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• The individual was airlifted from Vizag to Chennai due to rapid worsening related to extensive lung damage due to COVID-19, for ECMO initiation.

• He was managed successfully without ECMO by adjustment of medications guided by understanding the reasons for worsening of his COVID-19

Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu, today announced the successful treatment of a doctor, with severe COVID-19 infection and 99 percent lung involvement leading to respiratory failure.

The individual, a prominent surgeon from Vizag, was diagnosed with severe COVID-19 illness and was airlifted to Kauvery Hospital in Chennai.

Speaking on his condition, Dr. Srinivas Rajagopala, Senior Consultant, Interventional Pulmonology & Sleep Medicine/Director, Transplant Pulmonology & Lung Recovery Unit, Kauvery Hospital said, “He had a history of Myasthenia Gravis (a disorder characterized by weakness and fatigue of muscles, that is caused by an autoimmune disease) for which he was taking steroids and immunosuppression.

He was diagnosed with COVID-19 from the Omicron Variant in the last week of January 2022 (identified by gene sequencing) and was treated with Remdesivir, steroids and Baricitinib at Vizag. There was no oxygen requirement at diagnosis and CT scans showed only 40 percent lung involvement. He was discharged within five days.

After four days of his discharge, he developed progressive breathing difficulty, high fever and chills and was readmitted to the same hospital. His breathing difficulty worsened and he began to need oxygen, at 2-3 litres/min. CT Scans showed 99 percent lung involvement, with ongoing COVID-19 related damage.

SARS-CoV-2 antibodies were detected. He was started on high-end antibiotics, high-dose steroids, anti-coagulation and Baricitinib. His condition however deteriorated with rising oxygen requirement, delivered through High Flow Nasal Cannula, which prompted the possibility of needing ECMO within the next 24 hours.

The decision was taken to refer to Kauvery Hospital; he was airlifted to Chennai immediately by Air Ambulance.

The Kauvery team thoroughly went through his medical details and recognized that there was ongoing lung damage due to poor viral control by his over-suppressed immune system. Blood tests did not suggest any super-added infection.

We de-escalated antibiotics, reduced steroid dosages and held his immunosuppression temporarily to clear the body of COVID infection. This was done under consult with Neurology, who were closely monitoring for flare of myasthenia. With appropriate anti-virals, and with reduction in immunosuppression, his condition stabilized. He was managed in the ICU for the next few days on stable oxygen requirements.

Follow-up blood tests also showed control of his initially high inflammatory markers, which slowly improved with good treatment. We simultaneously continued ‘awake proning‘, and best supportive care with attention to nutrition and muscle strength. He also had lung fibrosis which worsened during his hospital stay. Anti-fibrotics have not been shown to be useful in resolution of COVID-19 related lung fibrosis, and are associated with collateral damage to liver in a significant proportion of patients. Also, the CT chest suggested an organizing pneumonia pattern, so a slow steroid taper was done, with very good recovery in fibrosis by the time of discharge, without the use of anti-fibrotics. Simultaneously, he was initiated on Pulmonary Rehabilitation which included cycling, treadmill, cardio, breath control and strength and endurance training,” added Dr. Srinivas.

His course was complicated by an episode of infection needing antibiotics but he was discharged after 5 weeks with no major complications and complete lung recovery without the use of anti-fibrotics, anticoagulation, his usual steroids and immunosuppression for myasthenia. Two weeks later, he is now off oxygen with a near normal chest x-ray and ready to start his clinic work.

Speaking on the success of the treatment, Dr. Aravindan Selvaraj, Co-founder & Executive Director, Kauvery Hospital, Chennai, said, “COVID has seriously and critically affected many patients, through different and highly pathological mechanisms. We are tirelessly working towards treating people who present with varied complications. The patient here is a doctor who fought courageously and won over the disease. We are proud to have assisted him in his fight against the illness. I congratulate Dr. Srinivas and team for their untiring efforts in saving his life. We wish the doctor a speedy recovery and in resuming his duties in serving the people.”