Saluting the medicos

Paran Balakrishnan | Updated on August 04, 2020 Published on August 03, 2020

They have risen to the Covid challenge

We are sprinting past one grim Covid-19 milestone after another with the caseload crossing 1.8 million. But we must stop to pay tribute where it’s due — to India’s medical profession that has been working tirelessly to save lives, even at considerable personal risk. (Nearly 100 doctors have died from Covid-19, the Indian Medical Association says.)

As doctors have learnt to face down Covid, they say patients who go into hospital now have better survival chances than a few months ago, despite India’s creaking healthcare system. Treatments have changed dramatically as doctors around the globe learnt more about the enemy they faced. Doctors here say India has benefited because the pandemic struck here badly long after it devastated Europe and the US. Doctors also agree that the lockdown helped slow infections and won them time to rapidly learn what medicos around the world were doing to stem the disease.

Initially, it was thought Covid was primarily a respiratory illness and so severely ill patients were put on ventilators but many didn’t survive. Then it was found that the lungs weren’t getting oxygenated blood and so ventilators weren’t the answer. This led to doctors using heparin, a blood thinner, to prevent clotting. Equally crucially, doctors learnt the simple trick of putting patients on their bellies in what is called the prone position which makes it easier for the lungs to draw in air.

Doctors also quickly learnt that patients often died because of what’s called a cytokine storm, when the body’s immune response overreacts. Doctors can figure when this is happening when inflammatory markers shoot up. Just recently, British researchers discovered certain generic, inexpensive steroids like dexamethasone could work against an overactive immune system.

Doctors recommend now patients with mild symptoms stay at home but keep checking the oxygen saturation level and go to hospital if it should fall below 94. Constant checking is important because there’s also an unfortunate condition called happy hypoxia where patients lose oxygen but don’t realise it. Only about 10-15 per cent of patients have moderate-to-severe infections and need hospitalisation and only 5 per cent need to be in an ICU. Such patients are treated with combinations of anti-virals like Remdesivir and Favipir, steroids and higher power non-invasive oxygen delivery systems. If other treatments fail, doctors are also now trying plasma therapy, though they concede no large-scale trials have taken place to confirm its efficacy.

There has been one treatment change in the last few months. Initially, almost everyone, except older patients with cardiac issues, were given hydrochloroquine, a drug that Indian doctors were extremely familiar with. Some health workers still take it, but it has been dropped from most treatment protocols.

Doctors, nurses and other frontline healthcare workers are fighting heroically, and the government and the public owe it to them to give them support. As time’s gone by, though, the ‘Jay and Jayashree’ public have tired of wearing face masks and social distancing and all the other tiresome restrictions that help prevent the infection’s spread.

But Covid is far from beaten and India will need to batten down the hatches and be prepared for an arduous battle in the coming months or even years. Our health workers’ efforts will be in vain if we do not back them every inch of the way.

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Published on August 03, 2020
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