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COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is now a pandemic affecting many countries globally.
The most common symptoms of COVID-19 are fever,
dry cough, and tiredness.
Other symptoms that are less common
and include aches and pains, nasal congestion, headache,
conjunctivitis, sore throat, diarrhea,
loss of taste or smell or a rash on skin or discoloration of fingers or toes.
These symptoms are usually mild and begin gradually.
Most people (about 80%) recover from the disease without needing hospital treatment.
Around 1 out of every 5 people who gets COVID-19 becomes seriously ill and develops difficulty breathing.
Older people, and those with underlying medical problems like high blood pressure,
heart and lung problems, diabetes, or cancer, are at higher risk of developing serious illness.
People of all ages who experience fever and/or cough associated withdifficulty breathing/shortness of breath, chest pain/pressure, or loss of speech or movement should seek medical attention immediately.
If possible, it is recommended to call the health care provider or facility first.
Covid helpline no. 1075
As there is no medicine or vaccine till date. 1st Aug 2020.
Prevention is BEST.
Wear a mask when out of house or when in close contact with any person.
keep at least 1 metre distance from other people .
Do not touch surfaces with your hands
If you have touched any unknown surface wash your hands with a soap and water for at least 20seconds or
Use a hand sanitizer for 20seconds.
If you have minor symptoms, such as a slight cough or a mild fever, there is generally no need to seek medical care.
Stay at home, self-isolate and monitor your symptoms.
Follow national guidance on self-isolation.
However, if you live in an area with malaria or dengue fever it is important that you do not ignore symptoms of fever.
Seek medical help.
Quarantine means restricting activities or separating people who are not ill themselves but may have been exposed to COVID-19. The goal is to prevent spread of the disease at the time when people just develop symptoms..
Isolation means separating people who are ill with symptoms of COVID-19 and may be infectious to prevent the spread of the disease.
Physical distancing means being physically apart.
WHO recommends keeping at least 1-metre distance from others.
This is a general measure that everyone should take even if they are well with no known exposure to COVID-19.
CMAAO Coronavirus Facts and Myth Buster: Paradigm shifts in COVID-19
Dr KK Aggarwal, 31 July 2020
Update on COVID-19
IMA-CMAAO Webinar on “Paradigm shifts in COVID-19” held on
25th July, 2020, 4-5pm.
Participants: Dr RV Asokan, Hony Secretary General IMA; Dr Ramesh K Datta, Hony Finance Secretary IMA; Dr Jayakrishnan Alapet; Dr Brijendra Prakash; Dr Sanchita Sharma
Faculty:
Dr KK Aggarwal, Padma Shri Awardee, President CMAAO & HCFI
Dr KK Aggarwal elaborated on the paradigm shifts in the management of COVID-19 from the month of March to July, based on his experiences of patients with COVID-19.
Key points from the discussion
COVID-19 was first considered to be a viral pneumonia, but now it is known as a mysterious virus, which is predictably unpredictable.
It spares joints and larynx, so no joint involvement or hoarseness of voice; also,
no lymph nodes involvement.
COVID-19 was earlier believed to be non-inflammatory, but now we know that it is predominantly an inflammatory disease.
Earlier, it was thought that the patient could become critical on any day of the illness;
now we know that Days 3-6 are the days to watch.
Social distancing has changed to physical distancing.
From macrodroplets (surface to human transmission) earlier,
we now talk of microdroplets (crowded ill-ventilated rooms).
Surface to human transmission was the most important route of transmission;
now it has become less important (heat and humidity).
The shift from no masking to mandatory masking in public has become the norm.
From simple masks, we have moved to N95 masks for all high risk patients (COPD, asthmatics).
Masking only when going out, is now joined by masking also at home.
Distancing of 3 feet has changed to 6 feet;
with microdroplets, this distance is now 9 feet.
We started in the pandemic with very high mortality (10%);
now mortality is around 0.3%.
Institutional care has shifted to home care.
In the early days, no treatments were available,
but individualized treatment is now available.
If inflammatory parameters are raised, then give steroids; if D-dimer is high, give anticoagulant; if early presentation, give antiviral, etc.
From mandatory ventilation, the concept has changed to noninvasive ventilation.
Children to grandparents;
now children pose no risk for transmission to adults or other children.
Menstruation reduces severity of illness.
We have shifted to no steroids to early low dose steroids.
Hydroxychloroquine (HCQ) for all to no HCQ for mild cases.
Late discharge – Earlier patients were kept for 30-40 days;
now patients are discharged early (Day 6) if no complications, to home quarantine.
Thinking of death to thinking of recovery.
No pooled test to pooled test.
We have now understood that after 9 days of illness, the virus is non-culturable and the person is non-infectious; the presentation is post-COVID sequelae due to persistent inflammation, or hypercoagulable state.
Before 9 days, it is COVID.
No Ct value to Ct value of RTPCR to find out if cohort isolation can be done; low Ct value means high viral load.
Testing has moved from antigen RTPCR to rapid antigen and now antibodies testing (total vs IgG).
Isolation to cohort isolation (multiple infected persons in a family can stay together).
Isolation; and now isolation/quarantine/monitoring.
From no oxygen at home to oxygen at home.
Closed camps/OPDs to open sunlight camps – microdroplets are killed in sunlight.
Earlier, testing was done only for symptomatic persons, but now liberal testing.
A mandatory government prescription has now become non-mandatory.
When it first began in Wuhan, China, it was pulmonary COVID and CT diagnosis was a must; but now it is also recognized as non-pulmonary COVID, involving GIT, CNS.
Typically, fever at the time of presentation; now no fever presentation.
Asymptomatic persons are really not asymptomatic; they may have some atypical symptoms such as diarrhea, sore throat, etc.
High grade fever, which is classically associated with viral illness to low grade (100oF) exertional persistent fever, due to persistent inflammatory process.
The six minute walk test (6MWT) was meant for only COPD, heart failure patients, but it is now mandatory from Day 3-6.
If the patient desaturates by 5% on walking, this is indicative of pneumonia with thrombosis. This is an emergency.
Transmission from joint families to nuclear families.
No toilet transmission; now toilets are recognized as a COVID chamber.
Contact time from 30/10 minutes to 15/5 minutes in closed areas.
Testing till Ag negative to no testing to confirm when Ag will become negative.
Fear to no or less fear.
Mortality is two times that of the government figures reported.
For every tested person, there are 20 untested individuals; for every 20 COVID patients, there are 80 patients with corona-like illness.
Stigma to less stigma.
Low mortality to high mortality amongst doctors.
Ignorance to knowledge.
Engineering (AII rooms) to social engineering: test for 5 parameters when screening – temperature (low grade, does not respond to paracetamol), SpO2 (happy hypoxia), loss of smell, loss of taste (give jaggery – first taste to go is sweet taste) and hand grip strength.
New loss of smell and taste has been seen in 20-30% of patients; the disease is mild in nature.
We now know that plasma therapy is effective if given early.
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA.
For details on Dos and Don'ts.
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