AFVOA Newsletter 03 of 2020

Section 5 - Memoirs CV 2 No. 03 / 2020 Page 70 of 167 CT CHEST has 95% Accuracy. Hence even If RT-PCR is negative, suspected cases CT- Chest is a must (Finding-sub pleural linear consolidation with ground glass appearance is called GGC) (Right lung has 3 lobes, left lung has 2 lobes, each lobe is given 5 points). Score >18 means severe, 12-18 moderate risk both require hospitalization. Score <12 Low risk - out patient care is enough. Initial phase for 5-7 days of exposure CT- CHEST may be normal and changes are seen only after 7 days. Pleural effusion is seen in CT-CHEST, then it is not Covid-19 since viral Pneumonia no pleural effusion occurs. Complete Blood Count (CBC)- LYMPHCYTE < 1000 ADMIT THE PATIENT IN ICU. Zero Lymphocyte syndrome has 100% mortality. Neutrophil: Lymphocyte ratio >3.5 is also ominous sign. Hyper-Immune syndrome (Pro- inflammatory markers)- ESR > 100; LDH> 400; CRP> 100; Ferritin >1000, IL6 > 80, Elevated D-Dimer These high values indicate impending cytokine storm(IL6- Interleukin; LDH- Lactic dehydrogenase; CRP- C Reactive Protein) How to know low O2 level in a home setting? PO2 is a test for Oxygen levels in blood If you have Pulse-oximeter at home DO WALK/TALK TEST (6 MINUTES) Normally PO2 > 96; ANY FALL WHILE WALKING/TALKING PO2 < 86 INDICATES LOW PFT (Pulmonary function Test)HAPPY HYPOXIA means lungs are already compensated PO2 < 94% but PCO2 is normal . When there is high grade fever, myalgia, extreme fatigue, loose stools even if PCR is negative do CT-CHEST. Covid-19 is a multi-organ systemic disease with varied presentation. Hence testing for pro-inflammatory markers & CT-CHEST will give an insight into the severity of the disease. These advanced tests however costly, is crucial to prevent fatality. When a person is under home quarantine, after the 1 st week especially Day 8,9,10 are crucial days to watch for symptoms as complications sets in only in the second week. High- risk patients must be hospitalized & observation at Covid Care Centre at GH for 14 to 21 days. 80% of cases were managed at GH. How Pandemic was managed at Government hospitals? Separate entrance & Special OPD (FEVER CLINICS) at GH was established for flu-like symptoms; Three important factors are assessed by staff at the clinic– COVID-19 STATUS, BREATHLESSNESS & CO-MORBIDIITIES Covid-19 Test Positive but patient has no symptoms admitted to COVID CARE CENTRE (CCC). Patient Clinically Stable with Mild symptoms are managed with Nasal O2 & drug prophylaxis