One among those who are fighting disease and death, working round the clock, is Dr Chaitanya Challa MBBS, MD, PDCC, FCCS, the Sr. Consultant of Internal Medicine and Critical Care, and COVID Care at Care Hospital, Banjara Hills. Here’s what he has to say on the current situation.
What, according to you, is a right approach to testing?
Coronavirus is not a new virus, it’s a virus known for over 30-40 years. It’s a new strain of the virus that is now affecting us. The way to identify coronavirus is through a polymerase chain reaction which is basically a swap taken from your nose and throat that identifies the Genome of the virus. The other way to identify it is through a card method that identifies antibodies IgM and IgG antibodies. IgM is an acute infection and IgG being an old infection. These two tests have their own advantages and disadvantages in the form, and they identify the antibodies don’t have much sensitivity or specificity, which also means that this cannot identify the antibodies accurately. The PCR test is a better test which is the standard for identification but also has its limitations as its accuracy is 90%.
You can also identify this by doing a CT scan of the chest which identifies ground-glass opacities, which will be seen on the CT. If one spot ground glass opacities it indicates Corona infection. We have what is called CO-RADS features 1, 2,3,4,5 and so on. If the features are suggestive in the form of ground glass and CO-RADS, then it is most likely Coronavirus. In India, because of WhatsApp messages, everybody wants to go and do a swab test, well it is not as useful as they think it is. Doing a CT, associating them with other tests like CBP, liver function test, LDH, D-dimer, IL6, Ferritin levels are more indicative of an acute level of infection as opposed to a PCR showing positive or negative which does not imply anything.
Reportedly, some patients have been tested negative the first time, and then positive the second time or vice versa. What is the accuracy of the tests and how much can patients and doctors rely on it?
Once you have an infection, it starts spreading in your body. Once it reaches a threshold at which a test can identify. If it is not at the level that the test that can identify, then the test will be negative. Almost all infections have an incubation period, during which time the test will not be able to identify the infection even if you have the infection. This is called an incubation period. So, if you do a test in this incubation period, your report will be negative even though you are actually infected with the virus. This applies to any virus.
For the PCR test to be positive, what we’re seeing clinically, is after the third day, the test gets positive. So someone infected today or the previous day, their test today will be negative. But your CT scan will definitely show features of Corona. Your IL6, D-dimer test values will be high.
If someone’s CT shows features of Corona with elevated markers in their blood tests - it then indicated/confirms Coronavirus.
Since most of the hospitals are full and no beds are available for COVID patients or even the ones with health issues, what according to you could be done to empower the hospitals?
Private hospitals have definitely risen today, to support the health requirements of the society. Government hospitals, being in the shape they are, have needed private hospitals to take a step forward. Hence healthcare is expensive. The cost of expense is generally the personal protection equipment that the healthcare workers wear, which cost anywhere between Rs 1000-2000, and for each patient, per day, at least 10 PPE kits are used, which itself accounts to around Rs 20,000 a day. Hence the cost. In private hospitals, the number of beds available priorly to Corona and today, are worlds apart. They are almost 80% of the hospital beds for Corona alone. Cardiac ICUs, Neuro ICUs, surgical ICUs - all their work has steadily reduced because, unless there is an acute problem, 90% are all for Corona care. Hospitals are full, emergencies are full. Rooms are full, ICUs are full.
COVID patients are being advised to not panic, but at the same time, there aren’t enough resources available for them to treat themselves. What could be done at home to recover from the disease?
What do we do for the patients every day we get calls for so many patients, literally turning them down every day we don’t have beds not available… hence home-care. Now, home-care also is not possible with every case of Corona. Patients who have the virus and are stable with oxygen level being monitored at home, with it being above the level of 95, you can start your basic medication, and you’re comfortable. But once you pass a threshold where your oxygen levels come down indicates a patient building pneumonia in your lungs that cannot be treated at home.
There clearly has been a drastic incline towards telemedicine…
Telemedicine was against the law until corona started. There is still no clear guidelines if it is allowed or not allowed. We suggest patients who used to come to the hospital earlier for their regular check-ups, such as thyroid, diabetes, etc., have been advised by us not to come because we cannot risk them having another infection. Once they get it by coming to a hospital, they start spreading it in their community - making it a bigger disaster than it already is. Hence telemedicine has definitely coming to play. I talk to over 20-30 patients a day for telemedicine. We’re answering literally another 200-300 calls every day for patients for admission, and 100-200 about just corona infections.
What are your discharge protocols like?
Once these patients have an infection and are treated at home or hospital, they will eventually, over time, depending on what the patient’s clinical status is, their PCR test becomes negative. Whether the test being negative is not a criterion for us to discharge. If the patient has no fever for three consecutive days for 10 days, we discharge the patient. The patient can go home but has to stay home for a total duration of 14 days. Where his infectivity levels come down, and his chance of spreading to others comes down. The discharge protocols are individualised. Ever patient with Corona is treated separately. Obviously, the protocol they have to follow is different.
How have your last few months been?
Last four months have been terrible. It has been over 30-days since I have not seen my mum, dad, wife or my 3-month-old son. It is quite difficult for us, but this is what we signed up for, and this is what I do. - Anahita