CME INDIA Presentation by Dr. H. D. Sharan, Sr. Cardiologist, Ranchi.
“There is no doubt about one thing, I was infected through airborne transmission.”
“There is no other way, I could have been infected. There is no doubt about one thing, I was infected through airborne transmission. Then there is music. It has the power to bring you back from the depths of depression. My body was in isolation but my mind was free to roam.”
Covid Day 1, 16th May 2021
- Had developed mild flu like illness yesterday. Had wheeze also. Has been having this problem since shifting to the new house, probably because of the construction work. But no work is going on at the moment. When it persisted this morning too, I requested for the RT PCR and the result came within a few hours. POSITIVE. Right now, nothing different from the flu that I get once in a year. Totally isolated in our master bedroom. Worried for Prabha. Watching an old black and white Dara Singh movie.
- Not able to decide what to do with my patients on tele consult.
- Decided to submit myself totally in the very able and young hands of Dr Nishith, the pulmonologist in Orchid. Lying in Isolation, I have coined a punch line. “Together, we will beat this demon.”
- Received a call from Covid control room. Nice to know that somewhere the system is still working.
Covid Day 2, 17/5/2021
- Woke up around 5 am. The cycles of chills and sweating disturbed the sleep. Having persistent fever between 100 and 100.5. That causes persistent headache.
- One silver lining is that Prabha has tested Negative. Strange isn’t it? I just got the infection out of nowhere and she did not get it in spite of we sharing the same bed. We still know very little about this virus. There was no let-up in fever throughout the day. It touched 101 before coming down.
- Feeling more or less comfortable now except for the nasal stuffiness. Enjoyed the chicken soup cooked by Prabha.
- Saw a movie on Netflix, The Interpreter. Also had a few tele consult. Those who are getting all right are really grateful.
- Time to say Goodnight to everyone.
Covid Day 3, 18/5/2021
- Disturbed sleep once again but that is something that I have got used to. Woke up at 12:30 due to nasal congestion . The persistent headache was almost gone. The temperature had settled after almost 24 hrs.(98.6). Persistent high temp is a bad omen for Covid patient.
- Took some nasal spray and something to stop the flow. Went back to sleep and when I woke up again, it was 4 am. That is my usual time to wake up. Temp had normalised (98.2)
- Talking to my family in the evening was the best part of yesterday. Could see evidence of worry on every face. Tried to convince them that everything was under control. Even the youngest one, although not worried was with her teddy bear and she reminded me that I had given it to her. Gave me fresh res…
Covid Day 4, 19/5/2021
- Had gone to sleep listening to some golden oldies from my album, “Harsh’s Fundas.” Woke up at 2:30 am. Had not expected to get more sleep as I had slept in the evening too. Still had fever although it had responded to Paracetamol I had taken before closing my eyes. SPO2 was behaving and I felt extreme thirst.
- Then I realised that I had no water. Both my bottles were empty and Prabha had also forgotten to fill the jug that is kept in the neutral area. I had no option but to call her. She is under great strain these days. Managing without any help and taking care of a Covid patient can be very exhausting. We have not yet overcome the loss of Sunil and now she was worried about me.
- She woke up and filled the container. And you know what, we talked on phone like 2 people miles away from each other and who have not spoken for many days. You may see the beauty of human relationship in this but it is also the biggest human tragedy of this disease. When someone goes to the hospital, you are not sure whether you will see him or her again and you cannot even hug him or her. What I saw in her eyes decided one thing for me. Hospitalisation is going to be the last resort.
- Although low grade fever persisted in the morning, the general feeling was that I had turned the corner. No sore throat, no body ache, no weakness. Just a low-grade fever.
- Is it Remdesivir that did it? Whatever the WHO says, I am still a great believer. It does help. I personally think that Remdesivir, Enoxaparin and Steroids at the right time are the 3 pillars of treatment of COVID-19. If only we can combine home isolation with Remdesivir. It is not very difficult to achieve. We can have day care centres where the patient can come and take Remdesivir, Dexa and Enoxaparin. 45 mint slots for 1 patient. Why can’t our policy makers think out of the box?
- Returned from hospital after taking Remdesivir . Refused to take the wheel chair. They are wonderful accessories at International Airports. And when you are forced to restrict yourself into a room for days together, the chance to go to the hospital is like enjoying an outing.
- So, for next 2 hrs, wife-imposed curfew.
- Looking out of your sealed bedroom window at some greenery of your terrace garden is a very soothing experience and if you can also see the lady of the house watering her plants, it is a big bonus. It is 7pm and there is no fever. The temp at this hour yesterday was 101. Things must be improving. You feel it inside if you remain positive. You feel that your body defences are fighting and winning. May God grant this Positivity to all my patients and their family members.
Covid Day 5, 20/5/2021
- Feeling much better. But the low-grade fever returns to bother me. Fever on the 7th day, even if 100 is not a very good sign. But Dr Nishith is keeping a strict vigil and getting my markers tested every day. In the worst case, I may have to consume steroids. Avoid if you are a diabetic but not at the cost of your life.
- The night was good. No fever, good saturation. But woke up again at 2 am.
- All parameters were normal. Saw the glucometer so did RBS. 76mg/dl. Had no complaints. Good excuse to have a chocolate and Oreo biscuits. 6am RBS 86mg/dl. Excuse to add some sugar to tea.
- While waiting for breakfast had symptoms of hypoglycaemia. Dropped Insulin and had tummyful of chilas with chicken sausages. A combination of Covid effect plus hypoglycaemia caused severe fatigue and I went to sleep after breakfast.
- Blood Sugar stays at 125 at noon despite the fact that I have not taken Insulin today. Covid is supposed to unmask diabetes not cure it. It strikes me that I had started using new strips. Amal helped again. He came with his glucometer. Sugar with his strips was 200. Even 200 is less because I have not taken 28 units of Ryzodeg that I take before breakfast.
- Good day after a week. Had mild fever only once that too settled without any Paracetamol. CRP further decreased to 15.6. Things should be OK now unless…
Covid Day 6, 21/5/2021 – 6 days of isolation has not been too difficult.
- I think it was a wise decision to continue the tele consult. At times, I had to ask for some time to respond because of high fever.
- One can imprison your body but no one can imprison your mind and soul if you do not surrender totally. My body was in isolation but my mind was free to roam. It was a bit difficult in the first 2 days. We had not yet overcome Sunil’s loss and now I had been infected. Prabha is a very brave woman but this time, her despair was written large on her face. That look on her face will always haunt me. We are going to complete 50 yrs. of our marriage this year. It has already turned out to be a sad year. Our Golden Jubilee without Sunil is difficult to imagine.
- I kept myself busy, read a lot wrote a few lines here and a few lines there and devoted myself totally to treating the patients. I can tell you that it is helping. When you are playing the role of a doctor, it is difficult to imagine yourself as a patient.
- The concern shown by the friends makes me emotional but I come out of it stronger. Vaccination is helping me. It may not help everyone but everyone should take it. Get vaccinated as and when it is your turn to take it. Feeling much better. But the low-grade fever returns to bother me. Fever on the 7th day , even if 100 is not a very good sign. But Dr Nishith is keeping a strict vigil and getting my markers tested every day. In the worst case, I may have to consume steroids. Avoid if you are a diabetic but not at the cost of your life.
- Jharkhand is doing really well as far as restricting the second wave of Corona is concerned. In fact, it is the best performer amongst the big states. Less than 1900 new cases on 19th with probably the best infection rate of 4.8%. The system is working too. I receive a call from the Circle office everyday asking me whether I need any help or whether I have medicines. They have packs of medicines approved by the government like Doxy, Ivermectin, Paracetamol, anti-allergic etc. which they bring to the patients who need them. They also ask whether I need to consult a doctor. I am impressed.
There is a stress on Home Isolation due to paucity of beds.
- By Now, every Indian understands what is meant by Home Isolation. Or do they? Easier said than done. After I put myself in Isolation, I realised that it is very difficult to create and virtually impossible to maintain. You not only need enough space in your house but also properly designed space. Instead of the Vastu, the future designs should take into account the need for home isolation.
- I will try to explain how we are doing it. Is that enough? God only knows.
- My washroom is attached to my bedroom on one side and my dressing room on the other. The dressing room in turn can be accessed from the dining hall too. This makes things easy.
- The dressing room is the Neutral Area or the NO MANS ZONE. The washroom and master bedroom are my territories. Rest is hers. The doors between dressing room and Dining Hall and also between it and Wash Room always remain closed. Both of us can enter this area but only after making sure that the other is not there and fully masked.
- Utensils that come to my territory cannot go back. I wash them and keep them on my side. When something is served, she lets me know beforehand and I keep the appropriate utensil in the neutral zone. I return and then she enters that area to serve the meals. After serving the meals, she withdraws and informs me that the meal has been served. I go and pick up the meal.
- For the clothes, I soak them in soap and hot water throughout the day in a bucket. She keeps another bucket in the dressing room. In the evening , I squeeze them and put them in her bucket. My bucket is white and hers is red.
- So, this is what our life has become since the 16th of this month. I decided to write about it because of what happened only a few weeks back. I was treating a family friend for Covid. Her husband used to call me and ask about the dose of Insulin to be given to her. One day while he was speaking to me, I could hear her voice clearly in the background . I asked the husband to get out of her room. His explanation was that he was not exactly inside, he was standing at the door to her room. My dear friend, I know you love your wife too much but so do I. And these days, whenever you feel like seeing her beautiful face, you can always do that on a video call , just as we do.
- Jokes apart, inadequate isolation is the major cause of spread of infection to the family members.
- Maximum temperature today was 99.3, SPO2 remained between 96 and 98. Good news came from the lab. CRP is down to 29 from 50 and D Dimer is normal. Let us hope that the healing process continues.
HRCT was done on 18th AS CRP had jumped suddenly.
Plan to do it again on the 22nd. First was normal.
Covid Day 7, 22/5/2021 – I have realised:
- Feeling much better. But the low-grade fever returns to bother me. Fever on the 7th day , even if 100 is not a very good sign. But Dr Nishith is keeping a strict vigil and getting my markers tested every day. In the worst case, I may have to consume steroids. Avoid if you are a diabetic but not at the cost of your life.
- Going through the rigors of disease gives one fresh insights. I understand the disease better now.
- I have realised that for the moment, the virus is much ahead of the human race.
- I have realised that there is a huge KNOWLEDGE GAP.
- I have realised that it is a serious matter and should be left in the hands of serious scientists with a spine. I have realised that the situation demands that we have policy makers who can think out of the box.
- I have realised that steroids that can save lives are not being used properly by most of the practitioners because most of them are not properly trained. The decision whether to start and when to start steroids should be left to the experts.
- I have realised that vaccination is very important and is the only thing that can save humanity. The Neutralising antibodies produced by the vaccination saved my life otherwise the path that my infection had taken led to total disaster. Everyone who understands the disease was very worried.
- Keep doing whatever you have been doing. It helps you to keep positive and diverts your attention away from the disease. Avoid people who keep reminding you about bad outcome of the disease.
- Observe the guidelines of isolation to the last word. You owe it to your family and neighbours.
Covid Day 10, 25/5/2021 – So many things are happening in this Pandemic that are extremely difficult to explain.
- I worked till 19th April. In the 10 days before this, all physicians and the Pulmonologists were down with Covid. I was the only physician left so the entire Medical OPD, all medical indoor cases were seen by me. One day, I even took round of 40 patients in the Covid ward and ICU. Between 12th and 19th April , I came in close contact with patients who ultimately were shifted to the Covid ward. I was very sure that I could not escape getting infected.
- So, I stopped going to the hospital from 20th April. By that time 2 physicians had recovered and Joined duty.
- Since then, I have not stepped out of the campus. I used to go down for morning walk inside the campus daily. Occasionally another gentleman also used to come down for walk at the same time. But we both wore mask and never came within 10 mtrs of each other. Couriers and home delivery people were asked to keep the package outside and leave. We then sprayed sanitizer on the package and allowed it to remain outside.
- I developed cough and wheeze on the 15th and tested positive on the 16th. I had planned to go to the hospital from the 17th May.
- How did I get infected? There were 6 to 7 families in the building which had infected family members. These I knew because I had treated some of them and had helped some of them. I am told that there were others too who had not informed anyone about getting infected. This behaviour from educated people is extremely hard to explain.
- We have a terrace attached to our flat where both of us spend a lot of time, sipping tea or tending to the plants. The balconies of about 32 flats open on to our terrace. If an infected person coughed or sneezed on his balcony, the aerosol could easily travel aided by gravity to our terrace.
- I was the victim of airborne transmission of infection from the balconies of the infected homes.
Covid Day 12, 27/5/2021 – How I feel depends entirely on me.
- It rained the whole night. In fact, it has been raining continuously since 25th night. Effect of the Yaas cyclone. Woke up with sore throat. The temp was 98.6 and by 10 am it had risen to 99.
- Dr Shwetam (Vicky for us) had been insisting that I should get another CT Chest done as the first one was done quite early. First CT had not shown any evidence of Covid Pneumonia. This one showed very mild pneumonia ( 3/25 , Corad 5). Fortunately, all blood parameters were within normal limits.
- If one has interest in reading, writing, music and old black and white movies, it is not too difficult to pass this period of isolation. Sadabahar Hits Channel on Airtel not only shows old movies, but also shows history of Indian Cinema and interviews of old stalwarts.
- Great time pass. Will recommend this channel to all. How I feel depends entirely on me. If I allow the disease to dictate that to me, it will overpower me.
- Yes, there is loneliness, the worst part of this disease. But I tell myself that I am doing this to save my wife from infection and then I feel good about it.
- The most important thing is to continue your daily chores as if nothing has happened. I clean my room, I make my bed, I clean the sink daily. I do teleconsultations, something that I did even during acute illness. When you are talking to a patient, you are a doctor. You forget that you are a patient too. Now that I have personally experienced it, I can say with confidence that it works.
- Then there is music. It has the power to bring you back from the depths of depression.
- Video calling is the biggest invention of recent years. Talk to your grandchildren and children daily and you cannot remain gloomy and depressed. Just waiting to test Negative. Thanks to the vaccine, I think I have beaten the demon. I kept myself busy, read a lot wrote a few lines here and a few lines there and devoted myself totally to treating the patients. I can tell you that it is helping. When you are playing the role of a doctor, it is difficult to imagine yourself as a patient. The concern shown by the friends makes me emotional but I come out of it stronger. Vaccination is helping me. It may not help everyone but everyone should take it. Get vaccinated as and when it is your turn to take it.
- I am trying to formulate the basics of treatment of Covid
|First week Anti-Viral. Keep a close watch on inflammatory markers. Cytokine or Chemokine storm usually starts on the 7th day but can occur early.
|Fever of 100 or more, hypoxia, raised markers on 7th day, start steroids, prophylactic anti-coagulants. No improvement in hypoxia for 48 hrs. Give Tocilizumab for whatever benefit it provides. Beyond this , it is respiratory management by an intensivist.
|Anti-viral No specific agent available. Up to the physician to use Remdesivir. I will use it because there is sound theoretical backing and animal models.
|In brief, steroid right dose at the right time and only if needed and prophylactic anti coagulants are the only evidence-based treatment modalities. The other 2 are-Remdesivir in the first week and Tocilizumab if hypoxia is not corrected with steroids for 48 hrs.
|No other therapeutic measures are needed
|Oxygen therapy if SPO2 is less than 94 or 6mnt walking test is positive.
|1 to 5 litres nasal prongs
|6 to 10 litres. Facial mask
|11 to 15 litres NRBM
|16 to 30 litres HFNC
|Above 30 litres. NIV
|HRCT. 6th day. Earlier if markers are very high. Repeat once after 3 days if there is fever , cough or markedly increased markers.
|Antibiotics to used only if evidence of secondary bacterial infection.
|Keep looking for late Cytokine storm. Pts with CAD must continue anti platelet therapy regularly. People with known CAD are at less risk because they are on anti-platelet therapy. Steroids should be started on any day if there is hypoxia.
Dr N K Singh, Editor – cmeindia.in, asks:
- Please shed light on how you got infection? NIH says: Transmission of SARS-CoV-2 is thought to mainly occur through respiratory droplets transmitted from an infectious person to others within six feet of the person. Less commonly, airborne transmission of small droplets and particles of SARS-CoV-2 to persons further than six feet away can occur, and in rare cases, people passing through a room that was previously occupied by an infectious person may become infected. SARS-CoV-2 infection via airborne transmission of small particles tends to occur after prolonged exposure (i.e., ≥30 minutes) to an infectious person who is in an enclosed space with poor ventilation.(Ref-1)
Dr H D Sharan, Ranchi:
- As explained, I had not gone out of campus since 20th April. Had not come face to face with anyone and whenever I faced someone from about 10 to 12 feet, both were wearing mask and I was wearing double mask. At times while walking, I would remove the mask for 5mns but only when there was no one else in the vicinity. At one time there were about 60 patients in the society.
- I never used the lift because we are on the 1st floor. I am sending a pic to explain exactly how. In the picture, you can see my terrace and balconies of 2nd to 5th floor. We later found out that there were cases on the 2nd, 3rd and 5th floor flats exactly above us.
1.Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): scientific brief: Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 5/28/2021COVID-19 Treatment Guidelines 30 SARS-CoV-2 and potential airborne transmission. 2020. Available at: https://www.cdc.gov/coronavirus/2019- ncov/more/scientific-brief-sars-cov-2.html. Accessed January 26, 2021.
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