The ongoing coronavirus pandemic has thrown up new challenges which we have never faced before. More than 3 million people around the world, now tragically including thousands every day in India, have lost their lives to severe COVID-19. Though incredible progress has been made in a little more than a year to develop effective vaccines, diagnostic tests, and treatments, there’s still much we don’t know about what precisely happens in the lungs and other parts of the body that leads to lethal outcomes.
A Webinar On “Clinical Challenges In Covid” was held on July 1, initiated by Dr. M S Kanwar, MBBS, MD, DM, Institutes of Critical Care Respiratory and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi. In this webinar experts from all across the country came together to discuss key issues on “Clinical Challenges In Covid-19”
Eminent Doctors, Dr. Arun Prasad, FACS, FRCS, FRCSEdMS (MAMC), MBBS (AFMC) Senior General, GI & Bariatric Surgeon Apollo Hospitals, New Delhi; Dr. Abdul Samad Ansari, Director Critical care at Nanavati Super Specialty Hospital; Dr. Kalapna Nagpal, Senior Consultant & Robotic Surgeon, Department of ENT and Head & Neck Surgery, Indraprastha Apollo Hospitals; Dr. Kashmir Singh, MD, FACEP Emergency Medicine Physician; Dr. Om Shrivastava, Director, Infectious Diseases, Jaslok Hospital, Mumbai were a part of the panel.
Dr. Kanwar while concluding the webinar stated that it is also important to pay attention to Post covid fever, Post covid chest pains, and children with long covid.
Dr. Abdul Samad Ansari spoke about the ever-changing clinical picture during the Covid-19 pandemic. He said, “During this time we were realizing a sheer number of acute respiratory failure coming in, which we initially thought we are prepared of but a sheer number of significant severe ARDS was seen in elderly people with multiple comorbidities. Fighting this new illness by following all the precautions like social distancing, engineering solutions, rostering, getting your people to save to do their rotations, and thinking about what would be the right time to initiate any kind of extra corporate therapy was a big challenge.”
Many new variants of Covid-19 have already emerged against which vaccine may not be effective enough. Long Covid is another major concern. Some studies suggest that around 10% of corona-positive people are affected by long Covid.
“CT scan only helps in identifying the patient condition at the primary stage. It doesn’t help when the condition of the patient worsens. It is the clinical investigations like CRP and others help determine the reason for worsening patient condition,” said Dr. Sudha Kansal from Respiratory Senior Consultant Medicine Specialist and critical care, ICU Co-Ordinator Apollo Hospitals.
Demystifying the Myths against Covid-19 vaccines, Dr. Kashmir Singh said, “The vaccine is Safe on pregnant, lactating women but some institutes are spreading the rumor that vaccine was made with the placenta tissues and many more such rumors. Hitting the 70% Target in the US for vaccination is getting difficult.”
Sharing his experiences about challenges during surgery, Dr. T Sunder mentioned that in Lung transplant we had to make sure the donor, recipient, and the immediate carrier are covid negative.
He said it seemed like a nightmare, usually, it takes around 6-8 hrs surgery in normal times but during covid, the surgeries went on for a longer duration.
Bronchotomy was even more full of risks.
He also mentioned that lung transplant may be beneficial but in the current scenario, 6-8 weeks should be given to the covid 19 patients to recover.
While talking about what were the challenges in surgery in particularly with active covid cases?
Dr. Arun Prasad mentioned some important points on what difficulties they had to face during surgery, he said, operating in covid OT, PPE kit, three layers of protection was really difficult. Touching the monitor screen led to fear of infection. Surgical smoke. The time between surgeries was longer than usual. We were exhausted post-surgery.”
“Covid has been very harsh on Kidney patients, the incidents of Kidney involvement have been so high as compared to the mortality that we have been seeing in these patients. Incidence of AKI is reported as low as 0.5% in community Covid disease to as high as 46% in the hospitalized population,” noted Dr. Sanjiv Jasuja.
“It’s better to intubate the patient in time. appropriate time of intubation is necessary. Don’t delay, post covid complications prolong because of delay in intubation”, noted Dr. Sudha Kansal.
