A Pulmonologist Quietly Leads Fight Against COVID-19 In This Kashmir Hospital

As COVID-19 positive cases continue to rise in the Valley, SKIMS Medical College at Bemina are treating patients in an intense but quiet battle and J&K’s premier Pulmonologist Dr. Javaid Malik is leading the fight from the front.

Of 300 positive cases in Jammu and Kashmir, 96 active patients are being treated in this hospital alone. The college was first to be designated as COVID-19 hospital and has 150 dedicated beds for isolation wards along with 20 beds in high dependence unit and an Intensive Care Unit (ICU). Entry to the hospital is restricted and only COVID-19 positive patients are taken inside.

Dr. Malik, a Professor and Head of Chest Medicine at SKIMS Medical College, says they work as a team in hospital and patients behave well with them.

“We reassure the patients that majority of the COVID-19 infections are self-limiting and do not need any drugs. We also explain to them that their stay in hospital is primarily to prevent their families from getting infected and also to prevent community spread,” he says.

“This helped us a lot,” Malik adds.

At present, Dr. Malik says there is no specific drug or vaccine available against coronavirus and it is important to understand that all Covid-19 infections do not need drugs but need isolation in hospital primarily for two reasons-- to prevent spread of infection to others till they turn PCR negative and to monitor patients for possible progression of the disease.

A view of the SKIMS Medical College compound. Photo: Umer Asif

Dr. Malik, who is DM in Pulmonary Medicine from PGI Chandigarh, says there is no doubt that Covid-19 cases are rising in the Valley but it is not alarming.

“Cases in Kashmir are increasing steadily but not at an alarming rate because of effective measures like hand hygiene practices, social distancing, contact tracing, testing and treatment of positive cases and lockdown by the government authorities in containing it,” he says. According to him, testing and contact tracing of the COVID-19 active patients have pushed number of the cases up but it has helped to stop community transmission in J&K.

He says that besides conservative management they are actively working on all experimental treatments including convalescent plasma therapy as an evolving treatment option for COVID 19 infection. He adds that his college is trying to collaborate with AIIMS Delhi and PGI Chandigarh for future research areas related to COVID-19 infection to devise preventive strategies in future.

Regarding the treatment, he says nearly 80% of COVID-19 patients are asymptomatic or have mild symptoms and therefore need either no drugs or only symptomatic intervention.

Remaining 20% are severely symptomatic out of which more than 5% progress to critical illness and succumb to the viral onslaught. Some patients develop respiratory failure of varying severity and usually get multiorgan dysfunction that includes cardiac problems, kidney failure, formation of blood clots inside vessels, etc. These issues are compounded by secondary bacterial infections thereby adding fuel to the fire. These complications are highly likely in the elderly and those with comorbidities like diabetes, hypertension, cardiac disease, chronic lung and kidney diseases.

"These issues (age and comorbidity factors) are compounded by secondary bacterial infections, thereby adding fuel to the fire. In those patients who require treatment, we are using Hydroxychloroquine and depending upon the severity, we also add Azithromycin," he explains.

“Oxygen supplementation and bronchodilators are added as and when required depending upon the clinical status. Non-invasive ventilation with BiPAP device is also used if oxygen level does not improve. Invasive mechanical ventilation with low PEEP strategy is used in those patients for whom oxygen level does not improve with conservative treatment. Use of ECMO (extracorporeal membrane oxygenation) is preserved for refractory hypoxemia but is not available in majority of the hospitals in our country.”

He says broad-spectrum antibiotic therapy, if and when required, is decided on a case to case basis by the concerned doctors.

He further adds that some drugs like remdesivir, liponavir/ritonavir are used with caution and under controlled settings in certain institutions as part of WHO sponsored SOLIDARITY trial. The conservative use of these drugs is due to limited evidence that favours their use for COVID-19 and the evidence is drawn primarily from SARS and MERS Coronavirus epidemics of 2002 and 2012 respectively.