Dr Nair, India, Summary

welcome to this talk now we've just been talking to dr prabhan nair who's a consultant in infectious diseases in just north of bombay maharashtra in india and he came up with a lot of really important things now i'm doing a sort of a summary of this on this video now so i'm going to summarize what he said because the sound quality wasn't very good and i don't want to lose the content of what he's said now the first question i asked was how is the situation in india now are you seeing a lot of cases and dr nerd said well basically they weren't very well prepared for the situation in india um they presumed that there was immunity after the first wave and there was some vaccinations been done and they presumed that the the country was a herd immunity well not dr ned he didn't presume that the the authorities were thinking that he's an infectious diseases doctor so obviously he was better informed and cautious but he said basically there was a failure of planning after the first wave after the first wave in india last year they thought the the authorities thought the pandemic and for india was over that people had developed immunity and life was basically back to normal with no social distancing and no mask wearing and also there was some extra facilities that were put up in the first wave to handle more patients and they were dismantled after the first weight before the second wave began so provision that had been put in place was dismantled now you did talk about intensive care beds and the cue for intensive care beds so patients that need intensive care they have to wait for 24 to 48 hours and of course the people that were sick enough to need intensive care within 24 to 48 hours a lot of them have died already most of them have died already he said so basically people are dying because they can't get into intensive care in his areas in the city ward beds are available but he did say that oxygen supplies had ran out in the past so oxygen supplies are just done on a sort of hour by hour day by day basis but places have run out of oxygen in the past and people have unfortunately died as a result of that i then went on to ask him how is the death rate are there lots of deaths now and in the past week now we did say that a lot more people are unfortunately dying now than in the first wave and the intensive care patients the patients that are poorly when they're admitted are not doing well and a lot of those are dying milder cases that he's treating at an earlier stage are getting better so the patients with milder disease that can get to medical care earlier on are doing reasonably well and a lot of them are getting better and going home it's the intensive care the sicker patients that are dying but he did say the situation was unmanageable due to the sheer pressure of amount of people requiring care at the moment all at the same time next question i asked what is the cause of death in covered patients is it mostly respiratory failure and he said yes a lot of patients are dying of respiratory failure and we know about this this is the the acute respiratory distress syndrome where the alveoli fill up with fluid for inflammatory reasons but then he surprised me he said a lot he didn't give a percentage but he said a lot of patients are coming in with stroke because of the increased coagulability of the blood the clotting of the blood so of course you've got arteries that are going to the brain and they divide into smaller arteries to take the blood supply to the brain now there's a thrombus if you if you get a cerebrovascular thrombosis that's going to cut the blood supply off to a part of the brain and that causes stroke if the blood supply to this side of the brain is cut off that can cause stroke on the right hand side if the blood supply to the right hand side of the brain is cut off that can cause paralysis to the left hand side of the body so seeing quite a few patients with strokes because of the increased coagulability and he also talked about people with diabetes who have immunocompromised now about forty percent of the poorly patients dr nair is seeing are diabetic about 40 of patients are diabetic now to be fair diabetes is very very prevalent in india basically there's an epidemic of diabetes in india maybe about 20 of the population of india are actually diabetic already so so that means diabetics are being represented in his poorly patients twice as commonly as the general population but he did say diabetes is a big risk factor 40 of his patients having diabetes and then of course because these patients are poorly because the risk of developing the acute respiratory distress syndrome he has to put them on steroids these drugs like dexamethasone which is a steroid drug but a side effect of the steroid drugs is they put your blood sugar up they can put your blood sugar up quite dramatically and when the blood sugar is high that inhibits the functioning of the immune system itself so he's talking about this cascade reaction the patients have to go on steroids so they can breathe but they go on steroids so that raises the blood sugar levels and the the raised blood sugar levels interferes with immune function as well making the patients more immunocompromised so this takes quite a lot of of jiggling around we we have to titrate the the blood sugar level quite accurately when we're looking after these poorly patients at the best of times but with 40 of them being diabetic that is actually a big risk and because of this cascade reaction a lot of them are actually dying unfortunately and i was just reminded of a conversation i had with a friend of mine who's an intensive care nurse in the uk and uh he said they were using huge amounts of insulin so a lot of patients that were diabetic were being put on insulin intravenous insulin to control the diabetes and this is being titrated on what we call a sliding scale and uh it does seem to be a big part of the problem in india well the next question i asked dr nair was what are the proportion of people getting sick compared to the number of people that are getting infected and i found this answer really quite surprising he thought it was 30 to 40 percent so about 5 of the people that were getting infected were needing hospitalization in the uk at the uh in the peak of the uk waves here it seems to be much higher 30 to 40 percent needing some oxygen and care but he did point out that's complicated because whereas in the uk and the us will follow protocols in india people very often try and treat themselves with over-the-counter medications and this can distort the data and what it means is that very often by the time people have tried to treat themselves which of course is less expensive but because people have tried to treat themselves it can be nine to ten days after they got sick and he said that nine to ten days after the onset of illnesses the critical period if he only gets patients to treat nine to ten days after they get sick they're already in the inflammatory phase of the illness and this means a much poorer prognosis so more people are probably getting sick because they're presenting later in a more serious condition because they're trying to treat themselves and by the time they get into medical care their nine ten days after the onset of of the symptoms as if they are getting able to get into medical care but even if they are able to get into medical care the prognosis is worse next i asked her have you had difficulties with supplies of oxygen and drugs and he said that most hospitals in the cities where he works have ran out of oxygen at some point in the past 15 days now he didn't say this but if if hospitals run out of oxygen for some time then the results of that are not good people will die through the lack of oxygen he said that patients are being sent home due to the lack of beds and told to come back at later but by that time some patients have already deteriorated so the oxygen situation really is quite critical now i said most drugs like dexamethasone are readily available which is encouraging remdi severe which does have some antiviral effects has run out i asked him about the use of anticoagulants the blood thinners because remember it said a lot of patients are getting strokes and they said they don't use anticoagulants routinely what they'll do is they'll check a test called the d-dimer so the d-dimer test is a test that is done in hospitals to see if there's blood clots in the vasculature in the blood system so if there's no d if the d-dimer is low it looks like he's not giving anticoagulants but if the d dime is high indicating that there are thrombosis that there is blood clotting going on inside the vascular system then he is anticoagulating his patients next i asked what are the local drivers of infection are people following mask wearing protocols and social distancing and the answer to that one was they certainly have not been although they are starting to try and do so now so distancing and mask wearing has been very poor lately because of this sort of complacency that's set in in india there's also the effect of the new variance of course now the degree to which the new variants are driving this is still unclear but the answer is probably to some degree but he did point out that uh in the cities around india in mumbai especially they have a very high density of population and the trains are absolutely packed now when you say the trains are packed they are packed like sardines people are literally standing like this crammed into a train or into a bus and things had got back to normal as people commute to work to try and make a living so the conditions were there just waiting for this disease to to spread out and he used the term tsunami this is caused a tsunami of cases and they are overwhelmed now i asked about the risks to people in the united kingdom in the united states in europe should the india variant escape and start proliferating in western countries he did say it's more infectious he did say it's more transmissible so this will spread more readily but he thinks the distancing that is practicing western countries and the fact that we've had high levels of vaccine should mean that we're probably going to be okay from that now that's fairly optimistic and i hope is right personally i'd rather not find out of course so next i asked about the effectiveness of the vaccines that had been given and dr nair did say there's not that much data he can actually refer to but he has seen some patients who have had two vaccine doses and are still getting sick and some still being admitted to the intensive care so he is seeing some patients who have been vaccinated who are getting sick now we knew this was the case and of course we don't have the actual figures on this because of course doctor dr nehe's a doctor so that the patients he sees are a bit a bit of a self-selecting sample he's more likely to see the sicker patients but it doesn't alter the fact he has seen some patients with two vaccines who are getting sick i then asked about the availability of the the tests if they're able to do plenty of tests and he said the pcr availability is good he can test all the patients he needs to to see if the they've got sars corona virus too and and they are indians the institute the india medical research council are greatly scaling up the availability of testing now so this means that the figures we're getting from india will be progressively more accurate as testing in india is scaled up i asked her how are you treating patients with mild and more severe disease and he said that ivamectin is widely used in mild and moderate disease and they also use a doctor cycling which is an antibiotic but does seem to have anti-inflammatory and perhaps even antiviral properties and the combination of ivamectin and doxycycline is giving good results in mild and moderate cases so i asked about preventing severe deterioration and he said yes that the combination of either mechanism and doctor doxycycline is preventing progression to severe disease i actually pushed him a little bit on that and he said yes it's definitely working so his strategy of either mechanin oxycycline he feels is definitely working and he's in the thick of it he's the person to ask and he did say that patients that are treated with either mexican doxycycline can be discharged earlier now we did talk about the drugs to some extent of course you won't take any medical advice from this video you'll go to your own doctor this is for educational purposes from what he's doing there um so um anti-viral drugs is there an antiviral effect from doxycycline uh from from ivormectin rather and he said yes definitely so he's convinced as an infectious diseases doctor there is antiviral effects from ivormectin or at least from ivamectin combined with doxycycline now what he said was he believes the ivormectin is acting against viral replication so ivamectin there is preventing replication of the virus that is his view and of course this is what he does full time all day every day so antiviral effects definitely he said either my vermecting acting against viral replication doxycycline he believes is acting mostly against the cytokine storm uh he he also uses vitamin d multivitamins and zinc and he believes in the immune boosting cooperative of vitamin d and personally is taking 60 000 units of vitamin d once a month now this is the way they tend to take the supplements in india there is actually data suggesting that it's probably better to take a smaller amount more regularly but um that's what they're doing so i'm not going to criticize him and say is wrong for that he's taking 60 000 units once a month and so far has remained disease free which is excellent to hear about now i asked him do patients develop secondary bacterial infections after covered and the number he sees in hospital the number he sees developing secondary bacterial infection is relatively low about five or six percent so if you have a viral infection in the chest then it's quite common that you get secondary bacterial infection but it says these figures are low this five to six percent is low because they're monitoring the patients in hospital and giving antibiotics at an early stage and this is preventing the bacterial pneumonia if patients weren't in hospital then it's reasonable to assume that there would be more cases of secondary bacterial pneumonia and another complication is seeing after covered is fungal infections three to four weeks later now we haven't heard much about fungal infections in the uk but he is seeing a lot of fungal infections now we can treat them if they're picked up early and it is they see a lot of cases where fungal infections have gone into the facial sinuses causing fungal sinusitis he says that is very common so interesting there we have uh fungal infections as a sequelae of um i've covered 19. there is some cases of lung fungal disease as well and the fungal infection can sometimes spread to the brain and the eyes with systemic fungal infection and now obviously he's an infectious diseases doctor he can treat it early patients in other parts of india don't have access always to his level of expertise so it looks like these fungal infections could be a problem the final question i asked was do you think many people might develop long covered with longer term sequelae and he thinks that is the case particularly people with diabetes and longer-term autoimmune diseases sorry that was the penultimate question the last question i asked him was what's going to happen in the next month or two and he was pretty convinced that infections are going to keep on rising until may between may the 15th and may the 20th so for the rest of april and for the first two or three weeks in may infections in india are going to rise this is going to put even more pressure on the health services which are already completely overwhelmed so data is showing that cases will carry on increasing in india for the next few weeks up to about the 20th of may when the peak will be reached now given that things are bad at the moment it's just horrendous to think how bad things could get so we really need to think about how we're going to help india with provisions drugs and oxygen and oxygen producing facilities and as a matter of absolute emergency because this is going to carry on increase until the 15th to the 20th of may it's a long time yet then the number of infections won't drop down dramatically they'll taper down gradually till august so that means we've got the rest of april may june july august there's going to be an awful lot of people still getting sick in india right up until august he did stress the need for more vaccines um because if if more people aren't vaccinated what's happening now could prolong the second wave could prolong and could even merge into a third wave it is concerning that he's seeing reinfections after disease and after people have had the disease previously and people that have had two vaccines but as as i've said because he's treating people he's more likely to see people that are sicker we don't know the proportions in india of people that are getting sick after having previous disease or having two vaccines we would hope it's going to be low but he does tend to see the sicker patients and he did stress that lives could have been saved with greater preparation so that was dr pravin there um infectious disease doctor and uh i just was so grateful that he took the time to talk to us because he's really got to be one of the busiest guys on earth at the moment i do know his working uh incredibly uh incredibly long hours in many in many situations at the moment so some pretty important information there thank you dr nair and uh thank you if you've stayed till the end of this video

Channel: Dr. John Campbell

Views: 102,699

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: YQdKsLZjmaQ

Length: 18min 18sec (1098 seconds)

Published: Sat May 01 2021