Dr. Krishna Murty
Subharti Medical College,
Meerut
It has been almost 1 year of me working almost continuously in covid L3 setup. I loved seeing so many patients recovering under my care and God was kind enough not to infect me. Although I took the needed logical precautions, PPE dress was not one of them. I saw almost 70-80% of patients and their progress on a daily basis. Following is my experience:
1. April 20 – June 20: treatment was based on common sense, basics on how to treat viral illness. The concept of Remdesivir was not there. Ventilation and O2 therapy of covid lungs were quite different from other respiratory patients. It was a fast-learning time.
2. July 20 – October 20: Remdesivir provided good symptomatic relief. The main player was O2 therapy by HFNC. Other trial therapies were decently established. HRCT gave good guidance on patient prognosis and Remdesivir need.
3. October 20 – January 21: was bad. Remdesivir response was visibly less. HRCT was a very good predictor of prognosis. The effect of HFNC was not as effective. Many patients were better off with double O2 therapy. Cases reduced against logic except for a post-Diwali spike.
4. January 21 – March 21: minimal covid patients. A lot of allegations of improper care and negligence and Various attempts to blackmail on the threat of doing negligence cases. Most of the time went is replying to official nonsense trying to prove how we were so bad last year as if no work had been done for 1 year.
5 . April 21—- now: Remdesivir effect is good in providing symptomatic relief. Our experience of * is greatly helping in serious patients. HRCT is not correlating with prognosis.
O2 requirement and breathing pattern is possibly the most important prognostic marker. Even SPO2 is not a marker like before. I mean patients with very bad HRCT are doing well including 25/25 score patients. Low SPO2 (70 on high O2) patients are improving, unlike last year. A significant number of younger patients are admitted (35-50 yrs).
I was possibly due to the irrational use of azithromycin and doxycycline and meropenem and tigecycline (although I was very strict about unnecessary antibiotics in my patients) for 1-year resistant klebsiella and pneumococcal infection is now visible and concerning. Anxiety relieving and breathing counselling is the most important treatment followed by oxygen therapy.
Will irregular Remdesivir administration lead to some sort of resistance of SARS -CoV 19 to it? Also, I am again waiting when allegations of negligence from all sides will start and rather than seeing patients, I will have to make replies to letters. This is just my personal experience of say 5000 patients seen 1 to 1. It may or may not be similar to that of other centres or even incorrect considering the starting of the wave.