Connecting Research to Clinical Practice in COVID-19 with Dr Shankara Chetty

Dr. Shankara Chetty is a family physician in South Africa with a wide range of patients. • 1:52

Dr. Chetty has successfully managed over 4,000 COVID-19 patients without any deaths, hospitalizations, or need for oxygen. • 3:26

Global response to Dr. Chetty’s perspective on COVID-19 treatment has been positive, with interest from physicians worldwide. • 4:09

Dr. Chetty is collaborating with doctors internationally to influence treatment protocols and public health perspectives. • 5:31

Discussion on autoimmunity in COVID-19, exploring the concept of a hypersensitivity response. • 6:12

Viral-mediated autoimmune diseases are not uncommon and can trigger autoimmune responses. • 6:52

Serum ACE-2, when floating freely in serum, may play a significant role in COVID-19 severity. • 9:27

Demographics of severely affected COVID-19 patients align with characteristics linked to serum ACE-2 levels. • 10:12

Male sex, ancestry, BMI, diabetes, age, and blood pressure are factors associated with serum ACE-2 levels. • 10:41

Asian descent and male patients seem to be more affected by COVID-19, possibly due to serum ACE-2 levels. • 11:02

Virus binding to serum ACE-2 may contribute to the severity of COVID-19 cases. • 11:22

ACE-2 binds efficiently to SARS-COV, leading to autoimmune response. • 11:46

Primary therapy for COVID-19 involves the use of steroids. • 12:11

Antibody production critical around the eighth day of infection. • 12:50

Asymptomatic stage precedes flu-like symptoms in COVID-19 patients. • 13:08

Interferon production crucial for the body’s defense against the virus. • 13:44

Clinical recovery often noted on day six or seven, followed by deterioration on the eighth day. • 14:27

Fatigue commonly experienced on the eighth day, progressing to dyspnoea if unchecked. • 16:15

Patients may experience fatigue, body aches, and odd temperature spikes on the eighth day. • 16:36

Shortness of breath may not be the initial symptom, with variable onset times post eighth day. • 17:25

CRP blood test revealed critical illness despite only experiencing fatigue as a symptom. • 18:10

Antihistamines and Montelukast showed benefits due to mast cell degranulation and mediators release. • 21:45

Antihistamines were used early on for symptomatic treatment in COVID-19 patients. • 22:03

Antihistamines were primarily used to prevent the spread of the virus into the lungs. • 22:28

Severe allergic reactions on the eighth day were managed with stronger antihistamines. • 23:06

Elevated serum ACE-2 levels may indicate a risk for severe cytokine storm. • 23:31

Prior exposure to coronaviruses may lead to mucosal immunity and early interferon response. • 24:14

Antihistamines early on could potentially mask symptoms critical for detecting reactions on the eighth day. • 24:36

Education of patients helped in recognizing changes despite the use of antihistamines. • 25:18

Starting antihistamines early did not stop reactions but may have lessened symptoms. • 25:40

No major risks associated with starting antihistamines early in COVID-19 illness. • 26:37

Symptoms should be closely monitored, especially on the eighth day of illness. • 27:01

Patients need to be educated on recognizing changes in symptoms and seeking timely medical attention. • 27:38

Importance of gauging onset of symptoms and distinguishing from normal health variations. • 28:06

Advice to mark the eighth day after symptom onset for potential deterioration and intervention. • 29:04

Observation that COVID-19 tends to resolve by the sixth or seventh day, with eighth day being crucial for intervention. • 29:25

Significance of eighth day symptoms in determining the course of illness and need for aggressive intervention. • 30:06

Experience with patient cases showing deterioration specifically on the eighth day of illness. • 30:50

Caution against early use of ivermectin without clear understanding of its impact on COVID-19 pathophysiology. • 31:36

Ivermectin did not impact reactions in COVID-19 patients on the eighth day. • 31:59

Ivermectin can clear pulmonary eosinophilia and benefit patients with dyspnea. • 32:45

Research suggests ivermectin may interfere with virus evading interferon response. • 34:22

Immunomodulation with drugs like Azathioprine could show benefits in COVID-19 treatment. • 36:42

Steroid dose critical for outcomes; 50mg effective in first wave, 80mg in second wave. • 37:24

Quickly adjust steroid dose for non-responsive patients; higher doses may be necessary. • 38:51

Prednisone more effective than dexamethasone for COVID-19 treatment. • 41:21

High doses of steroids may be necessary for clinical recovery despite concerns. • 41:56

High doses of steroids may be necessary for severe reactions in diabetic patients. • 42:15

Proper monitoring and adjustment of insulin is crucial when using steroids in diabetic patients. • 42:33

Steroids should not be avoided due to fear of side effects like black fungus, which is rare. • 44:28

Clinicians may be hesitant to use high doses of steroids, but appropriate dosing is essential for effective treatment. • 45:11

In cases of severe pulmonary hypersensitivity, high doses of steroids up to 500mg/day may be necessary. • 46:21

Appropriate dosing and duration of steroid use are key to stopping the reaction effectively and avoiding prolonged use. • 46:41

Steroids aim to prevent intubation or ventilation to manage severe COVID-19 cases. • 47:00

Failure to control immune response can lead to lung vasculitis, causing severe damage. • 47:54

Severe lung vasculitis can result in blocked blood vessels, leading to organ damage. • 49:17

Histamine, CRP, and interleukin levels can serve as indicators of immune response progression in COVID-19 patients. • 51:12

D-dimer levels may also be informative in assessing the severity of the immune response. • 52:09

CRP and interleukin-6 levels spike significantly post day eight, indicating a severe reaction. • 52:09

D-dimers and clotting profile tended to rise after the 8th day. • 52:30

CRP and interleukins were good markers for patient response. • 52:51

Anticoagulation became important for patients with clotting issues. • 53:36

Early intervention crucial to prevent hospitalization and escalation of treatment. • 54:00

Antivirals may not be effective in later stages of COVID-19 infection. • 54:40

Long covid potentially linked to immune changes triggered by diet. • 55:29

Steroids and antihistamines early on led to recovery in all treated patients. • 56:30

No cases of long covid observed in patients treated early with the mentioned approach. • 56:54

Similar approach showed positive results in patients with long covid symptoms. • 57:12

A combination of aspirin, antihistamines, and Montelukast can lead to clinical recovery within a few days. • 57:30

Early intervention is crucial at the onset of deterioration, typically around the eighth day. • 57:45

Long COVID may result from an inappropriate immune response that can be mitigated with timely treatment. • 58:08

Consider COVID-19 as a self-limiting virus and focus on managing the individual’s immune response. • 1:00:10

Challenge traditional paradigms in managing COVID-19 to improve outcomes and reduce mortality rates. • 1:00:33

Re-evaluate the approach to COVID-19 treatment to prevent fear-driven practices and encourage early, proactive care. • 1:00:56

Mortality in COVID-19 is often due to delayed treatment and isolation without proper intervention. • 1:01:23

Utilize high-dose steroids without hesitation to control the inflammatory response. • 1:02:05

Administer antihistamines to suppress additional immune responses, particularly from mast cells. • 1:02:28

Starting treatment on the eighth day is crucial and every day lost is significant. • 1:02:52

Interrogating patients on the eighth day is essential to identify symptoms. • 1:03:15

Education about the importance of the eighth day is vital for the community. • 1:03:33

Continued discussions and collaborations with Dr. Shankara Chetty are expected in the future. • 1:03:47

Expressing gratitude and signing off the conversation. • 1:05:07