Ranjana Thakur I POINT OUT
COVID-19 is disease which can have a very diverse range or symptoms that patients present with and therefore can be challenging for physicians and hospitals to identify and manage, says Dr Akhilesh Jha, Clinical Lecturer in Experimental and Respiratory Medicine in Department of Medicine, University of Cambridge, England. He speaks to THE POINT OUT and discussed several important issues from dealing with COVID-19.
Here are excerpts from the interview:
Share your experience of treating COVID-19 patients. What are the unusual symptoms you noticed so far?
COVID-19 is disease which can have a very diverse range or symptoms that patients present with and therefore can be challenging for physicians and hospitals to identify and manage. For most people, they do not experience any symptoms and may carry the virus in their nose and upper airway without noticing (but are therefore also likely to spread the disease without realising).
Other people may have just a runny nose, mild cough and fever. Some people also experience a loss of sense of smell or taste. It becomes more problematic if you start to experience shortness of breath or chest pain as this indicates the disease has moved lower down into your lungs, so you should probably then seek medical attention. Strangely, some people have very low oxygenation levels without even experiencing shortness of breath.
There is also a variety of more unusual symptoms that we have been witnessing. These include a change in heart rhythm, collapse, confusion, diarrhoea, heart attacks, blood clots, skin rash and others.
Are Non Vegetarians most vulnerable to the disease? Why?
We do not know yet whether diet and certain foodstuffs are directly related to susceptibility to the disease. However, we do know that people who are obese (body mass index over 30) and those with hypertension and diabetes are amongst the most vulnerable. So I would say it’s probably best to cut back on all those Gulab Jamuns and Ladoos!
What is the line of treatment in absence of any tested medication? Who decides it?
For most people, they will experience only mild symptoms which can be managed by rest, staying hydrated and using paracetamol for a high fever, along with self-isolation in your house to avoid spreading the disease. For those requiring hospital admission, they are likely to have low oxygenation levels and will therefore require extra oxygen. Some people will require a special type of tight-fitting face-mask called non-invasive ventilation to support your breathing. If you become more ill then you may require higher levels of support in an intensive care unit.
Other than these supportive measures and managing any complications of the disease (such as a blood clot) there are currently no approved medications anywhere in the world specifically for the novel coronavirus. Lots of doctors have tried different treatments but we do not know for certain whether these have a beneficial effect. It is very important these are tested properly in formal clinical trials (for example https://www.recoverytrial.net/).
Dr Anthony Fauci from the USA has indicated that an interim analysis of data suggests that Remdesivir may work as an anti-viral but the full results are still awaited. The main focus of developing new therapies are to use drugs that either (a) act against the virus, (b) boost your body’s antiviral immunity or (c) reduce and dampen down your own body’s harmful inflammatory response. Ultimately, developing a new effective vaccine will be key to limiting the chances of getting the virus in the first place.
How do you define Coronavirus? How do you differentiate it from other flu causing viruses?
The diagnosis of coronavirus is made using a swab taken from your nose or throat, or from a sputum sample. This detects whether you actually have the virus at the moment. They are not 100% accurate as the result may be negative even if you have the disease but this is the best technique we have at the moment and is specific for the novel coronavirus rather than other viruses such as influenza, which can be detected separately.
There are also new antibody tests that are being developed which tests whether you have previously had the disease. These are also not accurate in everyone but are an important part of understanding how widespread the infection is in a particular community.
If anyone contract the Virus, what are the precautions?
If you think you have the disease because you have a new cough, fever or change in smell/taste then it is important you should limit your contact with other people and stay in the house, and ask others to drop off your food shopping etc.
In particular, stay away from vulnerable older people or those who have long term medical conditions. If you are experiencing more severe symptoms such as shortness of breath, chest pain, confusion etc. then you should seek advice from a health professional. The issue of whether people should wear masks is being debated internationally and by the World Health Organisation.
If you have symptoms you shouldn’t be leaving the house but if this is unavoidable then I think it is sensible to wear a face mask outside. You may wish to do this if you have underlying medical conditions. However, the MOST important thing you can do is to have good hand hygiene by washing your hands at regular intervals, before and after food, after going to the toilet and also before and after going outside for trips particularly if using public transport.
How to boost immunity, what are the precautions one should take to remain safe?
In addition to the above precautions, try and keep yourself as fit as possible. Eat well. Rest and sleep. If you are overweight then try and lose some Kgs by exercising and eating better. Be physically distant from others but not socially distant – keep in touch with relatives to maintain your mental health during this difficult time.
Are Asthma patients with COVID-19 more likely to become seriously ill?
This is an interesting area as there is very varied data on people with asthma across the world. For example, in the Chinese datasets on patients who were admitted to hospital, asthma was relatively uncommon but recent UK data suggests it may be as common as 14% of hospitalised patients. However, despite low oxygenation levels when arriving in hospital, in general the outcomes for those with asthma tend to be quite good compared to others. The biggest risk factors for those with more severe outcomes are older age, hypertension, diabetes and obesity.
These are challenging times for everyone across the world and we should certainly listen to the public health advice that is given by national and international authorities. With this collective action from the public and the amazing science that is going on globally to develop new vaccines and therapies, I believe we will be better prepared to manage COVID-19.
Dr Akhilesh Jha is a Clinical Lecturer in Experimental and Respiratory Medicine in Department of Medicine, University of Cambridge, England. He has a research interest in mucosal immunity to respiratory infections, especially in diseases with dysregulated host responses such as asthma. Dr Akhilesh is a member of the British Thoracic Society Science & Research Committee.
Follow him on Twitter @EATSreg