After rapid deaths, docs go back to case sheets

‘Virus May Be Affecting Central Nervous System’

Pushpa.Narayan@timesgroup.com

Chennai:07.04.2020

After four sudden deaths of Covid-19 patients in Tamil Nadu in the past three days, the health department has asked experts to do a minute-to-minute analysis of their case sheets. An infectious diseases expert in the private sector, meanwhile, said the virus could be invading the central nervous system of some of the patients, besides affecting the respiratory system.

Health secretary Beela Rajesh said on Monday that doctors have also been asked to keep a close watch on people showing symptoms of the disease. Doctors said five of the six Covid-19 deaths in the state happened rapidly. “Critically ill patients usually have severe acute respiratory infection (SARI). In some cases it leads to septic shock and multi-organ failure. We did not see these in at least three patients who died. They came with respiratory infection and before we could do much they went into cardio-respiratory arrest. We couldn’t bring them back,” said a senior doctor.

A 57-year-old woman from Vyasarpadi in Chennai, who was taken to the Rajiv Gandhi Government General Hospital at 5.30pm on Sunday with respiratory infection, was stable and responding to treatment till around 5am on Monday. Her samples were sent for Covid-19 test. “We put her on a non-invasive ventilator for a few minutes before we intubated her. She died at 7.30am,” said dean Dr R Jayanthi.

Infectious diseases expert Dr Subramaniam Swaminathan said medical literature suggests that the virus could be having a neurological impact.

“The effect of this novel virus may not be confined to the respiratory tract. It may be invading the central nervous system,” he said. And when it does, it masks hypoxia (low oxygen level) and allows the body to function normally. That probably explains what many doctors have been observing: Covid-19 patients with low oxygen level (hypoxia) not showing discomfort.

The state expert panel comprising infectious diseases experts, pulmonologists, intensivists and critical care experts will now go through the dead patients’ case records and compare them with international protocol and emerging evidence from literature to learn more, the health secretary said. The new protocol for those testing Covid-19 positive includes a chest X-ray, lung ultrasound and, if needed, a chest CT scan.

Doctors are discussing if putting patients early on ventilator helps. “But 90% of people who were put on invasive ventilators could not be revived,” said infectious diseases expert Dr V Ramasubramanian. There is another group that argues that putting patients on non-invasive ventilators could increase infection risk as the virus can get dislodged on surfaces of equipment, walls and healthcare workers.

SAFETY NET: A disinfection tunnel at the Rajiv Gandhi Government General Hospital