The UK experience that we should learn from.

Lessons from the second wave.

India today seems to be in the same situation that the UK was in mid December. First an exponential number of people testing Covid positive followed a week later by an exponential increase in number of hospitalisations followed 2 weeks later by an exponential increase in Covid deaths. Given below are the lessons that need to be learnt.

1. 99% of Covid positive recover on their own. The only things needed for them are oxygen level monitoring to make sure sats are >93, paracetamol (Crocin or Dolo) for fever and body ache and home isolation to make sure they do not passit on to others. There is no need or benefit in giving plasma, remdesivir, ivermectin, hydoxychloroquine, antibiotics or even steroids, blood thinners or toclizumab to these 99%. There is NO need for hospitalisation as long as oxygen levels are above 93%.

2. Covid is an illness that affects a lot of people at the same time, however, it is how severely it affects the 1% who are unlucky enough to have severe covid which makes it the dreaded illness it is. All our medical resources (hospital beds, oxygen cylinders etc) need to be saved for those severely affected 1% and not the 99% with mild illness irrespective of wealth, contacts, influence etc.

3. For the 1% that have severe illness the only medications that have been found to have significant benefit are steroids and blood thinners. Toclizumab also has been found to have benefit (only 4%) and should be given whenever available. Remdesivir has very minimal benefit (no mortality benefit at all) and should be given if available, however, the patient does not lose much if not given. It would be wrong to call either of them life saving in Covid.

4. Plasma has been extensively studied and found to be of no benefit. This is after painstaking analysis of 11,000 patients given plasma vs 11,000 not given plasma. It should NOT be given. It uses up a significant amount of resources with no benefit.

5. Hydroxychloroquine/vermecin. No serious medical organisation in the world found any benefit in giving them and should not be given. However, they are cheap and relatively harmless.

6. Oxygen shortage. Many hospitals in the UK had to stop admitting patients due to running out of oxygen for short periods of time. We only need to give enough oxygen for levels to be above 93 to 94. There is often a tendency to turn oxygen flows to the highest levels possible. This has to be avoided.

7. Vaccine. In London before the vaccine all our ICUs were full, all theatre recoveries were full, all cardiac HDUs etc were full of intubated covid patients and we were transferring intubated covid patients to as far as Scotland, Bristol etc in helicopters to relieve ICU capacity in London. After the vaccine we have hardly any hospital admissions and almost, nil new ICU admissions. However, this could also have been due to the serious nature of the lockdown.

8. Rationing of resources. In the UK every patient who needed a hospital bed got one and every patient who was suitable for an ICU bed got one. This was only possible as there were strict criteria for hospital admission which meant that the 99% of Covid positive who do not need oxygen were not hospitalised. This needs to be done strictly in India as well.

9. Once someone has tested covid positive there is no need to get retested  to see if they are still covid positive. This unnecessary retesting results in wastage of testing resources. Once 2 weeks of home isolation following date of onset of symptoms is complete a person is considered covid negative and non infectious.

- Dr Nishit Sud, Anaesthetics/Critical Care, NHS London.

My take.

No doubt, we are passing through difficult times but together, we would flatten the curve and bring down the severity of the pandemic. This, too, shall pass. Prayers for the unfortunate people who had borne the brunt of the stretched resources. Om Shanti, Sadgati.

Tailpiece.

Got up at 6, the chores and was ready by a quarter to 10. The Aquaguard service engineer comes and carries out the first servicing as per the renewed AMC.

Sifting the truth from the fake news is becoming a tedious problem!