Consecutive Hits of COVID-19 in India: The Mystery of Plummeting Cases and Current Scenario.

The novel coronavirus disease 2019 (COVID-19)-related pandemic has been in existence for almost 2 years now after its possible emergence from a wet market in the city of Wuhan of the Chinese mainland. Evidence of the emergence and transmission of this virus was attributed to bats and pangolins. The causative virus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly spread globally, affecting humans considerably with its current death toll to be over 4.7 million out of more than 233 confirmed cases as of September 2021. The virus is constantly mutating and continuously trying to establish itself in humans by increasing its transmissibility and virulence through its numerous emerging variants. Several countries have been facing multiple waves of COVID-19 outbreaks one after the other, putting the medical and healthcare establishments under tremendous stress. Although very few drugs and vaccines have been approved for emergency use, their production capabilities need to meet the needs of a huge global population. Currently, not even a quarter of the world population is vaccinated. The situation in India has worsened during the ongoing second wave with the involvement of virus variants with a rapid and huge surge in COVID-19 cases, where the scarcity of hospital infrastructure, antiviral agents, and oxygen has led to increased deaths. Recently, increased surveillance and monitoring, strengthening of medical facilities, campaigns of awareness programs, progressive vaccination drive, and high collaborative efforts have led to limiting the surge of COVID-19 cases in India to a low level. This review outlines the global status of the pandemic with special reference to the Indian scenario.

Thromboembolism and anticoagulation therapy among the COVID-19 patients

Coronavirus disease 2019 (COVID-19), which is caused due to severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), can be complicated with coagulopathy through disseminated intravascular coagulation (DIC) in severe stages leading to profuse morbidity and mortality. The prothrombotic character of DIC can potentiate a higher risk of venous thromboembolism (VTE), whose incidence among COVID-19 patients in intensive care units appears to be a bit higher and severe. The prevalence of VTE was high in the COVID-19 patients due to inflammation and stasis of blood vessel endothelium resulting from viral infection. D-dimer monitoring can help in early recognition, proper treatment, and better prognosis in the high-risk COVID-19 patients. Recent studies show that anticoagulant therapy reduces the mortality in severe COVID-19 patients with sepsis-induced coagulopathy or markedly elevated d-dimer. Direct oral anticoagulants or low-molecular-weight-heparin can be administrated in hospitalized COVID-19 patients to minimize thrombosis risk. However, constant observation on anticoagulant therapy and post-discharge thromboprophylaxis in COVID-19 patients is recommended.