Battle with COVID-19 is still on. The devastating second wave of the COVID-19 pandemic may be behind us, but many painful memories are fresh in our minds. Many have lost near and dear ones to Covid-19. One may not realize how serious a threat it is unless one goes through it when sadly many known ones fought unsuccessfully and lost. Experts have warned of an imminent third wave of Covid peaking around October-November. This has prompted me to recount the battle fought by a retired air warrior against Covid, which may help in shielding oneself against future Covid wave.

T. Vasudeva Reddy (Vasu in short), a 53 year old retired Wing Commander, had a close encounter with Covid. It was thought he successfully defeated the coronavirus when he was infected with Black fungus, which leads to a nightmarish experience.

India saw the peak of the second wave in April and May when four lakh cases a day were reported. Vasu's RT PCR Test on April 8 came back positive. He had not taken vaccination for it was just open to below 60 years on April 1. Fortunately, his wife and two daughters had tested negative. Initially, he took online guidance from Dr. Kuruganti Suresh, a known consulting Covid doctor. Oximeter reading which was improving following breathing exercise started slowly dropping below 94 and also lead to loss of smell by the fourth day. HR CT test on the 12th showed the disease as moderate (23/40). When the oximeter level dipped below 90 the same evening, accompanied by headache and vomiting feeling, as an Ex-servicemen Contribution Health Scheme (ECHS) beneficiary, his two teenage daughters took him to Military Hospital, Secunderabad around 03.15 am of 13 April.

The usually patient-centric and known for efficient medical management, advised home isolation with no need for admission, even as oximeter reading showed 91. Despite apprehension due to gradually falling oxygen levels during the day, he was reluctantly taken home by his two daughters around 03.45 am. As the oxygen level was slowly dipping, efforts were made for admission in any of the ECHS empanelled hospitals. Non-availability of a bed for admission was the standard reply and ECHS was of little help to assist in the admission. Late at night on the 13th, in the given situation, Vasu was admitted to an ECHS non-empanelled private hospital 'Citi Neuro Centre' Hyderabad in the Covid ward through timely help from SriNageswara Reddy, whose support in many ways continues till date.

The treatment started within minutes with the first dose of Remedesivir injection and oxygen support. It was followed by an infusion of convalescent plasma on the 15th. The Covid norms meant strict restrictions on visitors. The condition was going bleak with HR CT reading going up to 29/40 and the family was advised to procure Inj Tocilizumab which was an attempt at the life-saving effort. This was the moment of utter despair in the family. It is here the will to fight had to be summoned prayers for divine intervention notwithstanding. Vasu's in-laws KV Subba Reddy and Lakshmi Devi arranged daily prayers and Homam at Shirdi Saibaba temple in Kamalapuram. His brother Srinatha Reddy was frequently in touch with Vasu from Visakhapatnam besides flying down to visit him a couple of times. The attending doctors – Dr. Adil, Dr. Anjan Pyal, Dr. C.Nikhileshwar Reddy, Dr. MuraliKondaiah, and Dr. B. Chandrasekhar Reddy, the MD himself gave all necessary support, medical and moral. It was a real herculean effort to procure the Tocilizumab injection. Every family member strived and spared no effort – the injection was in huge demand and was a banned drug with import having dried up. It was providential that one injection could be managed on the first day with the help of a close family friend abroad K. Vinod Reddy by late in the night.

Vasu's younger brother Manohar Reddy, also a retired Wing Commander who was of great support went to hand over the injection could speak to him briefly to boost his mental strength and the will to fight to win. The hope, missing in the morning, suddenly revived before the day crossed. The tension re-engulfed when he was shifted to ICU the next morning, ostensibly for better monitoring, while the anticipated need for a second dose of injection was communicated. Hundreds of calls throughout the day to and through all known contacts at various levels, in the end, helped in managing yet again one more vial courtesy C Chandrasekhar Reddy and Srinivasa Reddy. The position considerably improved the next morning without the need for a second injection. A short midnight message of 'feeling better' from Vasu to his wife Srilatha upped the mood. The HR CT reading came down to 23/40 and it meant the battle was being successfully fought. The next day he complained of headache, looseness of upper teeth, reduced vision in the right eye, and swelling on the right cheek, and discharge was delayed.

The second battle: OUT from the jaws of death and testing negative for Covid -19 on the 26th, Vasu's treatment now started for new symptoms. The emergence of Mucormycosis (Black fungus) among post-Covid patients started around this time. The disease had rarely been prevalent in the country before Covid. The threat of it was thus not widely known. The use of steroids to control airway inflammation due to Covid caused an increase in blood sugar levels and drop in immunity levels resulting in the exponential increase in the number of mucormycosis cases. The surge in cases lead to a sudden demand for Liposomal Amphotericin B injections for its treatment. The Government stepped in to regulate the supply of Black fungus drugs Liposomal Amphotericin B, Posaconazole, and Isavuconazole. As their availability literally dried up Black fungus emerged as a big threat among Covid infected persons. It was once again time to mobilize these from anywhere. Bhavya and Alekhaya, his two daughters hardly slept for days on end activating their social networks to mobilize the injections – the requirement was five vials of 50mg per day. All contacts in the pharma industry were tapped, particularly by K Gopi who had known many of them. The hospital too was not getting the supplies. Chaitanya, a close friend of Vasu's elder brother Hari, both living in the US chipped in with some vials through courier. A gap of seven days when no injections were available necessitated re-admission due to enhanced symptoms. MRI brain report showed urgency for surgical intervention, which was undertaken, under general anesthesia, for right Hemi maxillectomy, left partial maxillary and bilateral maxillary sinus debridement – in simple terms surgical removal of upper eleven teeth from the right and scraping of the right jaw for physical removal of entrenched fungus.This was done on a Sunday 23rd May by Dr. Nitesh Reddyand HOD Dr. Ritesh Rajan of neighboring Omega hospital. Dr. Chandrasekhar Reddy who was personally monitoring the case coordinated the procedure on an emergency basis. Both of them constantly supervised the progress. All feed and oral medication after that were through Ryles tube, for the next six weeks. By then 239 Liposomal Amphotericin B injections had been given.

Vasu was discharged on May 31. The social activists were of immense help in fetching the injections released by the Government and delivering them at home even late at night and in the hospital without accepting any service charges. A relative of Hari, Dr. Geetha, a cardiologist of repute in Connecticut, kept monitoring the status /progress on a nearly daily basis and provided admirable support both medically and psychologically. Fortnightly reviews based on the latest report of MRI scan were carried out by Dr. Ritesh Rajan or Dr. Hemanth Kumar, the dentists from Omega. The last review was on 06 August, with more reviews to follow for adjustment of dosage in the use of the Posaconazole drug. It would take 3 to 4 months of further monitoring after which reconstruction of upper teeth could be planned.

Shielding against future Covid wave: The first thing is to remember the old adage "Prevention is better than cure". There is no bravado in being casual and then face the consequences, which are not limited to the patient. The entire family undergoes strain and stress. Mental health takes a beating, particularly more among dependent children. Parents feel sapped in energy. The times would require every kind of support from friends, relatives, and work colleagues to de-stress both the patient and family. It is safer to adapt to the lifestyle changes – work from home, less physical contact with colleagues, friends, and relatives, online schooling, etc. These may induce considerable mental stress, but the need of the hour is to adhere to these as the new normal. Improving immunity levels through food habits, exercise, and quality family time, and maintaining social contact with some of close family or friends with appropriate protocols is important.

Tailpiece: The journey through Covid and black fungus carries full of anxiety, fear, stress, tension, and mental trauma to the entire family. Covid taught us how precious life is. Moral support from family not only helps but works as a weapon to defeat the virus. The focus should be on the physical aspect to recover soon with various ways to build immune system. Building inner strength is no less important for dealing with mental stress. Fear and anxiety are more dangerous than virus. Positivity strengthens the mind to overcome all the difficulties that come along with this dreadful disease.

Moral support from father: "Vasu, had good sleep? The improvement will be gradual. Not to worry. Do not feel stressed, because you have nothing to do, missing your office work, wanting to be with family etc. Think that you are to necessarily keep cool, be confident, have willpower, and be devoid of stress. You are well on the path of recovery, came out from a grave situation. Let the recovery take its usual course, could manage with one inj TOCILIZUMAB, and it was not necessary to use the second one itself augurs well. Stay calm. Eat well, by thinking more headaches will set in. Just be in good spirits". Daddy

TJ Reddy

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