CMAAO Coronavirus Facts and Myth Buster: COVID Loss of Smell

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With inputs from Dr Monica Vasudev

1030: Loss of smell associated with less severe COVID-19 infection: A study published in the Annals of Allergy, Asthma & Immunology, has revealed that loss of smell seems to be an independent positive prognostic factor of less severe COVID-19 infection.

The study enrolled 949 patients with COVID-19. The patients were assessed at Rush University Medical Center from February 1, 2020, through April 3, 2020. In all, 198 (20.9%) patients reported loss of smell. Anosmia was shown to have a significant association with younger age (mean age, 46 vs 49 years; P = .02), female gender (64.7% vs 52.8%; P = .003), and higher body mass index (33.6 vs 31.5; P = .001).

Anosmia had a significant association with decreased hospitalization (odds ratio [OR] = 0.69), admission to intensive care unit (OR = 0.38), intubation (OR = 0.43) and acute respiratory distress syndrome (OR = 0.45). The results continued to be significant following further adjustment for allergic rhinitis and chronic rhinosinusitis.

Loss of smell was also associated with less lymphopenia and higher albumin levels, pointing to a less severe reaction to COVID-19 in patients with smell loss when compared with those with intact smell, suggested researchers.

Mean lymphocyte count was 1.84 ± 3.69 among patients with anosmia compared to 1.11 ± 0.81 among those without smell loss (P = .001). The levels of albumin were 3.02 ± 0.83 versus 2.77 ± 0.83, respectively (P = .02). Other laboratory values and inflammatory markers had no link with anosmia.

The study also revealed a significant association between anosmia and history of pre-existing smell dysfunction (OR = 4.66), allergic rhinitis (OR = 1.79), and chronic rhinosinusitis (OR = 3.70), in comparison with patients without loss of smell. [DG Alerts Excerpts]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

CMAAO Coronavirus Facts and Myth Buster: Paradigm shifts in COVID-19

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With inputs from Dr Monica Vasudev

1029:  Update on COVID-19

IMA-CMAAO Webinar on “Paradigm shifts in COVID-19”

25th July, 2020, 4-5pm

Participants: Dr RV Asokan, Hony Secretary General IMA; Dr Ramesh K Datta, Hony Finance Secretary IMA; Dr Jayakrishnan Alapet; Dr Brijendra Prakash; Dr Sanchita Sharma

Faculty: Dr KK Aggarwal, Padma Shri Awardee, President CMAAO & HCFI

Dr KK Aggarwal elaborated on the paradigm shifts in the management of COVID-19 from the month of March to July, based on his experiences of patients with COVID-19.

Key points from the discussion

  • COVID-19 was first considered to be a viral pneumonia, but now it is known as a mysterious virus, which is predictably unpredictable.
  • It spares joints and larynx, so no joint involvement or hoarseness of voice; also, no lymph nodes involvement.
  • COVID-19 was earlier believed to be non-inflammatory, but now we know that it is predominantly an inflammatory disease.
  • Earlier, it was thought that the patient could become critical on any day of the illness; now we know that Days 3-6 are the days to watch.
  • Social distancing has changed to physical distancing.
  • From macrodroplets (surface to human transmission) earlier, we now talk of microdroplets (crowded ill-ventilated rooms).
  • Surface to human transmission was the most important route of transmission; now it has become less important (heat and humidity).
  • The shift from no masking to mandatory masking in public has become the norm.
  • From simple masks, we have moved to N95 masks for all high risk patients (COPD, asthmatics).
  • Masking only when going out, is now joined by masking also at home.
  • Distancing of 3 feet has changed to 6 feet; with microdroplets, this distance is now 9 feet.
  • We started in the pandemic with very high mortality (10%); now mortality is around 0.3%.
  • Institutional care has shifted to home care.
  • In the early days, no treatments were available, but individualized treatment is now available. If inflammatory parameters are raised, then give steroids; if D-dimer is high, give anticoagulant; if early presentation, give antiviral, etc.
  • From mandatory ventilation, the concept has changed to noninvasive ventilation.
  • Children to grandparents; now children pose no risk for transmission to adults or other children.
  • Menstruation reduces severity of illness.
  • We have shifted to no steroids to early low dose steroids.
  • Hydroxychloroquine (HCQ) for all to no HCQ for mild cases.
  • Late discharge – Earlier patients were kept for 30-40 days; now patients are discharged early (Day 6) if no complications, to home quarantine.
  • Thinking of death to thinking of recovery.
  • No pooled test to pooled test.
  • We have now understood that after 9 days of illness, the virus is non-culturable and the person is non-infectious; the presentation is post-COVID sequelae due to persistent inflammation, or hypercoagulable state. Before 9 days, it is COVID.
  • No Ct value to Ct value of RTPCR to find out if cohort isolation can be done; low Ct value means high viral load.
  • Testing has moved from antigen RTPCR to rapid antigen and now antibodies testing (total vs IgG).
  • Isolation to cohort isolation (multiple infected persons in a family can stay together).
  • Isolation; and now isolation/quarantine/monitoring.
  • From no oxygen at home to oxygen at home.
  • Closed camps/OPDs to open sunlight camps – microdroplets are killed in sunlight.
  • Earlier, testing was done only for symptomatic persons, but now liberal testing.
  • A mandatory government prescription has now become non-mandatory.
  • When it first began in Wuhan, China, it was pulmonary COVID and CT diagnosis was a must; but now it is also recognized as non-pulmonary COVID, involving GIT, CNS.
  • Typically, fever at the time of presentation; now no fever presentation.
  • Asymptomatic persons are really not asymptomatic; they may have some atypical symptoms such as diarrhea, sore throat, etc.
  • High grade fever, which is classically associated with viral illness to low grade (100oF) exertional persistent fever, due to persistent inflammatory process.
  • The six minute walk test (6MWT) was meant for only COPD, heart failure patients, but it is now mandatory from Day 3-6. If the patient desaturates by 5% on walking, this is indicative of pneumonia with thrombosis. This is an emergency.
  • Transmission from joint families to nuclear families.
  • No toilet transmission; now toilets are recognized as a COVID chamber.
  • Contact time from 30/10 minutes to 15/5 minutes in closed areas.
  • Testing till Ag negative to no testing to confirm when Ag will become negative.
  • Fear to no or less fear.
  • Mortality is two times that of the government figures reported.
  • For every tested person, there are 20 untested individuals; for every 20 COVID patients, there are 80 patients with corona-like illness.
  • Stigma to less stigma.
  • Low mortality to high mortality amongst doctors.
  • Ignorance to knowledge.
  • Engineering (AII rooms) to social engineering: test for 5 parameters when screening – temperature (low grade, does not respond to paracetamol), SpO2 (happy hypoxia), loss of smell, loss of taste (give jaggery – first taste to go is sweet taste) and hand grip strength.
  • New loss of smell and taste has been seen in 20-30% of patients; the disease is mild in nature.
  • We now know that plasma therapy is effective if given early.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

CMAAO Coronavirus Facts and Myth Buster: COVID Update

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With inputs from Dr Monica Vasudev

1019: North Korea’s leader Kim Jong-un has placed Kaesong City, near the country’s border with the South, under lockdown. A national emergency has been declared after acknowledging that the country might have its first case of the coronavirus. North’s official Korean Central News Agency has stated that a North Korean who had defected to South Korea three years back, had secretly crossed back into Kaesong City last week and was suspected to have been infected with the virus. Until now, North Korea has stated that it has no cases of COVID-19, claims that have been questioned by outside experts.

1020: Vietnam had no case of locally transmitted coronavirus for 100 days. However, on Saturday, a 57-year-old man in the city of Danang tested positive for the virus.

Vietnam is going to evacuate thousands of tourists from Danang after four residents there tested positive this weekend.

1021: President Jair Bolsonaro of Brazil has stated that he no longer has the coronavirus. He had experienced only mild symptoms. Over 86,000 people in Brazil have died from the virus.

1022: Australia reported its highest one-day death toll on Sunday — 10 people – all in the state of Victoria.

1023: France will do COVID-19 testing free for all.

1024:  Biocon suffered a setback on Sunday as the Union health ministry announced that the firm’s itolizumab drug is not a part of the national treatment protocol for COVID-19 patients. Less than two weeks ago, the Drug Controller General of India had given permission for the drug’s use on moderate to severe coronavirus patients.

1025: Hong Kong is closing all dine-in restaurant services and restricting public gatherings to two people after more than 100 new cases were recorded for the sixth consecutive day.

1026: President Trump’s national security adviser, Robert O’Brien, has tested positive for the coronavirus. He is the most senior White House official known to have contracted the virus.

1027:  Japan takes masks to a new level: In Japan, the use of masks was widespread even before the pandemic. But now, there has been a big push to innovate. Inventors have devised masks with motorized air purifiers, Bluetooth speakers and even sanitizers that kill germs. In South Korea, LG has created a mask powered with fans, thus making it easier to breathe. Another company is trying to build a mask with a translator. Masks were first used in epidemics in the early 20th century, when Wu Lien-teh, a doctor of Chinese descent, started promoting simple gauze masks to fight pneumonic plague outbreak. During the 1918 flu, the practice was embraced globally.

1028: Perinatal transmission of COVID-19 unlikely if precautions taken: Mothers positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at delivery will not likely transmit the infection to their infants during the perinatal period if proper precautions are undertaken, suggests a study in The Lancet Child & Adolescent Health. This is the largest cohort of neonates born to mothers positive for SARS-CoV-2 at the time of delivery, with prospective follow-up up to 1 month of life, noted investigators.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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