[poloman]

Hope the tide is turning in the country as far as new cases are considered. Only 6000 cases reported in Delhi with a positivity rate of 11% compared to close to 30,000 cases with a positivity rate of 35%, 2 weeks back. Other states like MH, UP, CH also showing similar trends. How ever KA and KL continue to report higher cases.

[balenoed_]

Ivermectin debate is still around. Would be interested to see what our resident doctors have to say. Yes, there were some discussions as well in the past I believe.

Not sure how authentic these articles could be, but it all sounds sad.

https://www.biznews.com/thought-lead...ivermectin/amp

Don’t mention Ivermectin; it’ll upset the vaccine rollout.

This would present a major headache for the big public health agencies led by the WHO. The vaccine rollout, outside of trials, would become illegal. The vaccine manufactures, having spent hundreds of million dollars developing and testing vaccines during a pandemic, would not see the $100bn they were expecting in 2021. In a pandemic, and for the next one, we need big pharma to react quickly, and the best way to that, is to reward them financially. Allowing any existing drug, at this time, well into stage 3 trials, to challenge the legality of the EUA of vaccines, is not going to happen easily. On the 31st of March 2021, the WHO recommended against the use of Ivermectin for COVID treatment, citing safety and lack of large RCT proof.

[SS-Traveller]

Originally Posted by balenoed_

Not sure how authentic these articles could be, but it all sounds sad.

https://www.biznews.com/thought-lead...ivermectin/amp

Read up a bit about the author of that article, Andrew Bannister, at this link.

For the day job, he specialises in green transport and corporate sustainability, but he has always written - initially for student newspapers and fanzines before moving on, encouraged by creative writing courses, to fiction. He's always been a reader and has loved science fiction since childhood. From the classics of the 50s and 60s to the present day, he's wanted it all: space, stars, astonishment and adventure - and now he's discovered that writing it is even better.

[m8002?]

Originally Posted by poloman

Hope the tide is turning in the country as far as new cases are considered. Only 6000 cases reported in Delhi with a positivity rate of 11% compared to close to 30,000 cases with a positivity rate of 35%, 2 weeks back. Other states like MH, UP, CH also showing similar trends. How ever KA and KL continue to report higher cases.

Even KA numbers are seeing a turnaround ( from the covid19.org site). Hope it continues next week as well. It is TN and KL that are still rising in this side of the country.

[jpcoolguy]

A query to the good doctors here -

My parents are staying alone and were started showing symptoms from Apr 27th, however they did not inform me till May 1st and when I asked them to get tested for Covid, they vehemently opposed and told they were just having mild symptoms and don't want to get tested. They, however, consulted a doctor from nearby SRM hospital in the Covid ward and was provided with the standard medication prescribed for mild patients and asked them to be in home isolation, since both their SpO2 levels were steady at 97-98.

However, the cough has not subsided for my dad and finally they agreed to get tested by May 9th. But, as expected the result turned out to be negative, due to the gap in getting tested from the day they first shown symptoms. Luckily, they were able to pull through and now both of them are back to their normal self, except for a mild tiredness and fatigue.

Now, my dad has got his first dose of Covaxin on Mar 26th, almost 50 days back and my mom yet to take her first dose.

My query is, can my dad take his 2nd dose next week since the gap after his 1st dose has already crossed 50 days?

Also, shall I ask my mom to take her first dose after a month or so?

Please provide your suggestions. Thanks in advance.

[warrioraks]

Originally Posted by poloman

Hope the tide is turning in the country as far as new cases are considered. Only 6000 cases reported in Delhi with a positivity rate of 11% compared to close to 30,000 cases with a positivity rate of 35%, 2 weeks back. Other states like MH, UP, CH also showing similar trends. How ever KA and KL continue to report higher cases.

It seems lockdowns are the only effective option to curtail the virus at this moment. Most places start showing downward effect from 3rd week of the lockdown.
I am reasonably sure people in Delhi will be out on streets with their own version of Covid Appropriate Behaviour as soon as the lockdown is lifted. I just hope the authorities are more pro-active and scientific in enforcing lockdowns for future waves. At least till sizeable population is vaccinated.

[drrajasaravanan]

Originally Posted by Gokuljayaraj

Hi Doctor,
My friend is not allowed in due to it being a COVID ward. Unfortunately I can’t PM you either most probably since I’m still relatively new here. Do you think it’s wiser to stick it out at the current hospital or keep looking to see if we can get a private bed elsewhere ?

Hi,
The current scenario in chennai, believe me when I say this, she is in a safe zone. I agree it may be uncomfortable but the hospital is well equipped with all the specialization required to handle any eventuality. She should have already been prescribed with the necessary medications and Will be monitored. There are specific timeline when an alert is issued for doctors and it will be individualized for her. Good luck.

[akhil994]

A query to the doctors here

A friend's family recently contracted covid and all of them are under home isolation at the moment. My friend's mother's oxygen has stayed fairly stable since she developed symptoms around 9th or 10th May, however, on the morning of 13th May , her oxygen dipped to 88-90 for a while. Since then it has stayed above 94 , being 95-96 for most part. Is that a cause for concern and should they look to procure a concentrator or look for an oxygen bed? She was recently diagnosed as diabetic about 3-4 months back.
Thankfully the situation in Delhi is way better and they will be able to get a bed were they to need it. The doctor they are consulting, told them that if they want to be extra cautions, to procure an oxygen concentrator for their home. But is it really required considering that one off incident or is that possibly a marker that it might fall to those levels again?

Would really appreciate advice here.

[drrajasaravanan]

Originally Posted by akhil994

A query to the doctors here
My friend's mother's oxygen has stayed fairly stable since she developed symptoms around 9th or 10th May, however, on the morning of 13th May , her oxygen dipped to 88-90 for a while. Since then it has stayed above 94 , being 95-96 for most part. Is that a cause for concern and should they look to procure a concentrator or look for an oxygen bed?

Hi,
Evaluate her baseline oxygen levels which should be more than 93 and ask her to do a six minute walk test. If she fails to complete even 3minutes or if her oxygen level drops more than 4% it's of concern and means her cardio respiratory reserve is inadequate. Having a oxygen concentrator is a stopgap and not a solution. If any of the above is true plus her lab values which the good doctor should have recommended and clinical evaluation justifies she is better off in a monitored area receiving appropriate medications than having a oxygen concentrator at home.

[SS-Traveller]

Originally Posted by GTO

I currently have antibodies, but lets say hypothetically on 1st June, the driver of the TD car I meet has Covid and he passes it on to me. While my antibodies will protect me, will I still carry the virus back to my family members?

Simply put, if I go out today (with the antibodies in me) and meet someone with Covid, can I still carry the virus back to my family members?

There are multiple strains / mutations of SARS-CoV-2 - your antibody may not be the perfect "killing machine" against the driver's viruses.

And yes, you can certainly carry back the virus to your family - on your skin & mucous membrane on the hands, nose, mouth and throat. Also, on your mask. It need not infect you, but if it finds another vulnerable host, it WILL infect them. So, it's absolutely important to wear that N95, maintain distance, and carry out hand hygiene, despite having antibodies, whether by vaccine or by prior infection.

Originally Posted by Thad E Ginathom

On the linguistic front, I notice that covid has given us the word vaxxed instead of vaccinated.

I've known of the term "Anti-vaxxers" for a long time. The euphemistic "have you been jabbed?", or even worse, "did you get the shot?" are terms I wasn't familiar with earlier.

[Sree]

Originally Posted by akhil994

A query to the doctors here

Would really appreciate advice here.

She started becoming symptomatic on 9th and developed transient hypoxia on the 13. I would like any patient who remains symptomatic after 5-7 days to be under medical supervision. Start doing blood investigations and then proceed to CT scans in a day or two depending on the results.

I am very sceptical of home oxygen therapy. It only leads to patients reporting late to the hospital. Please remember that oxygen delivery in various forms - nasal prongs, mask, high flow, ventilator, is only a small part of the total treatment.

[drrajasaravanan]

Originally Posted by Sree

.
I am very sceptical of home oxygen therapy. It only leads to patients reporting late to the hospital. Please remember that oxygen delivery in various forms - nasal prongs, mask, high flow, ventilator, is only a small part of the total treatment.

Hi,
+1 to that. I heard from my colleagues in Bangalore and Delhi that oxygenators are being sold for more than 1.25L and nothing for rental. Chennai its still available for rental and I still insist for anyone asking for it for appropriate clinical assessment, labs, CT if required and hospitalization. I am yet to find one scenario where the patient may be benefited by home oxygen therapy in acute infection.

[msdivy]

Originally Posted by Zen2001

Any clinical trial has to be properly structured, adequately powered, free from bias, free from confounding factors with defined primary endpoints. Current trial evidence from Australia, Florida, Bangladesh, Peru - suffer from many of these. Besides the pharmacokinetics of the drug itself do not allow for the therapeutic threshold to be achieved inside the human body (at doses that were being studied) as compared to those used in the in vitro studies on Vero Cell cultures. Even if that were possible, in vitro effects of a drug do not translate into the same in vivo results; none of the studies isolated viral cultures from the trial participants to demonstrate any causal relationship.

Had a discussion with a doctor friend. This is what I gather. Though Ivermectin is a veterinary drug, it is used in the treatment of the parasitic disease Filariasis in humans. After the treatment, Ivermectin effectively clears the lungs of worm debris. In the case of COVID-19, where it appears like pulmonary hypersensitivity pneumonitis not viral pneumonia, Ivermectin is found to efficiently clear the lungs of eosinophils. This provides relief to patients. Diethylcarbamazine can be used but is not available in all countries.

***

So far what I gather in the treatment of COVID-19 is:

Day 1-7: Patients experience non-life threatening and typical viral infection symptoms like fever, body aches, fatigue, cold, cough, chills. A physician must be consulted and appropriate medication must be started based on symptoms. Patients will find relief in 2 or 3 days but must continue medication as per the physician. For most, this is the end of infection but everyone must watch out for cytokine storm.

Day 8: Some say it occurs like clockwork exactly a week after the 1st symptom is noticed by patients. A small percentage of patients experience dyspnea (shortness of breath) due to allergic reactions in the lungs (type 1 hypersensitivity). The patients must report this condition to their physician immediately. Such patients must be treated with steroids and the physician might add antihistamines based on the severity. Patients' condition will improve, and they will completely recover in 3 or 4 days. So by the 14th day, even the severely affected COVID-19 patient can get back to normal life. This treatment is assuming other co-morbidities of the patient are under control.

Question to doctors. Is this clinical diagnosis correct?
Secondly, why there are fatalities in the current treatment, what are the main causes?

[warrioraks]

Originally Posted by drrajasaravanan

Hi,
+1 to that. I heard from my colleagues in Bangalore and Delhi that oxygenators are being sold for more than 1.25L and nothing for rental. Chennai its still available for rental and I still insist for anyone asking for it for appropriate clinical assessment, labs, CT if required and hospitalization. I am yet to find one scenario where the patient may be benefited by home oxygen therapy in acute infection.

Hello doc, sorry if it was answered earlier. Which out of the two is better for a Covid patient’s health when it comes to home oxygen treatment - Concentrator or Oxygen cylinder?

I completely take your point that hospitalisation is the best option but there have been cases, especially in Delhi where beds were not available. In such cases which of the above options work better? Or are both equally effective/ineffective?

From an operational viewpoint, my recent experience was that concentrators are priced prohibitively as compared to cylinders. But the cylinders needs refilling which is a pain so for a patient needing continuous oxygen - having two cylinders is a must.
I had setup a cylinder at home as a preventive measure for my mother but felt that operating cylinders wasn’t that straightforward. Had to arrange a regulator/flow meter kit separately which itself required going through multiple YouTube videos and conversations with the seller before it could be made functional. In a non-pandemic scenario, I would certainly leave these things to qualified professionals.

[drrajasaravanan]

Originally Posted by msdivy

After the treatment, Ivermectin effectively clears the lungs of worm debris. In the case of COVID-19, where it appears like pulmonary hypersensitivity pneumonitis not viral pneumonia, Ivermectin is found to efficiently clear the lungs of eosinophils. This provides relief to patients. Diethylcarbamazine can be used but is not available in all countries.

***

So by the 14th day, even the severely affected COVID-19 patient can get back to normal life. This treatment is assuming other co-morbidities of the patient are under control.
Question to doctors. Is this clinical diagnosis correct?
Secondly, why there are fatalities in the current treatment, what are the main causes?

Hi
Regarding Ivermectin not useful till we have evidence. Till now there is no evidence and not useful though we have govt declaring it as standard of care.
Regarding the time line you have detailed, you are asking to summarize more than a year of turmoil and I don't think I can. Simply put 50% don't need it, 45 % might need it, 3% will need it and 2% you are left chasing and 1% of them won't make it whatever we do. That's the ground reality. In ICU we try to limit damage and allow functions to return to physiological range but it's a hard fight. We do succeed and the ratio is getting better. To give a ratio of causes of death due to COVID, 50% die due to respiratory failure, 30% due to sepsis, 15 % due to cardiac ailments, 5% multifactorial. This ratio is an approximation of what I see in critical care and may not represent the whole picture.

Originally Posted by warrioraks

Hello doc, sorry if it was answered earlier. Which out of the two is better for a Covid patient’s health when it comes to home oxygen treatment - Concentrator or Oxygen cylinder?

Hi,
I can't recommend home oxygen therapy in acute scenario but if its an absolute necessity till further care could be provided, I would say whichever you have an access too. Concentrator are used mainly for patient who need long term oxygen therapy and I had posted a simple guideline in use in NHS in Concentrator thread. In corona it is not long term and the need is acute till you get to a hospital and oxygen cylinder should suffice. In Chennai filling a cylinder is not a problem as we have places where we have 24H service while renting or buying a cylinder is slowly getting difficult. Do remember oxygen is like a drug and if used inappropriately will injure the lung.