Thread
1 month since the diagnosis of the 1st #lka #Covid_19 Patient.
Webinar by @CCP Dr. Ananda Wijewickrama, Dr. Damayanthi Idampitiya & Dr. Eranga Narangoda.Physicians at the National Institute of Infectious Disease-NIID
#Covid19SL #Covid19LK
1/24

Some excerpts. Please watch the video for the complete discussion.

1. At the #NIID ( #IDH) 145 cases, 11 children. 97 male, 48 female. 8 ICU admissions. 5 deaths (1 death on admission, 4 in ICU). Discharged about 50
2.Number of new cases are static since last week.(7-10/day)
2/24

3. Most of the new cases have no symptoms, tested because they were contacts of diagnosed patients
4. Most of the patients are doing well. In comparison to the world (80%), most Sri Lankan(90%) patients have mild disease
3/24

5. Spread hopefully limited due to strict curfew measures and isolation of patients and contacts. The curve is flattened because of this. Isolating the returnees from Italy and Korea was a very good move.
4/24

Unsure when the restrictions can be lifted, but if precautions are maintained we can reduce the spread. Issues will arise when international travel starts again.
6. Currently, contacts are also being tested
5/24

Symptoms
7. Most patients have mild symptoms. Commonest symptoms were nonspecific like headache and body ache. <50% had a mild fever (<100F). Sore throat and dry cough were other symptoms. Only a few had shortness of breath, chest pain and not being able to smell.
6/24

When patients developed shortness of breath, if didn’t improve with the oxygen they were put to the ICU. Only 2 of the ICU patients got the disease from overseas.

8. 3 of the 4 patients who died had other illnesses.1 patient had a kidney transplant, Diabetes & pressure.
7/24

One had heart surgery,hypertension & Diabetes.Other patient also had diabetes and hypertension.1 patient did not have significant diseases.Was on the ventilator for 19 days & the last sputum culture was candida positive (fungal disease). All 4 were intubated and ventilated.
8/24

The other 4 patients who were in ICU have recovered and are now back in the ward. Right now no one in the ICU and no one who falls under the severe category.
9/24

9. All ICU patients had x-ray evidence of bilateral pneumonia and respiratory failure. But had very dynamic changes in the lung shadows and parameters. Consultant intensivists from the national hospital supported in the management of the ICU patients.
10/24

10. The reasons for putting patients into ICU were based on the guidelines. Severe category patients were taken in. If a patient still couldn’t maintain his oxygen levels even after oxygen was administered he was taken into the ICU.
11/24

11. Patients are discharged if they are clinically well, and do not have a fever for more than 48 hours. Then 2 PCR tests are done 24 hours apart. If both are negative patient is discharged.
12/24

Treatment
12.Though the effect of #hydroxychloroquine is not convincing,its being used on the patients as it’s a familiar drug to many physicians and was readily available. Since that decision was made (15/03), all patients who test positive now receive hydroxychloroquine.
13/ 24

Though there is now evidence against this drug, same management will be used for now. Combination of Hydroxychloroquine with #Azithromycin is not used due to side effects on the heart & also due to the lack of evidence regarding the combination.
14/ 24

13.There is no prophylaxis management for now.
14. #Lopinavir/ #Ritonavir is not considered since there is no evidence. (3 patients did receive the drug but was discontinued)
15/24

15. #Favipiravir(Avigan) also has no evidence, not even laboratory evidence. There is a stock of drugs(Donation) but this won’t be used for now.
16. #remdesivir is a promising drug, no stock in Sri Lanka. Trials are continuing.
16/24

17. #Convalescentplasma, Steroid therapy are still under study. These has been explored in critically ill patients. 4 patients who were severe received convalescent plasma, one survived but others died in the ICU. The patient who survived did not require ventilation.
17/24

one patient who died initially improved after been given plasma but then died probably due to other infections though it can’t be said for sure.
18.The plasma was given by two recovered patients. But their antibody levels were not measured.
18/24

1000ml of plasma was given to each of the 4 patients.
A registry of recovered patients is available,with consent been given if a need for blood donation rises. We are awaiting @GMalavige Antibody testing to establish so we can store some blood with high antibody levels.
19/24

FAQ
http://20.No  Benefit in #steaminhalation or drinking kenda in killing the virus, but it can help our overall health. No complimentary/alternative medicine has been used in NIID (IDH)
20/24

19. #Extracorporealmembraneoxygenation has not been used as yet. This also has low evidence. But it is in consideration since LRH has the facility.
20/24

http://21.No  drug trials are currently being conducted. There were plans to join #SOLIDARITY trial conducted by the #WHO. But since one arm of the trial required no drug management this was abandoned. Discussions are still underway.
21/24

22. As far as the world understanding goes, the virus is not airborne, it’s transmitted by contact or droplets. No transmission by inhalation.
22/24

23. #LKA doesn’t seem to have #communityspread, even though there is fear. worldwide 20% of patients have severe illnesses. But in #LKA we don’t see such numbers. Almost all the patients who tested positive were traced to their index case.
23/24

24. #Healthcare workers, when necessary should take precautions. Delays seeing patients, covid19 or noncovid19 should not happen. Most #PPE PPE are being misused, @CCP has given guidelines on how and when to use PPE.
24/24