Covid-19, The King of 2020: lessons learned and still learning from a tertiary care centre in Chennai, India

Covid-19, The King of 2020: lessons learned and still learning from a tertiary care centre in Chennai, India.

Padma Srikanth, Professor of Microbiology

Sri Ramachandra Institute of Higher Education and Research, Chennai, India

In March 2020, COVID-19 had advanced from China into Italy, Spain, France UK and USA, but it is thought that the pandemic would skip nations that had high levels of Bacillus Calmette–Guerin (BCG) vaccination due to local tuberculosis burden. However, by July 2020, India had the third highest number of COVID -19 cases globally with Chennai, Mumbai and New Delhi among the major cities affected. In Chennai at the Sri Ramachandra Institute, most RT-PCR tests performed in April were negative for COVID -19, although all our controls performed as expected. COVID-19 RT-PCR test results did reflect individual clusters and test results fluctuated dependent on cluster sampling. We tested sewage samples for SARS COV-2 with the results that our protocol predicted individual hotspots. A huge marketplace emerged as the epicentre for Chennai and new cases emerged due to proximity and comorbidities, but not necessarily related to age. With strict adherence to basic infection control practices: hand wash, hand hygiene, and masks, the virus skipped some hosts even in close contact. The infection rate determined by RT-PCR positivity increased as human vectors fanned out from the epicentre, and soon we are in the midst of the pandemic. Majority of cases were asymptomatic. Clinical progression was deceptive with most only showing pulse oximetry changes accompanied by slight breathlessness that one easily dismissed. Patient phone-conversations reflected the clinical presentation with tone and voice showing the same breathless dry quality. While severity of symptoms increased and recovery was slow, fortunately death rate is low. In our experience, positive RT-PCR indicated acquisition of infection; however, increased viral load was not indicative of disease progression. We believe that reducing opportunities for viral replication by saline or betadine gargles and steam inhalation prevented acquisition of infection. SARS COV-2 appears to use multiple pathways to cause a spectrum of disease which probably explains why different treatment modalities seem to work. The virus host interaction and the comorbid conditions suggests the need to customized therapy to individual patients and “one size may not fit all”.