Treating Covid-19: It will become more challenging to suspect and diagnose COVID-19, says AIIMS director Dr Randeep Guleria

AIIMS Director Dr Randeep Guleria said medical examinations showed that even months after recovery, lungs of COVID-19 patients continued to be in bad shape. (Photo: The Indian Express)

It’s been nearly six months since India reported its first coronavirus case; the number of infections in the country has gone past the 850,000-mark. COVID-19 patients have been dying of various complications. What doctors thought initially a pulmonary disease is now showing symptoms of vascular disease in some cases; patients are suffering from strokes and neurological disorders—new insights are emerging. Dr Randeep Guleria, director of AIIMS who also heads the clinical research group of the national Covid-19 task force, in an interview to The Indian Express, said,” When it (COVID-19) started, it was felt it was like any other viral pneumonia: as we see with influenza, it causes predominantly upper respiratory problems and in some people, it goes to the lower respiratory tract and leads to fall in oxygen saturation.”

As we are learning more and more about how this coronavirus behaves, Guleria said, they have realised coronavirus causes a lot of systemic effects. “The infection starts off with the lungs. So, it is still a pulmonary disease. But it has significant vascular problems. It can be termed as a vascular disease, to some extent. It can also be termed as a systemic disease because it involves the entire body,” The Indian Express quoted Guleria as saying.

Guleria said that medical examination showed that even months after recovery, lungs of COVID-19 patients continued to be in “bad shape”.

Whether COVID-19 can be termed as a vascular disease, Guleria in the interview said there is not much data on this. Doctors have also tried to culture the virus from the brain itself. “Whether it causes encephalitis, where does the virus enter the brain and does it cause inflammation in the brain or whether it causes inflammation of vessels supplying blood to the brain – all these are being looked at. Probably, it is a little bit of both,” he said.

He said with time, the symptoms of COVID-19 have expanded. Initially, it was just cold, fever, and cough. But now we have body ache, loss of sense of smell and taste; it will gradually expand. “It will become more challenging for the physician to suspect and diagnose COVID-19.”

Regarding the post-COVID syndrome in children, Guleria said, “This is a syndrome that is still evolving and mimics another similar disease, Kawasaki disease.”

On COVID-19 medicine and India still recommending hydroxychloroquine despite WHO discontinued the HCQ arm of the Solidarity trial, he said, the recommendation is only for treating mild cases; in these cases (mild), there is spontaneous recovery. “It is recommended because it is a safe drug, easily available, and evidence is as strong and poor as other drugs that have been promoted,” he added.

We also have authorisation for remdesivir and tocilizumab for emergency-use only, Guleria said. The initial studies did not show much benefit. But subsequent studies showed some benefits in decreasing hospital stay by four days, he said. There were suggestions that in more severe patients it may have a mild benefit but it was significant to say that there was mortality benefit, Guleria said as reported by The Indian Express. “But I don’t think we have strong evidence one way or the other. Currently, it is only a promising repurposing drug rather than a really effective drug for Covid-19,” he said.

Regarding the plasma therapy, he said not everyone is fit for plasma donation. Everyone does not have a good amount of antibodies. In a community, only 10-15% have antibodies and even people who recover don’t show that robust antibody production, according to studies. Guleria said one needed to get tested first to check whether the person’s blood has sufficient antibodies so that it can be given. Data is not strong also. “There is a large study of 100 patients (with) randomised control trials, which looked at plasma therapy and did not show any strong mortality benefit. It was also used for Ebola and the evidence is not that strong.”