Doctors flag early lung infections as new Covid-19 concern

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A couple from south Mumbai in their 60s consulted a doctor last week after having a fever for two days. As the doctor examined them with the help of a stethoscope, he heard what is known as bilateral crackles: typical sounds from the lungs that suggest pneumonia. A Covid-19 test returned positive and a CT scan of the lung confirmed pneumonia. But what surprised the doctor, consultant internist at Bhatia Hospital, Tardeo, was the progression of the lung infection. In the past, Covid-19 linked pneumonia was seen after at least 10 days of symptoms, but in this senior couple, pneumonia had set in on the third day.

“Involvement of the lung within the second or third day of the onset of symptoms is concerning,” said Dr Samrat Shah, who treated the senior couple. Shah said that their lungs were considerably diseased, and the CT scan severity score was above 7, which meant that they had already crossed the mild stage.

As Mumbai grapples with a surge on account of the second wave of the Covid pandemic, doctors across the city say that CT scans of positive patients are revealing faster pulmonary changes even as severity scores are rapidly turning to severe.

Given their age, the couple was an ideal candidate for hospitalisation. But they could not find a bed in a private hospital. They were put on intravenous steroids and antiviral medication at home and are now on the road to recovery. According to Dr. Shah, almost 30% of his patients are coming with early lung infections. During the last wave, only some of the immunocompromised patients would turn up with such early infections, he said.

Dr Khusrav Bajan, a physician, and intensivist at the PD Hinduja Hospital in Mahim said almost 15% of his Covid-19 patients are suffering from an early lung infection. “Last year, such cases were about 5% to 10%,” said Dr. Bajan, adding that the CT scans of these patients are deteriorating faster, within one or two days of admission.

A CT-scan severity score, ranges from 0 to 25; 7 to 12 indicates moderate infection; above 12 indicates a severe infection; below 7 indicates mild infection.

“I have so many patients who are slipping from a score of 5 to 20 within a day. They typically have pneumonia and acute respiratory distress. Also, a peculiar trend is that younger people, under 45 years of age, are coming with such early infections,” said Bajan.

From reporting an average of 526 cases per day in January, Mumbai’s daily average rose to 655 cases per day in February and jumped exponentially to 2866 cases per day in March. The surge continues further this month with the city reporting an average of 9500 per day in the first five days. The active cases in the city have jumped by over 700% within a month’s time: from 9055 on March 5 to 73,281 on April 5.

According to BMC’s Covid-19 dashboard, 12707 patients are currently hospitalised. Of these, 1776 are admitted to intensive care units. Another 1937 patients are admitted in Covid Care Centre (CCC2) that are meant for positive, asymptomatic patients. Around 2% of the total active cases are critical.

“Even as the numbers have risen, and more patients are symptomatic, the response rate to therapy is much better. This helps as patients don’t get to the critical state,” said physician Dr. Pratit Samdani who is currently treating one unusual case of a 65-year-old jeweller who developed lung fibrosis on the seventh day of hospitalisation. Lung fibrosis is a severe condition wherein the lung tissues are severely scarred and the damage is irreversible. “We generally see fibrosis after three to four weeks. It is unusual to develop fibrosis so soon,” he said.

However, experts also said that the sheer volume of Covid-19 cases in the ongoing second wave has resulted in doctors observing such trends more clearly. “Some patients definitely deteriorate faster. We are also seeing significantly affected lungs in patients but we did see a similar trend last year too,” said Dr Rahul Pandit, a critical care physician at Fortis Hospital and a member of Maharashtra’s Covid-19 task force. “I think what is concerning right now is the overwhelming number of cases.”

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