from your post to him on Saturday. Even he was confident that he would be allowed to travel to Bangalore from whatever the information that he has gathered before he left Mexico.
And because of kid, he thought he would be asked to do home quarantine instead of putting up in Hotel. But, all his plans got changed due to being quarantined in Mumbai.

[skchettry]

Originally Posted by kavensri

And because of kid, he thought he would be asked to do home quarantine instead of putting up in Hotel. But, all his plans got changed due to being quarantined in Mumbai.

I think there's still lack of proper communication of quarantine protocols or some of the airports might have allowed international passengers to travel to their final destinations immediately after arrival in the country which is being considered as the accepted procedures by some of the international passengers.

I travelled from Muscat to Mumbai on 3rd July. We were a group of around 20 people mostly from Mumbai, Navi Mumbai and Thane areas. One of us was from Indore. We all knew that all of us would have to undergo 7 days of institution quarantine at Mumbai regardless of where we are finally headed. So we all had booked ourselves in 5 star hotels (in fact hotel booking vouchers are mandatory before the agents issue travel tickets). These hotels have been empaneled by the local authorities at charges of around 4K per day, three meals included in the package. On the 4th/5th day of stay at the hotel, COVID tests are done and upon confirmation of negative reports, BMC issues Discharge Certificate for onward travel. I don't know if there was any special letter issued for my friend from Indore, but he too travelled to his hometown on the 8th day of arrival in Mumbai.

Similar experience has been shared by another friend of mine who is from Mumbai but could manage to land in Delhi travelling all the way from Papua New Guinea via Indonesia. He spent 7 days in Delhi. His passport was taken by airport authorities in Delhi and handed over to him once he arrived in Mumbai. On the 7th day in Delhi, he was handed over a letter stating he has completed the required quarantine and is allowed to travel to Mumbai. No COVID tests were done on him. Upon his arrival at Mumbai, he was allowed to travel to his home in Airoli after getting the 14 days home quarantine stamp on his arm. So he had 7 days of institution quarantine plus 14 days of home quarantine whereas I had 7 plus 7 only.

Regards
Sravan

[kavensri]

Originally Posted by skchettry

I think there's still lack of proper communication of quarantine protocols or some of the airports might have allowed international passengers to travel to their final destinations immediately after arrival in the country which is being considered as the accepted procedures by some of the international passengers.
Regards
Sravan

Even one of my relative who travelled from London to Bangalore via Mumbai (3 weeks back) was asked to board the flight to Bangalore after thermal screening in Mumbai airport.
So, there was no quarantine for him in Mumbai. But he had to undergo 7 days institutional quarantine as soon as he landed in Bangalore.
As you said, there seems to be no confirmed guidelines that needs to be followed for International passengers when they land at the first port in India, on their way to final destination.

[Latheesh]

Originally Posted by kavensri

My relative (along with his wife and 3 year old son)

Our Vande Bharat booking was from Frankfurt to Kochi. How Air India did is they included all Delhi, Bangalore, and Kochi passengers in one plane from Frankfurt to Delhi. All Bangalore and Kochi passengers were then asked to change the flight at Delhi. At Bangalore, they deplaned Bangalore passengers and took rest of us to Kochi. There was no mix up of passengers from other planes at both the locations.

What authority did in your relative's case is correct as he booked his domestic connection separately and there is a risk if he take domestic flight.

[kavensri]

Originally Posted by Latheesh

Our Vande Bharat booking was from Frankfurt to Kochi. How Air India did is they included all Delhi, Bangalore, and Kochi passengers in one plane from Frankfurt to Delhi. All Bangalore and Kochi passengers were then asked to change the flight at Delhi. At Bangalore, they deplaned Bangalore passengers and took rest of us to Kochi. There was no mix up of passengers from other planes at both the locations.

What authority did in your relative's case is correct as he booked his domestic connection separately and there is a risk if he take domestic flight.

I just checked with my relative and he did confirm that his Vande Bharath booking was from Mexico till Mumbai only. Actually he did not do these bookings and his office travel desk took care of his bookings.
The travel desk had told him that, even though there is a separate booking from Mumbai to Bangalore, he will still be allowed to board the flight without quarantine in Mumbai.
But, your explanation above is very clear on why they cannot do that. His office travel desk should have known these rules. Because of their mistake, he is under quarantine in Mumbai.

[aadya]

Been involved in the treatment of about 500 covid positive symptomatic to severely ill and dead patients. And with about 1000 direct encounters with mix of those patients, I would like to put on some observations. These are merely my observations and not perfect scientific facts, as our practical knowledge about this disease has evolved quite a bit from June first week. And I can be fairly confident about the observations as I work in tertiary care setup with high availability of resources to test and treat patients, and also in a setting with slightly limited resources.

1.This disease is certainly mild for the most, but killer for the rest. Its a throw of double dice to find out which category we fall into, not as simple as a throw of coin.

2.Old age, Diabetes, Heart failure(not heart attack), Kidney failure, Asthma and COPD patients are at heightened risk. But we have seen couple of patients with none of this succumb rapidly to the illness.

3.It is not airborne in literal sense. It spreads almost always on contact with droplets. Hence mask is very important tool in prevention, followed by hand hygiene. Closed non-ventilated environments are most dangerous.

4.Almost all the elderly got the infection from their family members who ventured out or from the domestic helps.

5.There is no point in checking antibodies - it will not tell us what to do - it is meant for serosurvellinance. It is like checking the honesty of the politicians. We can publish a Cover story in a magazine and thats it.

6.Antigen testing is like announcements in the railway station, almost always you might have to bend and see the railway track to confirm the train and check its actual destination. But helps in triaging the patients fast when they are positive.

7.Most youngsters who worsened are either obese or had diabetes or exerted too much before hospitalization. They also avoided testing or taking medical help for reasons only known to them.

8. Hospitalisation is mandatory for people with risk factors or with difficulty in isolating, managing at home or with flag symptoms and low oxygenation.

9.Favipravir works for mild illness and thats it, its like oseltamavir i don't think it is life saving.

10.Remdesvir works in a select set of patients and side effects are not severe. Availability and cost is a concern.

11.Tocilizumab is a double edged sword and when used in highly selected cases has helped tide over the crisis.

12.RT PCR is the gold standard at present. 95% accurate false negative reports are due to wrong technique and wrong timing of the test. Becomes highly positive between 3rd and 7th day of exposure or from the first day of symptoms. Remains positive upto 28 days after symptoms. Its usually due to the genetic material found in the epithelium(outer layer) of the nose and throat and these patients are non infective after 12 th day of symptoms - If these patients have good quantity of antibodies then we can consider them to be recovered(only clinical application of antibody levels).

13. Most common symptoms are Fever, Throat pain, Running nose, Cough, Breathing difficulty, Loose stools and abdominal pain.

14. Lockdown is a very effective weapon as it breaks the chain to a large swathe of population. But should be used judiciously - IMHO a 12 day working day(or even 24/7 in places where labour laws are not applicable) for four days a week(monday to thursday) with complete lockdown from Thursday night to monday morning would be effective without crippling the economy. Other option is 9 days lockdown starting with a Friday night and extending till next monday morning every month (it would involve only five full working weekdays). But longer the lock down it would be difficult to implement. It also cripples the hospital supplies too. But breaking the chain gives breather for the hospitals to improvise and fill in the duty rotas as some staff can be rested.

15. My question to the Government which is concerned more about economy(whose econonmy is a seperate question) and the opposers of lock down is what would be their solution/answer to the people who have lost a family member(after spending a big chunk of their savings) opposed to probably a loss of one third of their annual income(assuming 4 months of complete lockdown).

16. Timeline of the disease as I have observed - From the day of exposure usual symptoms appear between 3rd and 7th day - rarely before third day and rarely after 7th day. Disease severity manifests between 6th and 10th day. No major complications once we cross 12th day. Non specific symptoms like Fever, bodyache, cough can persists even for weeks. Infectivity comes down between 9th and 12th day and we shed dead(non infective) virus particles upto 28th days(not documented by us).

17. Government avoids testing in asymptomatic/otherwise healthy as it would increase the numbers and panic. And the logic is right that anyway the entire household should be isolated.

18. Death rate is not low as trumpeted by many as we see lives withering like leaves in autumn, the overall death news is low due to the decreased death rate in all the other diseases put together due to decreased economic activity, stress and pollution levels. But ask any family which has lost a loved one to this disease how fast and painful it was.

19. Steroids and Heparin are the two inexpensive weapons gained by delaying the peak which was not known as game changers till late april. We would have lost many lives if not for the unprecedented lock down.

20. Staff nurses and other support staff who are in frequent touch with the patient are the real covid warriors.



P.S. Excuse me for a not so good looking post as I have to type it in between clinical work. These are not obsevations with prejudice and all my prejudices I have corrected as the data and experience improved. I have literally taken only two days off since March22 janta curfew and I know some who have not done that too.

[DCEite]

Originally Posted by PaddleShifter

More than 90% were asymptomatic.

Just to clarify, they were totally asymptomatic or had mild symptoms ? If indeed totally asymptomatic, 90% is a high number. Very high. Specially considering that on the other end of the spectrum we have critically ill patients to the tune of 3-4%.

Strange virus is this. There has to be something. Something that the scientists still have not caught - regarding what exactly this virus thrives on. And what gives a vast majority such forgiving course of disease and a small majority horrible symptoms.

Is it Vitamin D ? Is it blood pressure ? Is it Vitamin B12 levels ? Is it BMI ? Some particular gene structure ? One doesn't know. But there is something which differentiate the mild from the severe patients. I hope the scientists catch hold of that something soon.

[AtheK]

Originally Posted by aadya

P.S. Excuse me for a not so good looking post as I have to type it in between clinical work. These are not obsevations with prejudice and all my prejudices I have corrected as the data and experience improved. I have literally taken only two days off since March22 janta curfew and I know some who have not done that too.

Thanks a lot for these insights.

Above all heartfelt thanks for your effort and your dedication alongwith your entire team, this situation has been very very demanding of you. Wish you and your colleagues the very best of health always, and thanks again!!

[am1m]

Originally Posted by aadya

And with about 1000 direct encounters with mix of those patients, I would like to put on some observations.

Originally Posted by The Rationalist

Our hospital has treated 3000+ patients , where we have presently 450 Covid patients at present and 50 ICU patients. I’m currently hospitalized with Covid-19.

Originally Posted by PaddleShifter

Lastly, we are testing more (17000 tests done in 85 days in 1 lab situated in a remote area is good number in my opinion) so we are catching more asymptomatic cases. Government is supporting us by providing us with the testing kits in adequate numbers and we are able to test more people.

Much appreciated sirs! Invaluable information from doctors and other professionals actually dealing with cases and testing, thank you! Has certainly helped me modify a couple of my wrong assumptions about testing strategy and weekend lockdowns. @The Rationalist, I hope you recover soon.

[The Rationalist]

Our hospital has treated 3000+ patients , where we have presently 450 Covid patients and 50 ICU patients. I’m currently hospitalized with Covid-19. In my last duty before getting admitted, I was looking after 10 patients, 9 on ventilator and 5 on prone position.

1) Lockdown is a foolish option.

2) Dexamethasone is no wonder drug, all hospitals were using Methyl prednisolone from beginning, the effect should be a class effect.

3) Remdesivir works or not is anyone’s guess, not proved by RCT.

4) My colleagues in Kerala are giving Plasma and claiming big success, no real proof for that also.

5) Heparin is used in all good ICU for DVT prophylaxis and it doesn’t make any difference in Covid, again no wonder drug as it is claimed to be.

6) Antigen test has 80% sensitivity and 99.5% specificity, PCR will take time and more effort and it’s sensitivity is widely variable too. We do antigen testing, if negative do rt-PCR, if that too negative CT chest screening in those having typical Covid symptoms.

7) Supportive care is the most important, sadly the part where Indian ICU’s fare miserably due to poor infection control measures. No amount of dexamethasone, heparin will help you with a virulent Gram negative bacterial sepsis. We need to produce high quality nurses and pay them well (instead of only paying doctors well) and not burden them by putting 1 nurse for 2 sick patients.

[PaddleShifter]

Originally Posted by DCEite

If indeed totally asymptomatic, 90% is a high number. Very high. Specially considering that on the other end of the spectrum we have critically ill patients to the tune of 3-4%.

On National level, critically ill 3-4% or even upto say 5-6%. Moderately symptomatic are around 10% if I am correct (I am not following any updates on COVID-19 now as I go home just to sleep). Rest are asymptomatic or have mild symptoms.

The fraction of asymptomatic and mildly symptomatic is highly variable but at the end, around 85-90% patients of COVID-19 are either asymptomatic or have mild symptoms. The number of asymptomatic cases are very high throughout India. If by miracle, a cross sectional study sort of tests the whole country, more than 90% cases would turn out to be asymptomatic. States that are restricting the testing of asymptomatic population have a higher fraction of symptomatic cases.

An interesting article in the same context:
https://www.financialexpress.com/opi...st-go/1986581/


Indeed we have such high number of asymptomatic infections mainly because:

Firstly, >99% are returning migrants in their 20s (I am serving in a difficult, remote terrian where youth has gone out of state for job opportunities).

Secondly, I also think that there could be some error in the data entry as well. There is always a possibility that an overworked sample collector may choose asymptomatic as that will allow him to skip filling columns such as date of symptom onset etc. I am just speculating here.

Lastly, we are testing more (17000 tests done in 85 days in 1 lab situated in a remote area is good number in my opinion) so we are catching more asymptomatic cases. Government is supporting us by providing us with the testing kits in adequate numbers and we are able to test more people.

[DCEite]

Originally Posted by The Rationalist

I’m currently hospitalized with Covid-19.

Sorry to hear that and just want to say take care of yourself. Wishing you a full recovery very soon.

[rohan_iitr]

Originally Posted by GTO

Would suggest this one to all BHPians. Fits perfectly in the cupholder & the placement makes it always available to you & your passenger. Convenient = after taking toll change back, sanitize your hands. First thing you step in the car, sanitize your hands. After filling fuel, sanitize your hands. This is a permanent fixture in my cars (including the test-drive cars).

Its not a good idea to keep hand sanitizer in the car permanently.

When parked outdoors, the alcohol evaporates, which in turn reduces the effectiveness of the hand sanitizer against germs. (Though it may not be a fire hazard)

A google search on this topic will give dozens of articles published in reputed publications.

Rohan