Paracetamol, chloroquine & Google translator: How Medanta treated Italians with coronavirus

Of the 14 Italian tourists who tested positive for coronavirus early in March, 11 have been discharged while two others have tested negative.

A coronavirus isolation ward (Representational image) | PTI

New Delhi: Thirteen of the 14 Italian tourists, who were among the first to test positive for coronavirus in India, have now tested negative for the infection.

Of the group, which was admitted to the Medanta super speciality hospital in Gurugram on 4 March, 11 were discharged Monday evening, while two are yet to be fully cleared. One tourist, who is in their late-70s, is in critical condition.

In the first week of March, Dr. Naresh Trehan, a top cardiologist who runs Medanta, had called an urgent meeting with Dr Yatin Mehta, specialist in critical care, and Dr Sushila Kataria, an expert in infectious diseases, to inform them the hospital would be treating the  Italians.

ThePrint spoke to Dr. Kataria and Dr. Mehta to find out what treatment procedure they followed, how they coped with patients without a common language to communicate in, as well dealing with a highly infectious virus that has no known cure yet.

First stage

The tourists were housed on a quarantined floor that had no contact with the rest of the hospital, and a team of doctors and nurses was put together to exclusively treat them. Just a week later, the World Health Organization (WHO) had declared COVID-19 a pandemic.

In the weeks that followed, Dr. Mehta and Dr. Kataria treated the tourists — all of whom are above the age of 65 and do not speak English — by relying on Google translator and WhatsApp.

The infection, which incubates for 2-14 days, is more severe for people with pre-existing lung conditions and the elderly.

“In the first week of their admission, half of them were asymptomatic. Post the completion of the seventh day, they started reporting illness ranging from mild to moderate, and then severe. Eight of them reported mild symptoms, which were treated with paracetamol, cough syrup and vitamin tablets,” Kataria said.

“Three patients were moderately ill while the other three were critical. Those who were moderately ill were given antiviral drug lopinavir along with antibiotic azithromycin and anti-malarial drug chloroquine. For severe patients, Roche’s drug Actemra is being given,” Dr. Kataria said.

Actemra is used to treat rheumatoid arthritis but has shown potential to treat pneumonia in patients with COVID-19.

The doctors took consent from the patients’ families in Italy before starting the medication and have been sending them updates through the Italian embassy.

“While the patients are now coronavirus negative, they are still on recovery path. Social distancing and hand washing precautions are the only way to fight this battle,” Dr. Kataria said, adding that the two are likely to be discharged in a week.

About 20 health professionals work in six-hour shifts to treat the Italians. They are advised to take rest and eat a nutritious diet after their shift ends.

“Longer working hours will be tiring, hence reducing the immunity of the staff. We wanted to avoid lunch breaks (where the staff might need to take off their protective gear such as masks, hazmat suits) so that there is no chance of an infection,” Dr Kataria explained.

When doctors risk becoming patients

Part of the process of treating COVID-19 positive patients includes taking care not to get sick yourself. Dr Mehta, Dr Kataria and the other medical staff wear hazmat suits when administering treatment to the patients.

So, when Dr. Mehta began displaying flu-like symptoms, he was a little troubled. “In (the) back of my mind, I thought these are symptoms of COVID-19 infections. I got worried. I was meeting so many people on a daily basis, including my family,” he said.

He quietly got tested for the coronavirus before his wife or children started asking about his well being. “Tests came up negative and soon, my cough got resolved. I take all precautions, there is nothing to worry, but at times, you are scared… not for yourself but for people around you,” he said.

Dr. Kataria, on the other hand, wasn’t sure if she should discuss her new role with her mother and adolescent children. However, she said her children noticed she was behaving unusually at home. “I wasn’t entering their room. I was restricted to my room, not touching many things in the house and avoiding the kitchen,” she said.

“Eventually, I told them. My 17-year-old son was fine with the decision but my 13-year-old daughter was worried,” she added, saying her daughter didn’t want her to continue treating coronavirus patients.

“I explained to her about the precautions I take and ensured that nothing will go wrong,” Dr Kataria said. Her mother, though, is still unaware about her new role.

It isn’t just families of doctors and medical personnel that need routine assurances, but the many of the junior medical staff, such as nurses and ward boys, are nervous about the situation.

“When we started treating these patients, young nurses, aged 20-25 years, walked up to me to ask whether they will die treating these patients. I and Dr Mehta, keep assuring our staff that with protective gear and precautions, infections won’t pass on to us,” Dr Kataria said.

Social media bridge

To keep everyone updated on the case while also maintaining social distancing, Dr. Kataria started a WhatsApp group.

“When we started, we knew it would be a long journey. We made a WhatsApp group (called) 14 Floor Friends where I keep sending motivational messages along with other health updates every day. Meanwhile, we are getting better with the sign language as well,” Dr. Kataria told ThePrint on a phone call.

The WhatsApp group includes Medanta’s medical superintendent and representatives from the Italian Embassy.

The doctors also occasionally connect with the families of the patients through messages.

Among them is the daughter of the critical patient.

“Her daughter is also a practicing doctor in Rome. She understands our concerns better. We keep sending her reports and treatment updates,” Dr. Mehta said.