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Table of Contents
GUEST EDITORIAL
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 2-3

Changing profile of COVID-19


Professor and HOD Geriatric Medicine,Yenepoya University, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, Karnataka, India

Date of Submission13-Dec-2020
Date of Acceptance15-Dec-2020
Date of Web Publication03-Feb-2021

Correspondence Address:
Dr. Prabha M. R. Adhikari
Yenepoya Medical College, Yenepoya Deemed to be University, Derlakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajim.ajim_104_20

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How to cite this article:
Adhikari PM. Changing profile of COVID-19. APIK J Int Med 2021;9:2-3

How to cite this URL:
Adhikari PM. Changing profile of COVID-19. APIK J Int Med [serial online] 2021 [cited 2021 May 14];9:2-3. Available from: https://www.ajim.in/text.asp?2021/9/1/2/308640



This issue of APIK Journal of Internal Medicine is publishing an excellent review by Dr. Vasantha Kamath on the topic “What's new in COVID-19”[1] with the description of additional nonrespiratory clinical features, radiological features, and severity scores and the latest treatment guidelines.

COVID-19 in India has caused havoc affecting as many as 96.77 lakhs with a mortality figure of 140,573 cases up to December 7, 2020.[2] While some of the states such as Karnataka are enjoying decline in cases, we have to learn from states such as New Delhi, Maharashtra, and Gujarat, which are hit by a second wave forcing the states to go for a second lock down. While vaccines are getting ready, we must remember that they are going to be only around 60% efficacious or even lower due to challenges in distributing and maintaining cold chain. Herd immunity, if at all we have developed; is not going to be long lasting. Hence, the only vaccine that is available to us is physical distancing and masking.

While Karnataka is reporting lesser number of cases, we are seeing tell-tale evidence of COVID-19 in every case that we see with inflammation in practically every organ. We are not sure of proportion of such cases. We are not sure as to how to include them as COVID-19 cases so that they get treatment as a case of COVID-19 would get. Whether it is a stroke or myocardial infarction, hepatitis or nephritis, encephalopathy or gastroenteritis, we see profound elevations in inflammatory biomarkers that are rarely seen in such cases when they have occurred due to non-COVID-19 conditions. Of particular interest is a presentation unique to geriatric patients who become mute, rigid, and immobile or in delirium following COVID-19–like illness with encephalopathy features. On imaging, they have features of small-vessel disease such as white matter hyperintensities, micro-hemorrhages, or lacunar infarcts. They do respond to steroids and DOPA therapy, if treated early. Some of them have electroencephalogram abnormalities and seizure disorder which may warrant antiepileptic therapy. Recent review on neuro-COVID[3] describes most of these changes; however, there are only a few case reports[4] of these cases responding to levodopa or dopamine agonist therapy. A recent article has predicted that  Parkinsonism More Details could be the third wave of COVID-19.[4] Pancreatitis, hepatitis, nephritis and nephrotic syndrome, serositis, prostatitis, and ileocolitis are some of the presentations that we have come across. In fact, patients with ileocolitis mimic either ileocecal tuberculosis, typhoid, or Crohn's disease in clinical presentations. However, literature survey shows an occasional case report.[5] Typical findings on imaging are circumferential wall edema of the ascending colon or ileocecal mass covered with omentum and mesentry. Even they seem to be responding to mesalamine and corticosteroids.

With regard to treatment, Does Solidarity trial[6] results change our clinical practice? Are we going to stop using all antiviral agents? The WHO and the ICMR have repeatedly warned us about use of hydroxychloroquine and if at all we are going to use, baseline Q-Tc and further monitoring is a must. Remdesivir although extensively used, Solidarity trial has already concluded that it has no mortality benefit. Of course, clinical trials on remdesivir also did not claim mortality benefit but claimed that remdesivir cuts down the duration of intensive care unit (ICU) stay by 4 days. Hence, the cost benefit has to be measured for its use in developing countries like India. If used early in the 1st week as early as possible after day 5, we may be cutting short the duration of illness significantly.

With regard to tocilizumab, although Lancet article[7] published that tocilizumab has no mortality benefit, it did clearly show that tocilizumab also cuts down the duration of ICU stay by nearly 7 days which is quite an advantage. A recent study[8] also confirms its mortality benefit in patient with C-reactive protein (CRP) >150 mg/dl or upper limit of laboratory normal which has been the experience of several clinicians from Maharashtra and our experience too. This benefit is not visible after a patient is pushed to ventilator, and hence, the decision to use the same has to be made early using CRP as a biomarker.

We have already learnt to manage the pandemic to the best of our ability. We cannot forget the sacrifices made by frontline workers for COVID-19 care. Each one of them has proudly discharged their duties to their fullest. Several of our own physicians have lost their lives. We need to learn to protect ourselves not only in COVID wards but also in our regular outpatient departments and wards where COVID-19 could be disguising as a non-COVID-19 disease.

I would like to end this saluting hundreds and thousands of COVID warriors who have slogged to control COVID-19 in India. Long live their clan!



 
  References Top

1.
Shareef UM, Kumar V, Kamath V. What's new in COVID-19? APIK J Int Med 2021;9:29-37.  Back to cited text no. 1
  [Full text]  
2.
Wikipedia. Template: COVID-19 Pandemic Data/India Medical Cases Chart.  Back to cited text no. 2
    
3.
Nepal G, Rehrig JH, Shrestha GS, Shing YK, Yadav JK, Ojha R, et al. Neurological manifestations of COVID-19: A systematic review. Crit Care 2020;24:421.  Back to cited text no. 3
    
4.
Beauchamp LC, Finkelstein DI, Bush AI, Evans AH, Barnham KJ. Parkinsonism as a third wave of the COVID-19 pandemic? J Parkinsons Dis 2020;10:1343-53.  Back to cited text no. 4
    
5.
Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA 2020;324:294-6.  Back to cited text no. 5
    
6.
WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19 — interim WHO Solidarity trial results. N Engl J Med. DOI: 10.1056/NEJMoa2023184.  Back to cited text no. 6
    
7.
Guaraldi G, Meschiari M, Cozzi-Lepri A, Milic J, Tonelli R, Menozzi M, et al. Tocilizumab in patients with severe COVID-19: A retrospective cohort study. Lancet Rheumatol 2020;2:e474-84.  Back to cited text no. 7
    
8.
Martínez-Sanz J, Muriel A, Ron R, Herrera S, Pérez-Molina JA, Moreno S, et al. Effects of tocilizumab on mortality in hospitalized patients with COVID-19: A multicentre cohort study. Clin Microbiol Infect 2020;S1198-743X: 30573-5.  Back to cited text no. 8
    




 

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