– Severely ill patients who recovered still being monitored routinely

By Navendra Seoraj

SOLID evidence that persons could be re-infected by the dreaded novel coronavirus is yet to be recorded, but, here in Guyana, health authorities have observed two suspected cases of re-infection between March, 2020 and now.
In Guyana’s context, information related to this virus is just over six months old, so a full analysis is not possible at this time. But Head of the COVID-19 task force at the Georgetown Public Hospital Corporation (GPHC), Dr. Mahendra Carpen, has said that two Guyanese, after being infected once and then recovering, have again showed symptoms of this disease.
For an infected person to be classified as ‘recovered,’ he/she would have to do two periodic Polymerase Chain Reaction (PCR) tests, which would have to yield negative results.

Of the over 5,000 cases of COVID-19 recorded locally, over 4,000 persons have so far recovered. And, considering the preliminary information, the joys of walking out of a hospital or a house after a fierce or even mild battle with COVID-19 could possibly be ‘short-lived.’
“I do not believe we have confirmation [about re-infection], but we have suspected one or two cases of re-infection,” said Dr. Carpen during an interview with the Guyana Chronicle on Sunday.

The first sign of re-infection was observed in a person from Region One (Barima-Waini) and, most recently, it was seen again in an individual from Region Four (Demerara-Mahaica); both persons have underlying medical conditions.
A probable case is said to be an individual who has not had a confirmatory test performed, but has: a positive antigen test, clinical criteria of infection and is at high risk for COVID-19 infection.

This newspaper understands that the suspected cases of re-infection remain listed as undetermined, but are being closely monitored by medical professionals. The World Health Organisation (WHO) in April had cautioned world governments and patients, who have recovered from COVID-19, that there is no “hard evidence” to prove that re-infection with the virus cannot happen.
The WHO cautioned countries against operating as if those recovered can face no new threat and therefore pose no threat to others, as this could add to the spread of the virus.

And, according to a recent report from Reuters, people who’ve had COVID-19 are highly unlikely to contract it again for at least six months after their first infection. The report cited a British study of healthcare workers on the frontline of the fight against the coronavirus pandemic. The results of this study suggest that cases of re-infection are likely to remain extremely rare.

Based on available information, most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.

But with the long-term effects of this virus still unknown, authorities in Guyana have been keeping tabs on patients who recovered after experiencing the severe forms of COVID-19.

“We have not really started seeing the long-term complications as yet, but our main concerns at this point would be the psychological impact and the impact it has on the various organ systems like the lungs and the kidneys,” said Dr. Carpen.

In further breaking down his explanation, Dr. Carpen said: “We do not know if the COVID-19 contributes to more kidney failure, which would lead to patients requiring dialysis and transplant, or if it causes lung damage to cause long-term shortness of breath.
“These things are still unknown because the pandemic is about a year old, so it is difficult to extrapolate what the long-term effects would be at this time.”
To ascertain the “long-term effects,” local authorities have established a system at the GPHC to allow for surveillance of patients who would have been medically cleared.

The “follow-up” sessions include assessing a patient’s lung function to determine their respiratory status, since this is the primary organ which is targeted by coronavirus. Other mechanisms to assess a patient’s health are being established as the need arises.

Dr. Carpen said health authorities are monitoring every bit of research on COVID-19 produced by the WHO and other reputable organisations. The WHO had recently advised against the use of Remdesivir- a drug being used by Guyana and other countries to treat symptoms of COVID-19.
The organisation issued a conditional recommendation against the use of remdesivir in hospitalised patients, regardless of disease severity, as there is currently no evidence that remdesivir improves survival and other outcomes in these patients.

When asked about this, Dr. Carpen said: “The recommendations, so far, have not yet been examined by critical independent sources, and that is where we try to make decisions…so they vary from what is considered standard in any condition, not just COVID-19.”

This recommendation, he said, will, however, be re-examined and vetted by other sources and independent arbitrators to determine whether this is the way to go.

There are several “unanswered questions” from the solidarity trials that were used to come to some level of conclusion, but those have not yet been resolved.

“So before we make dramatic changes that affect our patients, we need to be certain that these are accurate and reflect the best possible care for these patients,” said Dr. Carpen.

According to the New England Journal of Medicine (NEJM), remdesivir, a nucleotide analogue pro-drug that inhibits viral RNA polymerases, has shown in-vitro activity against SARS-CoV-2 ( the virus that causes COVID-19).

While Guyana has been able to acquire and use hydroxychloroquine, remdesivir had been out of the country’s reach for quite some time, as the supplier has been producing only limited amounts.

Most of the drugs were being consumed by the U.S., but Guyana was able to acquire 240 doses of a generic version of remdesivir from India.
So far, as Dr. Carpen said, there have been no adverse effects from the drug, but one patient who was critically ill could not be saved despite the drug’s responsiveness. Some of the patients are still under hospital supervision, but the doctor maintained that patients have been responding well.