COVID-19: expert advice for patients during the third wave of the pandemic
Written by:Highly reputable respiratory consultant physician Dr Syed A Husain has been involved in frontline work, caring for COVID-19 and pneumonia patients in the NHS. At what was considered the start of the pandemic, in March 2020 in the UK, Dr Husain kindly shared information with Top Doctors about the novel virus that was emerging. Here he is almost a year later* with an update on what doctors know now.
Are there any particular patterns or symptoms that you notice amongst patients?
The World Health Organization (WHO) has called it a pandemic which spreads mainly by droplet route of infection, but it can remain aerosolised in poorly ventilated or confined spaces and also through fomites various objects touched by the infected patient. The droplets could stay on stainless steel and plastic for more than 48 hours or so and on cardboard for around 24 hours [1].
The COVID-19 infection could affect adult patients of any age group and we have seen variation in age groups from young to old age. The mortality was clearly noted appreciably higher in the above 60 years age group, especially those with co-morbidities. These include hypertension, COPD and diabetes mellitus, lymphomas, leukaemia and cancers along with many others.
Cough, shortness of breath, fever, loss of appetite and a loss of taste and sense of smell were common symptoms. In a few cases, diarrhoea was also seen with abdominal pains. In less than 5-7% of patients, we noted arterial or venous thromboembolic disease, varying from myocardial infarction to strokes in younger patients, and ventricular thrombus, deep vein thrombosis to pulmonary embolisms.
Have there been any developments in how you are treating the virus?
The advantage of treating COVID-19 with Dexamethasone (a corticosteroid) was noted in the UK’s national clinical trial RECOVERY.
Antiviral medication Remdisivir reduces the length of hospital or ITU stay but more importantly Tocilizumab an Interleukin-6 (IL-6) inhibitor was found to be useful in the combination of corticosteroids in the severe cytokine storm situation. This is where patients can become quite unwell and die.
Patients treated with corticosteroids in combination with Tocilizumab had 56 % mortality reduced compared to patients receiving only standard of care alone. [2]
Further treatment strategies include starting low dose Dexamethasone as one, which has been shown to reduce deaths in one-third of the ventilated hospitalised COVID-19 patients and one-fifth in other patients receiving oxygen only. However, there was no benefit in patients not requiring any oxygen or respiratory support from one treatment arm of the RECOVERY trial. The author welcomes the use of Dexamethasone 6mg once a day for 10 days [3].
How concerned should members of the general public still be at this point?
About 80.9% of cases of COVID-19 are mild and are managed at home. Among the remaining cases, 13.8% require hospitalisation because of low oxygen saturation (hypoxia), chest pains and occasionally altered mentation, and only 4.7% require ITU admissions with intubation and ventilation [4].
In the UK, as high as 8-20% mortality was noted in hospitalised patients including ITU admissions where the mortality figures were as high as 50%. As this is a disease which can kill patients, one has to be very careful and wary about that effect of this virus, which can be lethal.
What’s your medical advice to the UK public currently as we face the third wave?
I recommend that the public continues to adhere to the following:
- Be vigilant and alert
- Wear face masks when in public places
- Keep at least two to three meters distance from one another
- Regularly wash your hands with soap and water
- Use hand sanitiser containing a minimum of 60% alcohol.
The government advice is to strictly self-isolate if unwell or if you have a flu-like illness. Patients should download the trace and testing mobile phone app and get a throat swab from their designated centre.
If the patient is breathless with dropping oxygen levels, they should be assessed in A&E and patients with chest pains and altered mentation are other reasons to think that hospital admissions would be necessary.
The difficulty in diagnosis and treatment can partly be attributed to the relatively high false-negative rates of RT-PCR throat and nasopharyngeal swabs as evidenced by several studies done in China. Some authors are reporting a detection rate as low as 60% in some exclusive swab-based diagnosis.
References:
1-Van Doremalen N, Bushmaker T, Morris DH. Aerosol and surface stability of Sars Cov2 as compared with SARSCov1. N.England J of Medicine2020;382:1564-1567. DOI10.1056/NEJMc2004973
2-Narain S, Stefanov D, Chau A, Weber A, Marder G, Kaplan B, Malhotra P, Bloom O, Liu A, Lesser M, Hajizadeh N. Comparative Survival Analysis of Immunomodulatory Therapy for COVID-19 'Cytokine Storm', CHEST (2020), doi: https://doi.org/10.1016/j.chest.2020.09.275
3-Low cost Dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications COVID19. Recovery trial16th June 2020.http://bit.ly/3hZMybw
4-The novel coronavirus pneumonia emergency response epidemiology team. The epidemiological characteristics of an outbreak of 2019novel coronavirus disease-China2020(J)China CDC weekly.2020;113-122.DOI10.3760/cma.j.issn.0254-6450.2020.02.003
*The information about COVID-19 in this article is based on what is happening in January 2021 and is subject to change.
You can book an appointment to see Dr Husain via his Top Doctors profile for his expert medical opinion in your case.
