Pandemic sinkhole: Experts seek better monitoring of quarantined cases

In a similar incident, Raj Kumar (46) of Tambaram was sent home from a care centre after four days of observation. But his condition deteriorated and was rushed to the Rajiv Gandhi Government General Hospital (RGGGH) where he was on oxygen support for four days but succumbed to the infection. 

Several such cases have been reported where patients sent home from care centres developed complications and succumbed, exposing deficiencies in the monitoring mechanism. 

Doctors said the timeline of treatment and medical intervention are important to check the progression of the virus. Dr V Ashwin Karuppan, infectious diseases and emergency care consultant in general medicine at Gleneagles Global Health, City said patients usually take CT scan/X-ray on the first or second day of infection. But this is when cytokine storm – the immune system going into hyper active drive, which complicates matter – is missed. 

“Monitoring the symptoms, including saturation levels, tiredness, persistent cough and fever, is important even after 4-5 days of infection. If the symptoms continue, testing and consultation are important. Blood tests are required to detect inflammation, and CT scan is necessary at this stage to check lung involvement,” he added. 

He added that blood tests, including CBC, D-Dimer, CRP, Feratin, LDH, and IL-6, are done to check the progression of the disease and understanding the inflammation in the body. The markers in the body indicate the severity of the inflammation and thus the disease is at a particular stage. This is when the doctors can take a call on when the steroids can be given. “Evaluating blood sugar levels and inflammatory markers after five days is important. Inflammatory markers help to decide if a CT scan is required or steroids should be given. If the markers indicate an increase, medical intervention should be sought immediately so that the steroids and upgraded treatment in hospital care are given,” said former Public Health director Dr Kolandaisamy. 

He added that blood investigation, too, is required for evaluation even on the 10th day to check disease progression. Oxygen saturation levels cannot be the only indicator and a CT scan can be done to indicate the infection level. 

Dr Narendra Nath Jena, senior consultant of emergency medicine at Meenakshi Mission Hospital and Research Centre, Madurai, said Ivermectin, Azithromycin and steroids do not help reduce the virus progression or replication. 

“Antibiotics are required only to prevent secondary infection, or in case of bacterial infections, mainly they are required for diabetics and hypertension patients,” he added. 

He added that if saturation levels go beyond 94 per cent or respiration is less than 24 per minute and temperature levels fluctuate, medical intervention is required. Patients should seek hospital care or they might suffer from hypoxia or complications related to their comorbidities, he added.