Opinion

Covid lessons from UK

Roopen Arya | Updated on June 09, 2021

Mass vaccination has been key to flattening the curve

Since March 2020, the National Health Service in the UK has been engulfed by two tidal waves of Covid-19. Over a year on, case numbers and deaths are now right down. The rapid and effective mobilisation of the NHS in the fight against Covid is one of the notable successes of the past year, commercialisation of aspects of public health like ‘test and trace’ less so.

The efforts of the frontline staff redeployed to the care of Covid patients on the wards and in intensive care have been nothing short of superhuman and the same could be said for the millions of healthcare colleagues in India. The knock-on effects on non-Covid medical care both in India and the UK will unfortunately mean numerous missed diagnoses or delayed care and burgeoning waiting lists for routine surgery. Health inequalities have also been in sharp focus in the UK, with ethnic minorities hardest hit by Covid.

Patient management

Amidst all this, there’s now a better understanding of how to manage patients with Covid. In severely affected patients, incremental changes have helped improve outcomes. These include general measures such as nursing patients on their fronts, better fluid balance and optimal levels of respiratory support. Specific beneficial measures include use of steroids and tocilizumab to target immune over-activity and remdesivir for the antiviral effect. Once-popular treatments such as hydroxychloroquine and convalescent plasma therapy have been discarded.

It is important to note that 90 per cent of infected individuals have mild disease and should be managed simply at home with the use of paracetamol for fever and headache as well as self-isolation measures. Other than the test to confirm SARS-CoV-2 infection no further tests are required, certainly not the vast amount of unnecessary blood tests and scans being undertaken in India, engendering anxiety and uncertainty.

In those moderately affected patients not requiring hospital admission, a pulse oximeter can provide useful indication of a drop in oxygen levels. In mild to moderately affected patients being managed at home there is no role for the polypharmacy being widely used including steroids, antibiotics and remdesivir.

Activation of the body’s defence systems by SARS-CoV-2 triggers inflammation and thrombosis. There is a marked increase in venous blood clots which include pulmonary embolism in the lungs and deep vein thrombosis in the legs. Venous clots in unusual sites such as the brain or gut are also seen as well as arterial blood clots in the heart, brain, and limbs. The increased blood clot risk in hospitalised patients means that most of them require blood thinners (usually heparin) to prevent thrombosis.

Blood thinners for clot prevention should only be used in hospital and should not, in the absence of a blood clot, be used in mildly affected patients at home or routinely in patients after discharge from hospital when recovering from Covid. The practice of checking D-dimer and CRP blood tests at home resulting in prescribing of blood thinners is common in India, but there is no evidence to support this approach which is potentially harmful and should be discouraged.

The explosion of research in Covid means nearly 3,000 randomised controlled trials are registered, and each day 400 new papers relating to Covid get published. It is important to stick with the science as, at times, Covid has been an excuse to change practice based on not much evidence. With hospitals full of Covid patients there is pressure to adopt freshly tweeted results, with full publication of data still many months away.

The roll out of the mass vaccination programme in the UK has been critical to breaking the link between infection, hospitalisation, and death.

Nearly 40 per cent of the UK’s 67 million population has received both doses of vaccine as opposed to 3 per cent of India’s 1.35 billion population. India aims to vaccinate all eligible citizens by the year’s end, which is a mammoth challenge. Rich nations need to realise that the only enduring global solution for the pandemic lies in worldwide sharing of vaccines, else we will remain trapped in a circle of infection as new strains continue to emerge.

The writer is Professor of Thrombosis and Haemostasis, King’s College Hospital, London.

Published on June 09, 2021

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