Ambar wrote:Thank you for your insights DrRatnadip. How often do you see aged patients with co-morbidities do well after severe covid ? How long does Remdesivir take to act ?
Many elderly pts ( around 60 %) , even those with comorbidities improve relatively well.. Pts who present late i.e those require ventilation within 24 hrs of admission have poor outcome.. I think so called " happy hypoxia " is at play here.. Pt dont realise about gross lung damage untill they feel difficulty in breathing..Such pts present with SpO2 less than 85%.. That is why it is important to monitor oxygen saturation with SpO2 probes..
It is hard to tell if Remdesivir is effective in perticular pt.. It is used in moderate pts who are already receiving cocktail of many drugs.. Those who are responding show clinical improvement in 24 to 48 hrs.. Improvement with Tocilizumab is rapid..
When i made this post asking Dr Ratandip on his experience on the recovery rate of covid patients with comorbidities , i was hoping my next post on this dreaded and depressing thread would be to share an uplifting story on how my family survived the coronavirus scare. Unfortunately fate had a different plan all along and I lost my dad to covid 5 days ago.
He was a 'Corona-Warrior' in the truest sense. Despite his advanced age of 73, despite having comorbidities like asthma and a coronary artery bypass, he continued to visit his clinic in one of the poorest neighborhoods in my town just as he did everyday for the last 44 years including Sundays and every holiday. After graduating from Mysore Medical College in 1975, he chose a district in the malnad belt of Karnataka, opened a small practice in a working class neighborhood and served in the same place for 44 years without expanding, building nursing homes/hospitals etc like many of his peers did. When the covid hit, we begged and pleaded with him to stop working atleast temporarily but he always retorted saying if doctors stay at home, then where will the patients go ?
In the week of July 6th he came down with a cough and fever. Being a doctor he self medicated himself thinking its just a seasonal flu. After 3 days of antibiotics his fever went away and cough improved . But from around July 13th his cough was back and much worse, and he continued to treat himself until the 17th when he finally got his xray done and found out he had pneumonia in his lungs. Later that evening his oxygen dropped below 90, and he finally got the covid antigen test done and found out he was positive.
Our nightmare began later that evening as the town he lives in only the district government hospital is treating covid patients, and despite him being a doctor, and the severity of his condition, we had to run pillar to post to find a ICU bed for him. Once they took him inside we lost all contact on how he was being cared and by whom. The government health authorities have zero communication plan, and the terrified family members are left begging and pleading for information. We were told that he was now on oxygen and his O2 saturation is now normal. Day 2 they began administering Ramdesivir and anti-inflammatory steroids, but we have no idea if they were also giving him his daily heart medications. The communication improved as the DHO and the government doctors started getting a deluge of calls from IMA, other prominent doctors in the town, regular citizens and the media. On day 4 we were told that his condition had suddenly deteriorated as he had pulled the oxygen tubes likely due to ICU hypoxemia, and we were asked to make arrangements in a corporate hospital elsewhere. After we explained that his condition is too critical to move him to a bigger city 4 or 5 hours away, and no air-ambulances are accepting covid patients, they relented and continued his care.
At this point my sister and my brother in law both of whom are doctors, had contacted atleast a dozen of their colleagues seeking advice on next steps, and heard about this anti-inflammatory drug tocilizumab . As some of you may have heard, the drug has a severe shortage in India, it is being sold in black market for 4 to 5 times its price, and even then it is near impossible to find. And then there are stories of fake tocilizumab being sold in the market. My sister was able to find 2 vials from Bangalore with great difficulty and was shipped overnight to the city where my father was being treated. After the 2nd dose of the drug, my father's condition began improving dramatically, and by day 7 of his hospitalization his lung had begun to clear significantly. He was conscious , and the effects of hypoxemia seems to have reversed as he was able react to the commands of the doctors. At this point, probably due to the relentless pressure by my family and other citizens of the town, the doctors in the hospital suggested plasma therapy. They claimed it was absolutely safe even for those with heart conditions. Later that day they found out a neighboring city hospital had 2 bags of plasma that matched my dad's blood group, and we made arrangements with the local blood bank to immediately source it and passed it to the hospital without delay. Day 8 and day 9 both bags of plasma were used and my dad's condition had begun to improve significantly to a point where he apparently told one of the doctors to pass a message to us that he was feeling better. On the night of Jul 27 (day 11) of his hospitalization we were told that he had a massive attack and he passed away.
The details after his death are just too painful for me to narrate but neither me nor my sister could see him as neither of us live in the same city, and we couldn't travel. The body is not handed over to the family, and instead wrapped and dropped off at the cremation site with only 2 family members allowed to perform the last rites. So a doctor who cared for the poorest of the poor, the most vulnerable section of our society, the forgotten rural downtrodden masses, and someone who continued to care for his patients in the middle of this pandemic until he quite literally dropped was taken away from us cruelly by fate, and made much worse by the government. I'd like to make it abundantly clear that I am not blaming the doctors in the district government hospital who undoubtedly tried everything they could to save a fellow doctor but the lack of communication, no arrangement for the family members to see the patient even from a safe distance to boost their morale, and an undignified way of treating the departed soul has pained us deeply.
After having been through this ordeal, the pain of bereavement is something that I wouldn't wish on my worst enemy. It will probably take years if not a lifetime to overcome the grief and remorse. Please, please take all precautions against this dreaded virus, go get yourself tested at the first sign of trouble, and if you or your loved ones have pre-existing conditions then please stay as safe as possible, a life once gone cannot be brought back. As much as i love my country, if you and your loved ones are in an advanced, first world nation then thank your lucky stars. If the above can happen to a very popular doctor in a small city then i can only imagine the plight of those who have no support. God bless you all.