Severe Multi-inflammatory Syndrome in Children Temporally Related to COVID 19-Clinical Course, Laboratory Profile and Outcomes from a North Indian PICU.

Objective: We describe the trajectory of clinical course, laboratory markers and outcomes in children with severe multi-inflammatory syndrome temporally related to COVID-19 (MIS-C) admitted to our pediatric intensive care unit (PICU). Methods: This was a prospective case series of children admitted to PICU between May 1, 2020 and January 31, 2021, fulfilling the case definition of MIS-C published by World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC). We analyzed demographic, clinical, laboratory data and echocardiographic findings. We also plotted the variation in trends between survivors and nonsurvivors. Results: Of the 34 critically ill children referred to PICU with diagnosis of MIS-C only 17 fulfilled the WHO/CDC classification of MIS-C, rest were MISC mimickers albeit other tropical infections. Median age at admission was 4 years (range 1y 6 mo-8 years). Fever, rash and conjunctival redness were most prominent symptoms. Myocardial involvement was seen in 70.5% while 76.4% developed shock; Invasive mechanical ventilation was required in 64.7% cases. Inflammatory markers showed a downward trend such as-median C- reactive protein (mg/L) had a serial reduction in levels-from (median/IQR) 210 (132.60, 246.90) at admission to 52.3 (42, 120) on Day 3. Median Ferritin (ng/ml) (n = 12) was 690 (203, 1324), serum LDH (IU/L) (n = 12) was 505 (229.5, 1032) and Mean D-dimer (ng/ml) (n = 7) was 5093.85 (1991.65), suggestive of hyperinflammatory syndrome. Twelve patients received intravenous immune globulin, with adjunctive steroid therapy used in two third of the cases. Six children died, 4 of them were under-5 years of age. Tocilizumab was prescribed in two children with high vasotrope inotrope score (VIS), cardiogenic shock and oxygenation index more than 15, both survived. Conclusions: Severe MIS-C has a heterogenous presentation, local or regional outbreaks of prevalent infectious diseases often lead to confusion and overdiagnosis. Higher proportion of mortality was seen in Under -5 children with MISC. Shock-like presentation, presence of myocardial dysfunction or nonsurvivor status is associated with higher trend of inflammatory markers and more profound multi-organ dysfunction. If disease progresses rapidly despite first line therapy (IvIg and steroids), use of Tocilizumab should be considered-as a rescue therapy under resource limitations in the absence of extracorporeal support.

Prevalence of SARS CoV 2 antibodies among healthcare workers in a tertiary care COVID19 hospital in Delhi

Background:Healthcare workers posted at dedicated COVID 19 care centers are at increased risk of disease exposure as they work in environments chiefly involved in SARS-CoV-2 patient care. This raises concerns about the safety of the frontline workers. Antibody test can prove to be a critical tool in understanding the immune status of this population. This data can be utilized to make educational decisions about quarantine and risk stratify healthcare providers. There- fore, we took this study to better comprehend the sero-prevalence rate among healthcare workers. Methods:This was a cross-sectional study done in Department of Clinical Microbiology, Rajiv Gandhi Super Speciality Hospital, and Delhi on healthcare workers involved in the provision of care for COVID 19 patients as per WHO definition. All participants were asked to fill a questionnaire regarding their demographic information and possible exposure to COVID-19. Any participant reporting flu-like illness at the time of screening were excluded from the study. Written in- formed consent was obtained from all participants. Serum samples taken from the participants were subjected to com- mercially prepare semi-quantitative ELISA kit utilizing Spike 2 and nucleoprotein for presence of IgG antibodies. Results:Sero-prevalence rate of 19.24% was observed in our health setup. Among the different occupational categories, a rate 9.61%, 26.9%. 20.28%, 16.24%, 33.34% and 22.91% was seen in Doctors, laboratory technician, nursing staff, mul- ti-task worker, housekeeping staff and security guard respectively. Conclusions:This study better reflects the high exposure of frontline workers to this viral illness, most of whom were asymptomatic or had mild symptoms and were working in the weeks preceding testing. It also provides an insight into the adherence of healthcare staff in different occupational categories to protective measures. However, additional serial antibody testing is required to determine the duration of IgG response

Evaluation of SARS-CoV-2 antibody responses in healthcare workers at a tertiary care COVID 19 dedicated hospital in Delhi.

PURPOSE: Amidst the on-going SARS-CoV-2 pandemic, healthcare workers have been at a greater risk of disease exposure as they are working in environments chiefly involved in the COVID-19 patient care since March 2020. SARS-CoV-2 antibody testing can prove to be a valuable tool for better understanding of prevalence of disease exposure in this population. Therefore, we conducted this study to grasp the sero-prevalence of COVID-19 antibodies in our hospital to better comprehend the duration of IgG response. METHODS: This was a longitudinal study involving 305 healthcare workers at Rajiv Gandhi Super Speciality Hospital spanning over a period of four months starting from October 2020 to January 2021. Serum samples were obtained from the study group taken as Day 0 of the study and were screened for the presence of SARS-CoV-2 IgG antibodies using semi-quantitive enzyme linked immunoassay technology from ERBAlisa (India). The Antibody Index was determined. Those showing reactive in the screening test were further followed up on a monthly basis till January 2021 for serial antibody testing. RESULTS: The overall seroprevalence for IgG response among the workers was found to be 21.96%. Seropositivity rate was observed to be significantly higher in those having a history of RT-PCR confirmed COVID-19 infection (45.09%) CONCLUSIONS: Our study demonstrated that healthcare workers have a higher sero-prevalence. Our study also demonstrated that the antibodies developed following COVID-19 infection had a waning effect of protective response following infection.

Challenges in Preparing and Managing the Critical Care Services for a Large Urban Area During COVID-19 Outbreak: Perspective From Delhi.

The coronavirus disease-2019 (COVID-19) pandemic has put healthcare services all over the world into a challenging situation. The contagious nature of the disease and the respiratory failure necessitating ventilatory care of these patients have put extra burden on intensive care unit (ICU) services. India has been no exception; by March 2020, the number of COVID-19 patients started increasing in India. This article describes the measures taken and challenges faced in creating ample ICU bed capacity to cater to the anticipated load of patients in the state of Delhi, India, as a result of the COVID-19 pandemic. The main challenges faced, among others, were estimating the number of ICU beds to be created; deciding on dedicated hospitals to treat COVID-19 patients; procuring ventilators, personal protective equipment, and other related material; mobilizing human resources and providing their training; and providing isolated in-house accommodations to the staff on duty. The authors acknowledge and agree that the methodology proposed in this article is but one way of approaching this difficult scenario and that there could be other, perhaps better, methods of dealing with such a problem.