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  Senthil Reply

  Response from Dr D P Prakash It is very important for us to know the COVID status of our pre operative patient to PROTECT OURSELVES AND OUR STAFF. There should be no compromise on this unless you are not worried about getting infected or you have already been infected. But even then we are subjecting all our staff to risk of COVID infection. At Chennai we have a unique problem. Even though RT PCR testing is available at many government fever camps private hospitals and clinics people are reluctant to do the test because of the following concerns 1. If they test positive their homes will be SEALED WITH METAL SHEETS AND NOTICE POSTED ON THEIR COMPOUND. This is a social stigma for many and neighbors stop ???? interaction with them even by phone ????. More disturbing for them is that if they stay in a house with more than 1 portion like a duplex or 3-4 smaller houses in a compound then every other family is also shut down and isolated for no fault of theirs .... even if they are COVID negative. 2. Another huge concern is that if one person tests positive the whole family including the earning member is locked up for 14 days.... EVEN IF HE HAS RECOVERED FROM COVID QUARANTINE due to the lockdown of their house . This definitely is a DISCOURAGES MANY FROM UNDERGOING THE COVID TESTING BEFORE A STRAIGHT FORWARD ELECTIVE CATARACT SURGERY. *WE can tackle this issue by doing only an COVID ANTIBODY TEST. * An IgM/ IgG positivity can be easily detected with widely available kits that need 1 drop of blood ???? just like a pregnancy test. It takes just 60 seconds to get the results. The catch is many such kits are unreliable and false negatives may be high. To improve the reliability of this test THYROCARE is doing a COVID IgG ELISA antibody titer which according to them is approximately 98% sensitive and specific. HOW DO WE INTERPRET THIS ANTIBODIES TEST RESULTS FROM OUR CATARACT OR OTHER ELECTIVE SURGERY PERSPECTIVE? If the patient is IgG positive then in all probability he/she HAS HAD A PREVIOUS COVID-19 INFECTION AND IS NOW NON-INFECTIOUS. This patient can be safely taken up for surgery. This patient is similar to a VACCINATED INDIVIDUAL AND CARRIES NO RISK TO ANYONE. *If the patient is Ig M positive * This individual is recently infected with COVID-19 and may still be INFECTIOUS TO OTHERS. Best option to postpone surgery by 15 days and do an IgG test . Once it’s positive or IgM becomes negative we can safely take up this case. If the patient is both IgM & IgG positive still waiting for 15 days is prudent till IgM becomes negative. If IgM & IgG are negative we have to take a chance because either this patient is NON-COVID... or he’s in the **early stages of infection BEFORE ANTIBODY CAN BE PRODUCED. **For such a patient an RT PCR IS A MUST. A word of caution on the RT PCR TEST- 30% of infected patients may be a false negative. *So even if we have a negative Rt PCR we may need to do a Total &Differntial WBC count, CT CHEST & ESR to have some other clue to diagnosing COVID infection in such patients. * Remember - A POSITIVE RESULT HAS HIGH VALUE... a NEGATIVE RESULT DOES NOT RULE OUT THE INFECTION. THIS APPLIES FOR ALL ANTIGEN, ANTIBODY & PCR TESTING.

  23 July 2020 03:09 AM