Dr. Anil Sharma Answering All Your COVID-19 Questions #MustRead

Prof Dr. Anil Sharma, MBBS, MD, DM (Cardiology), FACC (USA), Professor & Head - Cardiology at Bombay Hospital, is a renowned Senior Interventional Cardiologist, who has contributed extensively to the growth and development of Interventional Cardiology in India.
Dr. Anil Sharma Answering All Your COVID-19 Questions #MustRead
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1) What is COVID – 19 (SARS-CoV-2)? 

COVID-19 (CO-Corona; Vi–Virus, D-Disease) is a clinical syndrome (severe acute respiratory syndrome) caused by Coronavirus. The first case was detected in China in December 2019.

2) What is Virus? 

A virus is a tiny particle that cannot be seen by naked eyes. It is an obligatory dead/living particle.

3) How does COVID-19 spread? 

It is a fomite-borne infection that spreads via respiratory droplets (coughing, squeezing).

4) What are the different types of coronaviruses? 

There are seven types of coronaviruses and a majority of them cause mild flu. COVID-19 is caused by the novel Beta coronavirus which is a single-stranded RNA virus.

5) What is the Incubation Period for COVID-19? 

The period from entry of virus in the body to appearance of symptoms (2 to 14 days).

6) What are the different stages of COVID-19? 

COVID-19 has three stages (5 to 7 days each stage):

a) Stage one: Early infection i.e. viral replication.
b) Stage two: Lung phase i.e. viral replication + immune response.
c) Stage three: Hyperinflammation phase i.e. Cytokine storm/Hyperimmune response.

7) What are the symptoms of COVID-19? 

  1. Stage one: Asymptomatic / Constitutional symptoms: fever, dry cough, body ache, headache, fatigue, abdominal pain, diarrhea, loss of taste, loss of smell, breathlessness.
  2. Stage two: Severe breathlessness, tachypnoea, high-grade fever. c) Stage three: Multi-organ dysfunction i.e. heart attack, heart failure, shock, arrhythmia, sudden cardiac death, paralysis, clot formation, etc.

8) Which organs are affected by COVID-19? 

COVID-19 affects many organs. The most commonly affected organs are the lung, heart & brain.

9) What is the treatment for mild COVID-19 infection? 

Mild disease means asymptomatic or mild symptoms with oxygen saturation >94%. Patients are advised home isolation with contact and droplet precautions, strict hand hygiene, hydration, and symptomatic treatment like antipyretics and antitussives. Inhaled budesonide is recommended for high-risk patients. Medications like ivermectin / 2-D Glucose, zinc, and vitamin C can be considered but have a limited role. Monitor pulse, temperature, blood pressure, oxygen saturation, blood sugar, etc. under medical supervision. Hospitalization may be considered for very high-risk patients. 

10)When to hospitalize in case of COVID-19 infection? 

  1. Difficulty in breathing.
  2. High-grade fever/ severe cough particularly if lasting for > 5 days.
  3. Fall of oxygen saturation level.

11) What are the tests to diagnose COVID-19?

  1. RTPCR (Reverse Transcription Polymerase Chain Reaction) Nasal or  Oral Swab: Get result in 8 hours. Sensitivity around 70%. Maximum sensitivity on the 6th day.
  2. Rapid Antigen: Result available within 30 minutes. Sensitivity around 50%

12)What are the indications of CT Thorax in COVID 19 infection?

  1. Clinical suspicion of COVID but RT-PCR negative.
  2. Suspecting alternative diagnosis like TB.
  3. Complications like pulmonary embolism.
  4. Evaluation of post-COVID fibrosis.

13) What is CTSS in COVID-19 Infection? 

CTSS stands for Computerized Tomography Scan Severity Score which is calculated from CT Chest which helps to determine the radiological severity of COVID-19 Infection.

14) What are the grades of CT severity score (CTSS) in COVID-19 infection?

On basis of CT severity score, COVID-19 infection is classified as

  1. Mild (CTSS- < 9)
  2. Moderate (CTSS- 9-15)
  3. Severe (CTSS- >15)

15)When is oxygen therapy recommended in COVID-19 Infection?

  • Oxygen saturation >94% is considered normal.
  • Oxygen saturation 92%-94% is borderline.
  • Oxygen therapy may be considered if oxygen saturation is ≤ 94%.

16) What are the laboratory features associated with severe COVID-19 infection? 

There is an elevation in levels of D-dimer, CRP, LDH, Troponins, Ferritin, IL-6, and CPK and a reduction in absolute lymphocyte count.

17) What is the treatment for moderate/severe infection? 

Requires hospitalization, supportive treatment, and TOAD on ROAD Mnemonic.

TOAD: Tocilizumab, Oxygen, Anticoagulants, Dexamethasone (Steroid). ROAD: Ramdesivir, Oxygen, Anticoagulants, Dexamethasone (Steroid).

18) What is Mucormycosis? 

Mucormycosis commonly known as ‘Black Fungus’ has been observed in a number of Covid-19 patients recently. A fungal infection mainly affecting people with medical health problems that reduce their ability to fight environmental pathogens. This fungus is found in the environment, dust, dead and decaying objects.

19) What are the predisposing causes for Mucormycosis? 

  1. Those with low immunity to fight with the disease for e.g., poor nutrition, chronic severe diseases, Poor hygienic conditions.
  2. Uncontrolled Diabetes mellitus.
  3. Prolonged use of steroids in high doses.
  4. Use of ill-maintained materials like face mask, tubing and oxygen cylinders.

20) What are the symptoms and treatment of Mucormycosis?

Mucormycosis affects the brain, eyes, mouth, nose, ear, and other organs. Symptoms of Mucormycosis include headache, fever, nasal congestion, sinus pain, blurring vision, blackened skin, tissue, and blisters. It can damage bone, brain, eyes and may be life-threatening. Treatment includes antifungal drugs like Amphotericin and Posaconazole.

21) What are the cardiac manifestations of COVID-19 infection? 

It can cause Takotsubo Cardiomyopathy, Myocardial injury/myocarditis, Cardiac arrhythmias, Cardiogenic shock, Myocardial Infarction/Ischemia, Pulmonary embolism, and Acute Cor pulmonale.

22) What is the spectrum of asymptomatic cardiac presentation in COVID-19 infection? 

Abnormal Troponins and BNP elevations, abnormal ECG, asymptomatic cardiac arrhythmias, and abnormal cardiac imaging.

23) What are the neurologic manifestations of COVID-19 infection?

It can cause Stroke, headaches, dizziness, encephalopathy, ageusia (loss of taste), anosmia (loss of smell), myalgia, and fatigue.

24) What are post COVID-19 persistent symptoms? 

They include fatigue, difficulty in breathing, joint pain, chest pain, palpitation,  cough, loss of smell, dry eye & dry mouth, rhinitis, red eyes, altered taste, headache, sputum production, lack of appetite, sore throat, vertigo, myalgia, and diarrhea.

25) What is long COVID? 

These are the patients with symptoms 4 or more weeks after covid-19 onset. If symptoms last beyond 12 weeks, it is termed chronic COVID.

26) What are long COVID Heart syndromes? 

It is characterized by persistent tachycardia, heart failure, persistent pulmonary hypertension, labile blood pressures, and labile heart rate.

27) What is the mortality rate of COVID-19 infection? 

It ranges from 0.3% to as high as 3.0%.

28) What are the proposed causes of a sudden cause of death in COVID-19 Infection? 

It could be due to acute myocarditis including stress-induced cardiomyopathy, post myocarditis sequel, heart attack, hypoxia, high-grade systemic inflammatory state, coagulation disorders (pulmonary thromboembolism, coronary thrombosis,  stroke), cardiac tamponade, electrolyte imbalance, underlying genetic predisposition and arrhythmogenesis (drug-induced, uncovering of underlying channelopathies and direct arrhythmogenesis by COVID-19).

29) Are health workers at risk from a novel Coronavirus? 

Yes. As health care workers come into contact with patients more often than the general public, they have a higher risk of acquiring COVID 19 infection.

30) How to prevent COVID-19 infection? 

COVID 19 infection can be prevented with vaccine, mask, social distancing and hand hygiene (Washing with soap or alcohol-based sanitizers).

31) Which vaccine is more effective? 

All vaccines are effective and have similar efficacy whether Covaxin, Covishield, or Sputnik V. Efficacy to reduce the chances of COVID infection is around 80% and efficacy to reduce serious infection is more than 99%.

32) Who should take can the vaccine? 

As per recommendations, everyone more than 18 years of age should take the vaccine. The vaccine can also be given to lactating mothers.

33) Is it necessary to take two doses of the COVID-19 vaccine?

Yes. It is recommended that both doses of vaccine should be taken for realizing the full benefit of vaccination. Both doses must be of the same type of vaccine.

34) When to avoid COVID vaccination? 

COVID vaccine is to be avoided in

  1. Pregnancy
  2. History of anaphylaxis
  3. Till 4 to 8 weeks after acute illness
  4. Till 3 months after COVID 19 infection
  5. Age < 18 years.
  6. History of bleeding and coagulation disorders.

People with a severe allergic reaction to any component of either an mRNA vaccine or the Johnson and Johnson COVID-19 vaccine should NOT receive that vaccine.

35) Is the Covid vaccine safe for heart patients? 

Yes, it is safe to take a vaccine for heart patients. It’s better to defer COVID vaccination for a month after a recent heart attack, Angioplasty, or stroke.

36) Special comment on COVID vaccination in heart patients. 

COVID vaccine is advised at the earliest.

  • Not to stop any antiplatelets (Aspirin, Clopidogrel, Prasugrel, Ticagrelor)
  • Not to stop any antihypertensives.
  • If on Vitamin K dependent oral anticoagulants (Warfarin, Nicoumalone), check INR and titrate to below 3 before vaccination.
  • NOAC (Dabigatran, Rivaroxaban, Apixaban) on the day of vaccination should be taken after vaccine only.
  • Recent ACS (heart attack), stroke or angioplasty: defer Covid vaccination for a  month.

37) What are the side effects of the COVID-19 vaccine? 

Local side effects can occur around the injection site, which is usually the upper arm. These might include swelling, pain, redness, an itchy rash, and other mild forms of irritation. It can also cause low-grade fever and body ache for 2 to 3  days. There is no evidence that vaccines against COVID-19 cause infertility.

38) Can the COVID-19 vaccine be given during menstruation?  

Yes. There are no issues with getting the vaccine during the menstrual period.

39) Can COVID-19 be transmitted through food? 

There is currently no evidence that people can catch COVID-19 from food. The virus that causes COVID-19 can be killed at temperatures similar to that of other known viruses and bacteria found in food.

40) What is the Delta variant of COVID-19? 

Delta, also called B.1.617.2 is considered as a subtype of what’s been referred to as the Indian variant – B.1.617. This Covid variant was first detected in India and has also been reported in 62 countries, as per WHO. There are certain issues regarding the infectivity, severity, and degree of protection by available vaccines.

About the author: IE&M Team
IE&M Team
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