On 24 Dec, 2022, Seniors Today hosted the weekly Health Live webinar with Dr Devashish Desai, a leading infectious disease specialist to speak on the new Covid scare to prepare us for what is to come, before the next wave and variant hits us.
Dr Devashish Desai completed his MBBS at Kasturba Medical College, Manipal. He then completed his MD General Medicine and DM Infectious Diseases at the All India Institute of Medical Sciences, New Delhi. He was a member of the AIIMS Covid-19 task force and has treated hundreds of patients with severe Covid-19 in 2020-21. He currently practices as consultant infectious diseases at Ruby Hall Clinic.
There is definitely a fear psychosis that has set in after seeing the news feed that we have been receiving from China; considering that they are seeing hundreds and thousands of cases per day and their crematoriums are packed. But in all probability this is going to turn out something like the Omicron was, as opposed to the 2nd/ delta wave.
If you look at China, this is their true first wave. They have never really had a widespread outbreak infecting a large population before this, because they have a zero Covid policy. Right from the start of the pandemic, if anyone tested positive in a city, the whole city would be put on lockdown, everyone who tested positive would be quarantined and the whole population would be mass tested again and again until the numbers would come to zero.
China has a large population that has never had a natural infection. What they are going through now, is what we went through in the entire year of 2020 and till March of 2021.
This is why, most of us are not expecting what is happening in China to happen here, in India as well.
But are we sure about this? No.
Covid has proved experts, even leading infectious disease experts like Dr Devashish Desai wrong many times in the past, says Dr Devashish Desai.
But Dr Desai’s best guess is that we have a lot of coughs and colds and the occasional severe disease, especially amongst the elderly, unvaccinated and people with comorbidities.
Having said that, severe disease is not the only thing we are worried about, there is also the risk of thrombosis, young people with heart attacks and strokes.
In terms of understanding the biology of the virus, the medical experts have come a long way. In the beginning, Dec 2019, we knew nothing about the virus. Over the last few years we have a better understanding of the course of disease, and as more and more data started coming in, we understood that there are a lot of individuals with asymptomatic illnesses.
A lot of people who are symptomatic get better by themselves over a couple of days.
But a small fraction of people, by the end of first week of their symptoms develop a cytokine storm, which means that the immune system goes into an overdrive and that is what causes a drop in the oxygen saturation, and that is what kills most of the people.
The understanding of the biology of the disease has definitely improved over the last years. And what drugs should be used and when and how to treat patients with severe Covid.
We are not expecting a major flood of patients with severe Covid this time around, but let’s say that it were to happen, the country now is better prepared, in terms of infrastructure after having gone through it the hard way over the last 2 years.
When a patient reports to a clinician and informs them that he/ she has tested positive for Covid, the treating physician’s concern is- whether it is a mild disease or a moderate to severe disease. The one parameter that differentiates mild from moderate to severe is the patient’s oxygen saturation level.
Most patients will have mild disease. Which means that even though the patient has tested positive, he would maintain his oxygen saturation more than 94% on room air throughout the course of disease.
A small fraction of patients, at the end of first week will have a slow drop in oxygen saturation and once it falls below 94%, that is when we have transitioned from mild to moderate to severe. This is when a patient needs to be admitted and started on IV antibiotics. This is when the patient has transitioned from the virological phase to the inflammatory phase.
Most cases of Covid pneumonia in the hospital are those patients who have desaturated in the first week of the disease.
Keep a saturation probe at home. If you have tested positive for Covid, monitor your oxygen saturation, as long as it is over 94%, there is nothing that needs to be done, just treat yourself symptomatically.
The problem with patients of moderate to severe disease is that as their saturation levels keep dropping, these individuals do not particularly feel short/ out of breath.
This meant that, earlier, the patient’s oxygen statuary ion would start dropping 3-4 days prior to their symptom of shortness of breath and by the time the patient presents to the hospital, the ARDS (Acute Respiratory Distress Syndrome) has already set in.
Thus our standard advice is, if you have tested positive for Covid, keep a saturation probe at home, monitor your oxygen saturation, as long as it is over 94%, there is nothing that needs to be done, and as soon as you notice your saturation dropping gradually and consistently below 94%, report to the hospital and get hospitalised immediately.
Informative!