This pandemic is now the only subject of discussion in all platforms, be it social media, printed news or television.

It has actually packed up all our minds and body in such a way as if there’s nothing else that determines our lifestyle and living today.

But if you look closely at human attitude and behaviour just pre-Covid, one can definitely appreciate a radical change in our approach to life and living now.

Mankind had actually got completely mechanical.

We would press a button of a preprogrammed stream of activities every morning and the day would keep moving like a sequence of codes.

Many times we actually did not understand why we kept busy with the same kind of priorities and most of our destinations were clustered around achievements.

Even the concept of holidaying was programmed to be exotic. This indirectly meant working tirelessly to make it happen.

Our children were pampered with goodies of choice at any cost. They were used to everything being streamlined by the helping hands before they got back from school or work.

Parents and children had limited interactions unless it was on a holiday because that got recognised as the perfect style of successful living.

But then caught most unawares this tiny ultramicroscopic virus changed lives news and views radically.

Some grounding realities that we have come into terms with are:

1) Life is actually very simple. We do not need anything fancy to make us happy.

2) We can accept all limitations and yet be content.

3) The day to day worries of work, home and pursuing goals are not so important.

4) Parties, pompous weddings, spectacular conferences are the least important.

We all learnt about this new evolving disease (Covid19) virtually.

Couples got married in decent small gatherings. Life changed radically from the concept of extravaganza to simple frugal celebrations.

To sum up, I feel as mankind touched reality which was almost getting extinct, we all threw away a lot of unrealistic baggage of worries, anxieties and nightmares we were carrying.

Families, who were worried of one member being sick, got hospitalised all together with Covid.

Holiday planning remained virtual and enjoyment at home became a reality.

The worry of a single day off business being lethal proved that months being off also kept life going.

Life had many other aspects like hobbies and creativity to be nurtured beyond the grueling whirlpool of only working for money.

Peace and happiness is right inside us and we don’t need to travel to calm places to put our thoughts in order.

Having reflected on the socio- philosophical implications of this pandemic, let us now explore a little into the scientific updates and various presentations of this new illness about which we are learning every day.

In the initial period, we learnt that it is a pneumotropic virus that primarily affects the lungs and hence is the need of monitoring the oxygen saturation and the urgent need to step up treatment whenever the saturation drops.

Subsequently, people observed that some patients deteriorated very rapidly and lung infiltrates detected radiologically kind of explained a lot of it.

It was also learnt that Covid19 virus attacks the beta chain of haemoglobin and releases iron into the circulation. So haemoglobin can no longer bind oxygen and there is resistant tissue hypoxia.

The released free iron is toxic and causes oxidative damage to tissues.

Hence ferritin levels are high.

Further, it was observed that a prothrombotic sequence of events explained a lot of symptoms.

This flow chart explains a lot of the symtomatology of Covid19.

COVID19

Next significantly high levels of cytokines and chemokines were noted in patients with Covid19 which included a variety of the interleukins, tumor necrosis factor and GCSF.

This accounts for the cytokine storm that occurs in many patients.

These are basic scientific information that all of us have learnt about the evolving Covid19 pandemic.

Now, as a clinician, I intend to share some interesting cases that we have come across during this crusade with corona.

The majority of our patients have come through our fever clinic with associated upper or lower respiratory symptoms or gastrointestinal symptoms.

However, off the usual we have a few presentations which are worth sharing.

1) We have seen a Covid19 patient presenting only with tachycardia and hypertension but no fever. Obviously, he had palpitation and dyspnoea. He was tested for Covid because he was a health care worker.

2) We have seen 3 patients presenting with gangrene of the limbs, but they had a preceding history of fever and hence was tested for Covid19 which came positive.

3) Another health care worker had only unusual fatigue with no history of fever but the HRCT chest showed typical ground-glass opacities and on being tested showed a Covid19 positive status.

4) One patient, who came with lower motor neuron type of paraparesis, developed fever after hospitalisation and turned out to be Covid19 positive.

5) A young gentleman in his early forties with no comorbidities had complained of vague unwell symptoms for a day and on the next day had chest pain, dyspnoea and sweating.

By the time he reached hospital, he expired on the way. His post-mortem examination revealed extensive Myocardial Infarction with a Covid19 positive status.

6) As an elderly lady had presented with behavioural changes on a background history of controlled hypertension. The initial workup was normal. But when her son mentioned casually about a preceding history of low grade fever, we did a Covid19 test which showed positive.

7) Few patients with lower GI or Upper GI bleed with no history of fever were tested for Covid19 (RT-PCR) pre-endoscopy, as per protocol, also tested positive for Covid19.

8) The biggest surprise came from patients who were kept in our ward for chronic diseases like Parkinsonisn, Chronic renal failure, Chronic heart failure or Chronic liver failure.

After a few days in the hospital because of deterioration of the primary illness and on preparation of shifting them to the ICU as per protocol, Covid testing came positive.

These patients were real fear precipitators for us.

Apart from all this apart, as we are all talking about herd immunity huge surprises have struck us all. Highlighting a few:

  1. During testing for plasma donation, it’s been observed that almost all asymptomatic patients and even some symptomatic ones had insignificant levels of anti Covid IgG antibodies.
  2. We have encountered patients who were discharged following RT-PCR being negative, coming back with fever around a month after the initial illness and on testing was found to be Covid19 positive (RT-PCR) again.

The questions unanswered are Relapse or Remission or just picking up dead virus or viral particles.

So the question of herd immunity being a reality or not remains fuzzy.

As I wrap up all this, the definitive hope out of the distressing but levelling situation is perhaps the vaccine which is starting to unfold.

Hope, nature and science agree and come to accept each other faults and fury and a way is paved out of this blazing pandemic #COVID19#.

(The author is a Professor of Medicine at Gauhati Medical College)

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