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Table of Contents
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 197-199

COVID-19 pandemic – What have we learned?

Editor in Chief, Senior Consultant in Internal Medicine and Diabetes, APIK Journal of Internal Medicine, API Karnataka Chapter, API Bhavana, Bengaluru, Karnataka, India

Date of Submission13-Sep-2021
Date of Acceptance13-Sep-2021
Date of Web Publication20-Oct-2021

Correspondence Address:
Dr. Manjunath Premanath
671, Prem Health Care, Kuvempunagar, Mysore - 570 023, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajim.ajim_94_21

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How to cite this article:
Premanath M. COVID-19 pandemic – What have we learned?. APIK J Int Med 2021;9:197-9

How to cite this URL:
Premanath M. COVID-19 pandemic – What have we learned?. APIK J Int Med [serial online] 2021 [cited 2022 Dec 2];9:197-9. Available from: https://www.ajim.in/text.asp?2021/9/4/197/328687

My Dear Colleagues,

This issue of AJIM is entirely on COVID-19 and its various aspects. We had published three review articles, an original article, and two guest editorials in the earlier issues (Vol 8 [3], Vol 8 [4], and Vol 9 [1]). Still, there were a lot of important articles on the subject, and we thought that bringing a whole issue on COVID-19 at this time would be the correct decision as these articles would not have had that much of importance after the subsidence of the pandemic. You would also be wondering as to why these articles did not appear earlier? In any epidemic or pandemic, epidemiology, diagnosis, treatment, or any other matter would be in a fluid state in the beginning and would change rapidly as the rage continues. Hence, articles nearer the end would have more value in all aspects than the articles at the beginning. Hence, we waited for everything to settle. This issue is much larger than the previous issues and is worth preserving.

A systematic review on electrocardiography (ECG) abnormalities in COVID-19 patients revealed drug-induced QT prolongation related to hydroxychloroquine, azithromycin, and chloroquine and nondrug-related abnormalities such as ST elevation. They were of the opinion that whether this ST elevation is related to myocardial injury or not was not certain[1] Anindita Menon et al., in their study in this issue, reported ECG changes in COVID-19 patients which were predominantly right sided. This was expected with predominant lung involvement in COVID-19. However, majority of the findings were not severe. Myocardial damage that may occur may result in an acute coronary syndrome pattern with an elevation of troponin.

Lymphopenia and an increase in the neutrophil/lymphocyte ratio (NLR) is considered as one of the hallmarks of severe COVID-19 infection. A study on this aspect by Avinash Rajanna et al. in this issue signifies the same. A study on NLR, platelet-to-lymphocyte ratio (PLR) correlating with the severity of computed tomography (CT) thorax lesions in COVID-19 revealed a higher NLR and PLR values in severe COVID-19 patients and an NLR value of more than 5.04 prompted for a thoracic CT and a value of more than 2.9 itself had higher specificity.[2]

Fever, cough, and dyspnea are the predominant symptoms seen in the majority of patients, but of-late symptoms referable to other systems are also seen. Mutating organisms may probably cause these variations. Vasanta Kamath et al. in their study published in this issue on this subject found diarrhea as one of the predominant symptoms along with other symptoms. Sometimes, this not common symptom may be the predominant symptom in a given patient. An extensive review on extra pulmonary manifestations in COVID 19 infections, the authors cited symptoms referable to myocardial dysfunction, gastrointestinal system, nervous system, and pancreas.[3] These were attributed to the presence of angiotensin-converting enzyme 2 receptors in all these tissues, which is the entry point for the COVID-19 virus.

Remdesivir, an antiviral drug, became raze in the treatment of COVID-19. Studies showed that this drug would reduce the viral load during the active replication of the virus and reduce the duration of stay in the hospital. A double-blind placebo-controlled randomized controlled trial on this subject[4] revealed that a 10-day course of remdesivir during a moderate disease would shorten the recovery time and was superior to placebo. It also showed an all-cause mortality of 11.4% compared to 15.2% with placebo (95% confidence interval 0.5–1.03). This study also showed a reduced requirement of oxygen in those who had remdesivir. A study by Mahendra et al. in this issue on this subject has shown a decrease in the duration of hospitalization and clinical and psychological improvement with no effect on mortality.

Comorbidities such as diabetes, hypertension, or Ischemic heart disease in a COVID-19 patient can be disastrous. They increase the morbidity and mortality rates. This has been shown very well by Avinash et al. in their study in this issue on comorbidities and their effect on COVID-19, wherein they showed higher mortality with diabetes, hypertension, and kidney disease. A study from China[5] revealed that any comorbidity in a COVID-19 patient had a poorer outcome and more the number of comorbidities had the worst outcome. Psychological issues such as fear, anxiety, and depression have been found to be very common with COVID-19 infection in general public and health-care workers are no exception. A study on this issue by Suganthi et al. revealed nurses being more prone to anxiety and depression, the younger ones were the worst affected.

Mortality in COVID-19 infection depends on many factors. Age, comorbidities, severity of infection, and complications are some of them which influence the mortality. In their study on factors influencing mortality in COVID-19 infection, Vasantha Kamath et al. in this issue did identify, advanced age, male sex, comorbidities, and the severity of infection as the confounding factors influencing the mortality.

COVID-19 infection is marked by its propensity to cause thrombosis in the blood vessels. It can cause extensive thrombosis in the pulmonary vessels and result in pulmonary embolism, which may be a part of the extensive pathology in the lungs seen in a severe case. A case report in this issue by Kushal Markanday et al. revealed hepatic vein thrombosis, which might be unusual but not unexpected. An extensive review of literature for splanchnic vein thrombosis in COVID-19 found six cases.[6]

Lung lesions in COVID-19 are that of patchy pneumonia extending to the lower lobes of both lungs giving a ground-glass appearance. Pleural effusion as a primary manifestation is not common which is highlighted in the case report by Mahendra et al. Any type of complication that can occur in COVID-19 is exemplified in the case report by Dilmo Yeldo et al., who report a case of Guillain–Barre syndrome. Probably, more and more such atypical complications may be seen if the disease lasts longer. Similar case reports of pleural effusion and Guillain–Barre syndrome in COVID-19 have been reported[7],[8] in the literature.

Various other tropical infections can occur along with COVID-19 and one has to be vigilant to recognize and treat them. Otherwise, patients may recover from COVID-19, to succumb from associated infections such as dengue and scrub typhus. A case report by Gautam Jesrani et al. in this issue throws light on the association of scrub typhus and its importance.

Post-COVID exercise, how much and how often, is an important issue as many patients who had recovered well, succumbed to complications of the heart and lungs post exercise. It was postulated that myocardial inflammation persisted in the immediate post-COVID-19 recovery period and undue exertion caused exacerbation of inflammation and rhythm disturbances causing sudden death. Pulmonary rehabilitation is another issue that takes a much longer time with so much of scarring in the lungs. An article published in BMJ[9] revealed that the risks have to be stratified before recommending a return to physical activity and only to return after a minimum of 7 days, free of symptoms, and to have only minimal exertion for at least 2 weeks. These aspects are discussed by Sadananad Naik in his review article on COVID patients and exercise in this issue.

In any pandemic, that is too viral, there cannot be a standard set of drugs to administer. The same is with the COVID-19 pandemic. Various drugs were and are being tried for prophylactic and therapeutic purposes with varying results. This is absolutely a trial and error. Hence, many drugs were repurposed and used in this pandemic.

As the disease lasted longer, more and more complications occurred. An unusual complication took the center stage in increasing the mortality. Mucormycosis which was not a very common disease otherwise became rampant. Various theories were postulated from prolonged steroid use, contamination of oxygen facilities, immune deficiency, to diabetes mellitus. The last word is yet to be said. In their review article on mucormycosis, Vasantha Kamath et al. have discussed all these issues threadbare.

Despite the umpteen measures undertaken to contain the disease, only masking, social distancing, and sanitization proved really effective. However, the behavior of the public cannot be changed overnight and despite repeated instructions to them to follow the COVID behavior. It was futile as it was blatantly disobeyed. For the pandemic to end, there should be herd immunity where at least 70% of the population should be infected or most of the population should have acquired immunity through vaccination. In a short period of time, a good number of vaccines were produced which in itself is a remarkable achievement. This was not heard off earlier with other pandemics. Vaccines against COVID-19 have shown good results to the tune of 70%–90%. There were a lot of ethical issues, production issues, and logistic issues and over and above, mal propaganda and mentality against taking a vaccine. Despite all these obstacles, vaccines against COVID-19 have proved that they are efficacious to a large extent and have protected people from getting serious diseases thereby reducing mortality. A study from Jordan[10] on acceptance of vaccines revealed that vaccine acceptance was fairly low at 37.4%. Many participants believed that there was a conspiracy behind COVID-19 and would not trust any vaccine. This may be true in many countries. Every information about vaccines that are available against COVID-19 and their pros and cons are discussed by Vasantha Kamath et al. in their review article on this subject, which should be very useful to all.

Since this is an exclusive issue on COVID-19, other regular features do not find a place, except letters to the editor. We hope you enjoy going through this issue. COVID-19 infection might have come down to a certain extent, but it has not gone. Mask, sanitization, and physical and social distancing have to be followed vigilantly. Hope we will have the disease reduced to such an extent to allow free activities at least by the beginning of 2022. We all have to work for in that direction.

  References Top

Mehraeen E, Seyed Alinaghi SA, Nowroozi A, Dadras O, Alilou S, Shobeiri P, et al. A systematic review of ECG findings in patients with COVID-19. Indian Heart J 2020;72:500-7.  Back to cited text no. 1
Man MA, Rajnoveanu RM, Motoc NS, Bondor CI, Chis AF, Lesan A, et al. Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and eosinophils correlation with high-resolution computer tomography severity score in COVID-19 patients. PLoS One 2021;16:e0252599.  Back to cited text no. 2
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;26:1017-32.  Back to cited text no. 3
Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of covid-19 – Final report. N Engl J Med 2020;383:1813-26.  Back to cited text no. 4
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 2020;55:2000547.  Back to cited text no. 5
Singh B, Kaur P, Maroules M. Splanchnic vein thrombosis in COVID-19: A review of literature. Dig Liver Dis 2020;52:1407-9.  Back to cited text no. 6
Hussein MS, Haq IU, Thomas M, Allangawi M, Elarbi A, Hameed M. Pleural effusion secondary to COVID 19 infection. Chest J 2020;158:A2442.  Back to cited text no. 7
Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: A case report. J Clin Neurosci 2020;76:233-5.  Back to cited text no. 8
Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A, et al. Returning to physical activity after covid-19. BMJ 2021;372:m4721.  Back to cited text no. 9
El-Elimat T, AbuAlSamen MM, Almomani BA, Al-Sawalha NA, Alali FQ. Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan. PLoS One 2021;16:e0250555.1  Back to cited text no. 10


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