Hot Wash : Webinar on ‘Post COVID-19 Care and Suggested Measures for Wave Three.

June 21, 2021June 21, 2021 admin Corona, Covid 19, Covid Wave 3

General

The webinar was held on 06 Jun 2021 under the aegis of the STRIVE and the SVIF. It was an interactive webinar with an extensive Q&A session. The webinar commenced after paying homage to the departed veterans on account of COVID-19.

The keynote speaker for the Webinar was Lt Gen (Dr) Bipin Puri, PVSM, VSM, Vice-Chancellor of the King George Medical University (KGMU), Lucknow. Another speaker was Lt Gen (Dr) BNBM Prasad, SM, VSM, Professor and Head of the Department of Pulmonology and Critical Care at KGMU. Three COVID survivors, namely, Col Ajay Dubey, Col RA Khan and Col AK Singh also shared their experiences, during the treatment and post-recovery . Maj Gen Harsha Kakar was the anchor of the Webinar.

Salient Points of Gen Puri’s Talk-

The symptoms of first wave were dry cough and throat infection. In the second wave it is breathlessness and drop in Oxygen levels. The second wave is different from the first wave in the sense that the extent of spread is larger (affected population is 54% as against 41 % during wave one), and the number of people affected is far more in a shorter time period. Multi-Organ Inflammatory Syndrome is noticed in more patients. However, there is no evidence to suggest that this wave impacted the younger generation more.
Long haulers will have to be guarded against by covid survivors- it has been observed that even after recovery from the infection a survivor may show symptoms of any of the following in next four to six weeks-
- Multi organ inflammatory Syndrome.
- Blood clots
- Brian fog.
There has been increase in the cases of Mucor Mycosis (Black Fungus) in the post COVID patients probably due to excessive use of steroids. However, it needs to be noted that in India death on account of this is only 12.5% as against the world average of 50 %. Here again it needs to be noted that prior to COVID the number of patients suffering from this disease was quite low as such the medicine Amphotericin B which is the medicine as per protocol was never in short supply has suddenly become scarce. This flags the point that onset of this disease is avoidable if use of steroids is done only under medical advice and as such rationing of the medicine will not be necessary.
No OTC sales of antibiotic medicines- it should be as per the advice of the doctor. Such a step will help in the patient getting the right line of treatment, besides avoiding artificial scarcity of medicines coming up due to tendency on the part of affected patients/ their NoKs indulging in hoarding of the medicines.
Hygiene and sanitation plays, an important role in creating an enabling environment for checking the spread of infection and hence all hospitals/ isolation places should be kept well sanitized and neat and clean at all times
The third wave of the Pandemic is inevitable because of mutations of the Virus. So far it has undergone 80 mutations and it needs to be noted that mutations make it stronger and as such increases the degree of difficulty to tackle it. Therefore, vaccination is the best solution at the moment to deal with this virus. It needs to be noted that if 40% are vaccinated, the probability of infection is reduced by 85 % and the risk of death reduces by 87 %. In vaccine management, managing the cold chain, related logistics and other administrative issues pose a challenge. However, the biggest challenge is to tackle the vaccine hesitancy based on religious beliefs, social misinformation, and prejudices based on political views pose a bigger challenge. Innovative ways to generate awareness is the key to address this challenge.

Salient Points of Gen Prasad’s Talk–

Explained the difference between the Pandemic which is global in nature and an epidemic which is local in nature. With that he brought out the increased probability of subsequent waves of the Pandemic due to movement of people and hence the degree of difficulty in its control and large number of mutations which makes the task of finding a standard protocol of treatment.
Self-medication should be avoided Unchecked/uncontrolled/ without the advice of a doctor, use of Oxygen and medicines like Remdesivir and steroids is counter-productive. Onset of Diabetes mellitus and Mucor Mycosis ( Black fungus) are actually an outcome of that. Excessive oxygen intake is toxic and cause damage to the lungs and may finally result into death in some cases. Therefore unchecked (without doctor’s supervision) Oxygen langars should be avoided.
Vaccines and the use of anti-bacterial/ anti-virus drug with doctor’s advice should be used. In the absence of a standard treatment protocol, we should allow the body to do its bit to defeat the virus and as such the treatment should be such that emergencies are avoided, body immunity improves and as such body itself fights against the infection.
System needs to be strengthened- it entails (in that order), recognition of problem, assessment of severity and then arriving at optimal treatment.
Pulmonary issues make a victim critical but addressing it should be under the close supervision of a trained doctor. In this regard self-medication is absolutely counter- productive and should be avoided at all costs.
Services of doctors should be utilized on clinical side, and they should be spared from performing excessive administrative jobs.

Feed Back from Covid Survivors

The response of the Command Hospital central command (CHCC) and the Base Hospital (BH), Lucknow came under lots of praise by the COVID Survivors. It has been the unique discussion of both the CHCC and the BH that no Veteran/ spouse of the veteran was turned away from the hospitals. In fact, it is to the credit of the doctors and the nursing staff of the two hospitals is that at the peak COVID ICU at CHCC had 180 patients and BH had 30 patients, and yet, they neither showed any impatience or rudeness towards the patients, which by itself helped in providing a psychological reinforcement to the patients, when they needed it the most.

Major issues raised / suggestions given were as follows:-

Need for psychological reinforcement by family, friends and medical staff.
Need to remain vigilant about the residual problems. Some of these are, as follows:-
- Constipation and breathlessness.
- Lack of sleep.
- Swollen ankles.
- Tongue infection
- General Weakness.
The response of medical authorities and health workers was praiseworthy, and they helped in creating a very positive environment which helped in faster recovery.
Initially (beginning April 2021)the system of admission had certain lacunae and those affected by CORONA had to run from pillar to post to get admitted in the hospital. However, it is to the credit of the hospital authorities that they responded very quickly and streamlined the system and thereafter the general opinion got changed and people who during the latter half of April had a far less stressful experience for admission as it had become systematic and staff more sympathetic to those who came in a depressed state.
One of the covid survivors stated that in post covid recovery, YOGA (particularly PRNAYAM) is helping him substantially to improve his general health and also helping him to get over the problem of breathlessness.
Few suggestions which the survivors gave, were as follows:-
- A reception Centre be established near the main gate of the hospital and once a person who has been tested positive reports there, his /her movement to the designated ward should be under hospital arrangements and infected persons should not be allowed to fend for themselves. Here itself, the patients who are advised home isolation should be segregated and should be provided the following:-
  - Complete set of medicines for the period of isolation.
  - Do’s and Don’ts during the period of isolation.
  - Instructions regarding actions to be taken, in case the condition of the patient deteriorates/ emergency.
  - Instructions regarding review of the patient after completion of the isolation.
- Nursing stations in Glass enclosures should always be there in COVID wards so that all patients needing critical care always remain under the observation of the staff.

Q &A Session

Two important recommendations emerged, which are as follows:-

Need to establish a Bio Medical Defence Research Authority.

To formulate the response strategy, the Italian model can be studied which entails, firstly, ‘Test-Track and Treat’ strategy, secondly, gradual lock down, thirdly, to break the chain Covid appropriate behaviour at local level and isolation of likely source from population by restricting air travel to and from played an important role in checking the spread. The introduction of the Special Continuity Assistance Units helped the health authorities to offer more specialised treatment for patients at home, preventing their arrival at hospitals in unrecoverable conditions. The integration of these units with community nurses and social workers can help to build confident and connected communities as part of efforts to improve health and reduce inequalities.

Video with Presentation on – The keynote speaker for the Webinar was Lt Gen (Dr) Bipin Puri, PVSM, VSM, Vice-Chancellor of the King George Medical University (KGMU), Lucknow.