[Dr Karto Ete]
A 55-year-old male – a gulf returnee with a history of hypertension – presented with complaints of mild fever and sore throat of three days’ duration. His RT-PCR was positive for Covid-19. He was categorized as ‘B’ and was started on standard HCQ, Azithromycin and other supportive measure after baseline ECG, as per protocol.
All routines were sent along with crp, ferritin and d dimer. Routines nothing significant. Crp, ferritin was highly elevated, d dimer mildly elevated. spO2 was 97 @ room air.
On day 2 of admission he developed breathlessness and spO2 was 86 percent and carrico index in emergency ABG was suggestive of moderate ARDS. Since I was the on duty, I got a call at 9:30 pm. On examination he was tachypneic, tachycardia was present, oxygen saturation of 86 percent with high flow oxygen on O2 mask.
We put him on NIV. (It’s not recommended due to risk of aerosol generation but had to do, so as to buy time.) we started him on broad spectrum antibiotics, steroid, lopinavir/ritonavir. Ecg showed sinus tachycardia, no st/t changes.
On NIV he was maintaining around 95 percent oxygen saturation. I informed my nodal officer, Dr Shinas Babu, and we arranged convalescent plasma and tocilizumab, three vials. At around 10:30 pm, we gave the first dose of tocilizumab, and convalescent plasma was ready by 5 am. By 5:30 am we sent a repeat acute phase reactants, and there was significant fall in both ferritin and crp. Patient was maintaining well in NIV.
Subsequent ABG showed improvement.
On the second day itself he was weaned off NIV and was put on oxygen. I went for rounds the next day; he was on oxygen and was sleeping comfortably after a breathless struggle of one whole night.
After coming out I took off my PPE and was happy and felt this is why I love this profession. We continued him on HCQ and Azithromycin for five complete days, steroid for three days, and lopinavir and ritonavir for 14 days.
The patient was discharged following two negative samples after 14 days.
Friends, this is just to let you know that timely intervention and team effort is required to tackle this Covid-19. Newer drugs are coming up, and vaccines may come up in future. This is the first case for which tocilizumab was given. We gave it to many more, and with cytokine release syndrome it helps.
We in Arunachal Pradesh should also acquire such lifesaving drugs like tocilizumab and arrange for convalescent plasma. Hence, let’s appeal to our government too to arrange for some lifesaving drugs. And why not try remdesivir or favipiravir, too? (Dr Karto Ete is Senior Resident, Dept of General Medicine, Medical College Manjeri, Kerala.)
