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‘Get tested and seek medical help, as delays can lead to death’
Dr. Eranga Narangoda
Don’t hide your symptoms because that could lead to severe disease and even death, warned a top clinician who has been treating COVID-19 patients from the beginning of the pandemic in Sri Lanka.
“Come early and we can save you. Lede hangagana inna epa,” said Consultant Physician Dr. Eranga Narangoda of the Homagama Base Hospital which has 200 COVID-19 patients currently, speaking of a 40-year-old who came very late.
The Homagama Hospital staff battled for 14 long days but could not save him, says Dr. Narangoda with regret, warning that the virus should not be ignored. The patient had died last week.
This patient had earlier consulted a doctor as he required a small procedure for a different ailment and when that doctor asked him why he was panting, he had just said, “Eh mage heti (This is the way I am).”
It was after one more week, when the patient became “very bad” that he had taken an RT-PCR test and been admitted to the Homagama Hospital.
“His oxygen saturation was very low and we lost him to COVID-19,” says Dr. Narangoda.
He says that the only way to find out whether a person is COVID-19 positive is through an RT-PCR Test or a Rapid Antigen Test. No one, not even a doctor can predict that you have COVID-19 by looking at you, so do not have a false sense of security. If you have symptoms, get yourself tested.
The symptoms in priority order are:
n Fever and body aches
n Commonly, a dry cough
n Loss of appetite
n Loss of the sense of smell and taste
n Breathing difficulty (which may arise quite late into the onset of the disease)
“If you or your family notice that you are more breathless than usual and there are also other symptoms, take them seriously and get medical help,” he says.
When asked whether with the third wave the patient profile has changed, Dr. Narangoda says that in the first two waves, around 80% were asymptomatic (without symptoms) and 20% were symptomatic. It was only 5% of the symptomatic patients who went into severe disease, mainly those with co-morbidities (such as diabetes, kidney disease, heart disease, cancer, etc.).
Now, however, in the third wave, among the 20% who get symptoms, there is a large number who progress into severe disease. More go into “significant” pneumonia X-ray evidence shows or they develop low oxygen saturation, he said.
Comparing the first two waves and the third wave, Dr. Narangoda said that those days, from 100 patients with severe disease, five would get pneumonia, but now from among 100 patients with severe disease, 20 would get pneumonia.
Another factor that he highlighted was that people should not misuse dexamethasone (a steroid). It must be taken under the supervision of a doctor who is treating COVID-19, as over-use could lead to a fungal infection in the eyes or even lungs. Steroids should also not be used for other mild diseases.
He urged all those having symptoms to get tested and seek medical help immediately, without hoping that COVID-19 would go away. “COVID-19 is deadly, but we can treat you.”
According to Dr. Narangoda, once patients recover from COVID-19, mild symptoms such as the loss of taste and smell and tiredness and lethargy may continue for about one or two months. A persistent mild cough may also last several weeks.
“Don’t worry,” he assures, adding, however, that if “rarely” the patient develops breathing difficulty which seems to be getting worse, he/she should see a doctor immediately.
| Smokers at high risk If you have a chronic disease, continue your medication and keep it under control, advises Dr. Eranga Narangoda. Referring to the risk factors that are sending young and healthy people into hospital with COVID-19 in this wave, he urges them to stop smoking immediately. “Young people who smoke and those who are obese (overweight) are at high risk of getting severe disease,” he adds.
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| If there is COVID-19 in your apartment….. With many COVID-19 patients being compelled to stay in their homes for many days after testing positive, the Sunday Times asked Consultant Physician Dr. Eranga Narangoda how people living in apartments can take care of themselves. Dr. Narangoda who has been treating such patients since COVID-19 hit Sri Lanka, is currently attached to the Homagama Base Hospital. Earlier, he was at the National Infectious Diseases Hospital (NIID or IDH), Angoda. Here are this clinician’s suggestions: n Don’t use public areas or the lifts (elevators). Avoid congested and closed areas. n If the apartment complex has central air-conditioning (AC), switch it off in your apartment. n Keep your apartment well-ventilated, open the windows (the virus can’t fly in through the window) and let sunlight come in. n Be cautious of what you come into contact with in public areas. Eg. Door handles or if you use the staircase, the banister/railing surfaces could be contaminated with the virus. Don’t touch them but if you do, wash your hands thoroughly with soap and water or use sanitizer. Avoid touching your face. Awaiting ‘RT-PCR variant detection kit’ for the Indian mutant Similar to the survival of the fittest concept in evolution, the United Kingdom (UK) variant has taken over the rampage, rapidly spreading COVID-19 throughout Sri Lanka, surpassing the dominance of the local variants, the Sunday Times understands. How the UK variant came into Sri Lanka and whether there was one introduction or many, would be difficult to determine now due its widespread prevalence, said the Head of the Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Prof. Neelika Malavige. Referring to the Indian variant which was also detected in a quarantine facility through genetic sequencing in Prof. Malavige’s laboratory, she said that in addition to genetic sequencing, special ‘RT-PCR variant detection kits’ are available to zero-in on unique mutations specific to the four ‘variants of concern’ currently worrying the world. These variants of concern are: the UK (B.1.1.7), South African (B.1.351), Brazilian (P.1) and Indian (B.1.617) variants. “These kits supplement our efforts in the early and not late detection of variants of concern and alert countries, giving an early warning. These kits also help us to overcome issues such as not-so-good-quality samples without high viral loads which hinder the performance of genetic sequencing,” she said, pointing out that sometimes good quality genomic material (ribonucleic acid – RNA) may not be available in the samples due to storage and transport issues and when sampled postmortem (after death). Then what comes in handy is the RT-PCR variant detection kit. Prof. Malavige’s laboratory has these RT-PCR variant detection kits for three of the four variants of concern – the UK, South African and Brazilian variants. Having detected the Indian variant, they are now in the process of securing the kits specific to this variant as well.
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| Children & COVID-19 One death of a baby has been reported in the third wave of COVID-19, while in the first and second waves four babies succumbed to the virus. A three-month-old baby Wattegama died this week at the Kandy National Hospital, according to the Department of Government Information. When contacted by the Sunday Times, Consultant Paediatric Pulmonologist Dr. Channa de Silva said that the five babies who have fallen victim to COVID-19 have been younger than six months. The clinical picture of ‘not very severe disease’ in the paediatric population affected by COVID-19 does not seem to have changed when comparing the earlier waves to the current one, he added.
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