News
‘Let’s analyse our findings’
A doctor who peers at bugs and also examines patients shares some of his findings so that all those treating COVID-19 can pool their views and analyze their data to deal with the pandemic better, both short-term and long-term.
The bug – SARS-CoV-2 – which is on the rampage is “very deadly”, says Consultant Microbiologist Dr. Muditha Abeykoon who is currently attached to the Kegalle District General Hospital.
Bringing to the fore a “striking and disturbing” aspect he has seen, he says that there were five patients from the same family who had got mild disease in the first wave, coming with symptomatic disease in the third wave. The usual thinking is that there would be no other infection for at least 1-2 years, in a person who gets a COVID-19 infection. However, this family had got re-infected within six months and the current assumption is that they may have caught a new variant. Urging that Sri Lanka needs to gather data from the whole country meticulously and carry out a thorough analysis, Dr. Abeykoon speculated whether an infection could be re-activated after sometime and looked at a different possibility.
The HIV/AIDS virus binds itself to the nucleus of the human cell unlike the chickenpox virus which does not bind with the genetic material of the nucleus but just the other parts of the cell, he says.
He explains that as a person’s immunity fights back, the chickenpox virus can lie latent and hide there for sometime or in neurons (nerve cells) and get reactivated later.“We need to determine whether this is also happening in some cases of the COVID-19infected, such as this family which got re-infected.”
Testing & need for differentiation
Referring to testing, Dr. Abeykoon says that sometimes the rapid antigen test (RAT) becomes negative even though there is a high viral load in the patient, while the RT-PCR test, a more reliable one, turns positive. It is a diagnostic dilemma that clinicians face when people come with shortness of breath.
He stressed that while RAT is a point-of-care test, the RT-PCR is the confirmatory or gold standard test. This becomes vital because with the rains in the rural areas, more patients are also coming in with pneumonia due to leptospirosis (rat fever). The need then is to differentiate whether they are actual leptospirosis patients; leptospirosis patients with COVID-19 pneumonia or COVID-19 patients.
Issuing a red alert, he also says that they need to look for different types of fungal infections that could affect recovering COVID-19 patients, especially if they are diabetics and have been in the ICU for awhile. These could include: aspergillus and candida. This is in addition to keeping an eye out for mucormycosis or the black fungus.
Dr. Abeykoon’s observations in the third wave of COVID-19 include:
n Acute disease can strike patients even up to the 10th day after infection and severe disease, specifically COVID-19 pneumonia, may commonly last 2-3 weeks.
n While people die due to pneumonia, there are other serious issues that can also lead to them dying after being infected with COVID-19. As the patients’ bodies battle the infection with a strong immune-response, some of them could face severe organ damage
or weakness.
These include: myocarditis (inflammation of the heart muscle); myocardial infarction (heart attack); and thrombosis (blood clot formation) in the brain, cavernous sinus (cavity at the base of the brain) or liver vein. Some of these could occur even after initial recovery.
This is why these patients have to be very careful and rest for at least 2-3 months. They should also avoid strenuous exercise till at least 4-6 weeks after recovery.
| Case observations Among the patients and deaths Dr. Abeykoonhas seen in the third wave are: Cerebral vascular accidents due to thrombosis – 6 cases mainly among the elderly Cavernous sinus thrombosis – 1 case of a young female in the 30-40 age-group Hepatic vein thrombosis – 1 possible case of a male around 40 years of age Myocardial infarction (heart attacks) – 10-15 deaths in the 40-70 age-group, mostly of the elderly Myocarditis (inflammation of the heart muscle) – 2 deaths, both in the 30-40 age-group Candidiasis– 1 death due to a severe fungal infection in the blood | |