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Sunday, April 18, 2021

In Gujarat, doctors hint at high viral load, new symptoms among patients

The advisory noted that the symptoms were “different” this time: absence of cough and fever and yet people were testing positive for the disease

Written by Sohini Ghosh | Ahmedabad |
Updated: April 5, 2021 8:51:20 pm
covid-19 GujaratThe medical fraternity in Gujarat has warned of symptoms like abdominal pain without cough and fever, the typical indicators of the disease, among patients (File)

As the daily surge of Covid-19 cases continues at an alarming pace — 2,815 infections and 13 fatalities recorded on Saturday — the medical fraternity in Gujarat has warned of symptoms like abdominal pain without cough and fever, the typical indicators of the disease, among patients. A higher viral load, they said, has been also noted among the patients recently as compared to the surge seen last year post Diwali.

On April 2, Surat Municipal Commissioner Banchha Nidhi Pan issued an advisory stating “the new strain of (novel) coronavirus is highly contagious” and because of its characteristic of high infectivity “the virus can quickly enter the lungs and cause pneumonia”.

The advisory noted that the symptoms were “different” this time: absence of cough and fever and yet people were testing positive for the disease. Joint pain, weakness and loss of appetite, it Gujarat Covid stated, could also be indicative of pneumonia caused by Covid-19.

Dr Ashish Naik, the Deputy Health Commissioner of Surat civic corporation, said till date Surat city had seen five cases of UK variant, but the higher infectivity reported among patients in this latest surge, especially among the youth, is indicative of different variants playing havoc.

“We have sent approximately 50 to 100 samples for genome sequencing. At present, we are awaiting the results and only then we will be able to say which are these variants,” Dr Naik added.

Infectious disease specialist Dr Atul Patel told The Sunday Express: “The second surge is seeing symptoms such as abdominal pain and diarrhoea more than that was seen earlier. This might be because the virus attaches to ACE-2 receptor and the receptor is present in the gastrointestinal tract. But we don’t have any specific explanation at present on why this is being seen at the current surge.” ACE-2 is an entry receptor for SARS-CoV-2, the virus responsible for Covid-19.

Currently, Dr Patel said, more youngsters were reporting infections and, among them, several were requiring hospitalisations with bilateral pneumonia, which was not the routine during the first wave. “During the earlier wave, while children would get infected, they would largely remain asymptomatic and later exhibit multi-inflammatory syndrome. This, too, appears to have changed now with several being symptomatic now,” he said.

The specialist added that at present a cycle threshold value of less than 15 was being recorded. Cycle threshold value is an indicator of viral load — greater the replication cycles during the RT-PCR test, lower the viral load.

“Because of this high viral load, we are seeing entire families getting infected, which is very striking and making the secondary attack rate much higher. Earlier, the secondary attack rate was around 2.8. We must have a systematic study of what is the secondary attack rate for the current outbreak. It appears to be a characteristic of the three variants — UK, South Africa and Brazil.”

Dr Patel also cautioned against a “lethal infection” that the new variant can cause. At a press conference on Saturday, he said while little was known in terms of the clinical outcomes of the Brazilian and South African variants, literature published across the world on the UK variant indicated that “it is potentially a lethal infection and we should not be careless. For the Brazilian variant, a major clinical concern is that it may not be able to recognise the antibodies and neutralise it, which means it may cause significant infection and antibodies created by the vaccines (Covishield or Covaxin in India) may also not be able to identify the virus. This is a major threat”.

The vaccines, he added, have proved to be beneficial with complete protection in at least half of the patients, lower disease severity and lower viral load, which implies reduced secondary attack rate.

Dr Maulik Sheth, the vice-president of Ahmedabad Medical Association and an anaesthesiologist, said, “According to the feedback that we are getting from our association’s doctors, we are right now seeing a lot of family clusters, especially since the last 15-20 days, which was not the case during the last surge. This indicates a high viral load or infectivity. The cycle-threshold values (of RT-PCR test) are found to be lower (indicative of high viral load) even with no symptoms… In (infection) symptoms, we are seeing some changes here, such as abdominal pain or diarrhoea and absence of cough and cold…”

While there is a low mortality at present, Dr Sheth said, it was too premature to comment on anything and that some clarity may emerge only in the coming weeks.

General physician and AMA secretary Dr Dhiren Mehta, too, attested that he had come across a different set of symptoms. “We are not seeing symptoms of cough and cold in many cases. Most patients are found asymptomatic or with very mild symptoms. Patients, I have seen, are recovering even in home quarantine. In many cases, they are complaining about abdominal pain and diarrhoea,” Dr Mehta said.

Meanwhile, Dr Patel said on the policy front it was imperative to detect which strain was prevalent among which community so that better target interventions and treatment could be extended.

“We must analyse genome sequence on an emergency basis. At least per day, more than five per cent of the positive case samples must be sequenced, that too from across the state, across districts and zones, so that we can confirm the predominant variant in Gujarat,” he said.

He added that if non-pharmacological interventions, such as social distancing were not adhered to, it would be advisable to go for a strict lockdown to “break the chain of transmission”.

Treatment Protocol
Hydrochloroquine, which was ubiquitous in the Covid-19 treatment protocol even as of September last year, has now been phased out. Steroids and Remdesivir continue to be the primary go-to drugs. Plasma therapy, too, has been discontinued unless a case history indicates immunoglobulin deficiency.

Dr Patel said, in steroids, dexamethasone could be replaced with Barcitinib. “We have had a good study. It is an oral tablet with duration of therapy between seven and 14 days. We have not observed clinically significant side-effects compared to Dexamethasone. The Dexamethasone drug has been associated with dysglycemia (makes blood sugar levels abnormal) and increases risk of fungal infections as well. Barcitinib, too, can increase the risk of all infections but because of shorter duration of therapy and no effect on sugar, it may be better,” infectious disease specialist added.

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