What I know after eight weeks of Lockdown:

The following are my medical opinions gleaned from two professors, a cardiologist, pulmonologist, paediatrician, physician and nephrologist.  We do not all agree with each other on all things, but their inputs have helped to inform my 2nd-wave treatment strategy views shared here.



A second wave:

It’s coming. As the population gets more exposure, we can expect clusters of outbreaks and infiltration of the virus into even lockdown communities. There are strong new views out of Europe of how the epidemic’s severity was overexaggerated and that there are many more patients who have recovered from a mild manifestation of the disease. New treatments and vaccines are being fast-tracked. Hospitals are prepared so it’s not all bad news.


Politics and science clash:

Fake news, conspiracy theories and lay opinions abound. Our government has expert epidemiologists and virologists advising them, but how are their decisions being weighted? Does Cyril favour saving lives or the economy, does he kow-tow to medical academics or dissenters in the ANC, or is he putting the Party first? I can’t read his mind.

Anxiety:

This is a growing problem. Over the past few weeks many of my patients have presented symptoms of psychological stress. This is fuelled by media sensationalism, poor explanations from our leaders for their actions, personal experiences with those unusual cases that succumb and conflicting views among medical professionals. I don’t think that running totals help the problem. After all, who takes cognizance of our running murder or MVA rate? 

It takes 40 days for habits to form, and we are all now habitually anxious. It’s time to stop watching CNN and Sky and choose credible and balanced sources of information.  It is also high time for some sensible leaders to diagnose the rising stress condition and treat it with trustworthy information, plausible explanations and direction. I have attached a link below for an article on this subject.

https://www.weforum.org/agenda/2020/04/this-is-the-psychological-side-of-the-covid-19-pandemic-that-were-ignoring/

Witchcraft and other remedies:

Without proven treatment options and in the absence of dependable information, people are increasingly resorting to a myriad of remedies and self-medication. I am constantly bombarded for validation of farfetched ideas including crocodile oil. Trump now professes to be an equal amongst the medical profession!



Corona gets your help to make you sick:

Like all viruses, the Corona one also hijacks your DNA and RNA factories in order to multiply. This results in the cell being starved of nutrients, overloaded with by-products and eventually bursting to release its offspring and waste into your body for the cycle to happen again in a new cell. Your body responds by a process called inflammation, which calls for white cells to produce antibodies. A rise in temperature makes your metabolism faster; channelling energy to other parts of your immune system, which is why you feel tired and want to go to bed. Waste products and inflammation make your body sore and you get muscle aches and a headache. After about five days, your antibodies start killing the virus and you return to normal. Different people respond differently to individual viruses, hence the term ‘man flu’ for those who succumb more than others.

The contagion affects everyone differently, especially those at risk:

Here the Corona virus effect may differ in some individuals. After an initially mild early stage, your immune system invokes an inappropriately strong response. This affects the lung lining, haemoglobin and red cells, which all carry oxygen. This may then progress, causing your body to form millions of tiny clots, which block the small arteries to your lungs and kidneys, further interfering with oxygen exchange. Red blood cells migrate out of the blood vessels, releasing iron which further aggravates the inflammation. This is the Cytokine storm that you have read about.

Treatment for different phases of the disease:

The following treatments have been proposed and all may work at different stages of the disease, but not out of sequence. You definitely need to talk to a doctor and not self-medicate. For example, aspirin is an anti-inflammatory and a high dose may worsen your initial disease, but could be useful as an anti-clotting agent later, although there are much better drugs for this purpose.

Prevention:

Vitamin D and hydroxychloroquine weekly and zinc daily have all shown promise. Chloroquine is being debated seriously at present with some weak studies against it and a large body of anecdotal experience for it. Time will tell.

After exposure:

Nasal washouts and heat to your sinuses may reduce the initial rate of replication allowing more time for your immunity to build up.

Early disease:

Low-dose chloroquine and symptomatic treatment with Paracetamol only. Go to bed. Definitely no anti-inflammatory drugs such as ibuprofen.

Progressive disease:

Hospital: Oxygen, antiviral drugs, anti-clotting agents, cortisone and possibly Zithromax if secondary infection is anticipated. The purpose here is to prevent ICU admission.

Severe disease:

Hospital, ICU, ventilation, IV cortisone and dialysis may be necessary. You have a 50% chance of dying at this point.

Post Covid-19 syndrome:

This rare event may develop in children with a severe inflammatory disorder affecting blood vessels.

Treatments with no proof of effect:

Copper dust, crocodile oil, ionized air, high dose vitamins, chlorine dioxide, intravenous antiseptic and ozone to name a few.

Some possible merit in these:

Surface decontamination with copper salts, TB immunization.

Next wave threatens medical skills:

This epidemic is still in its early phase and the fatality numbers are reassuring in South Africa. A big problem I see is that the average age of a doctor in the private sector is over 60 years, which puts them in the vulnerable group. I know a lot of them who have decided to remove themselves from any patient contact.

Some people will die, but not a lot and I have written previously about those at risk.  Even if the lockdown does end, we still need to protect our elderly.

I have spoken of loneliness before: please switch off your TV and phone someone you know to be lonely.

Dr Mark Holliday  21 May 2020

Addendum:

Mark Holliday 23 May

Addendum to yesterday’s bulletin. A large meta-analysis study released last night summated the effects of Antimalarial drugs and Zithromax in 95 000 hospitalized patients and showed no beneficial effects on mortality rate and a possible worsening effect. 

This was for patients started on these drugs at high doses only once hospitalized. It didn’t consider the effect on non-hospitalized patients or people taking low dose prophylactic chloroquine. These effects are still to be conclusively studied. This is a pity as we had hoped to have a fall-back treatment should anyone get seriously sick. 

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