COVID-19: Breathing hard

April 14, 2020 11:57 pm | Updated 11:59 pm IST

Dr. R. Narasimhan
Senior Respiratory Physician

Dr. R. Narasimhan Senior Respiratory Physician

On one hand, COVID-19 infections are on the rise, and on the other, people with chronic lung diseases are worried. This is because the presentation of COVID-19 is with nasal symptoms, loss or decrease in smell, chest pain and breathlessness. This is always associated with fever, body pains and fatigue. Most of the bronchial asthma and COPD patients too are present with these symptoms, when they get an infective exacerbation.

In bronchial asthma, the symptoms are sporadic and patients respond well to inhaled bronchodilators and if necessary, they respond to antibiotics rapidly unlike in serious COVID-19. The lungs get affected in serious COVID-19 when a cytokine storm occurs with stiff lungs, small clots in lung vessels and the oxygen carrying capacity of the blood becomes low.

The combination of these factors pushes the person into full blown respiratory failure and recovery from this becomes difficult.

This is quite in contrast to what happens in infective exacerbation of asthma. The response to treatment is quite dramatic and within 48 hours they start finding symptomatic relief. I advise most of my patients who call over the phone and it is only if they don’t respond, do I ask them to come in for a consultation. With this lockdown, the number of infective exacerbations have come down significantly and most of them do well with telephonic advice. I have not found any increase in admissions due to this problem.

Cancer and COVID-19

This is in contrast to people who have suffered from lung cancer or had treatment for cancer with chemotherapy or are on treatment with biologicals, or those who have undergone surgery and/or are on chemotherapy now. Most of these individuals are around 60 years with their immunity compromised. The symptoms of cough and breathlessness cannot be brushed aside casually in them as COVID-19, if it occurs, can proceed at a galloping pace. This is because of co-morbidities that reduce the immunity along with the treatment that reduces the immunity.

This somehow does not appear true of TB. I have not had any patient who had treatment for tuberculosis regularly call me and ask me whether he should undergo any tests for COVID. A lot of talk about the correlation between BCG immunisation and vulnerability to COVID-19 is going on. For example Italy, U.K., Spain, U.S., who do not administer BCG as a part of the mass immunisation programme, have more COVID-19 cases and mortality rates. On the other hand, in countries like India, Pakistan, Brazil, Japan, Portugal the effect is relatively less although not completely absent.

Although there may be an argument that we are not doing enough tests to pick up more infections we have not seen any unusual increase in mortality during this season in hospitals both government and corporates put together. Mortality rates cannot be hidden though there may be some undetected asymptomatic infection in the country due to non-testing. Some are also making a case that malarial endemicity and consequently the persistent use of hydroxychloroquine might have offered India some protection.

With these factors such as BCG pre-immunity, malarial endemicity, along with the lockdown, physical distancing and India’s capacity to withstand and triumph over many epidemics, we can be sure that we can get over this pandemic with relative ease.

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