 I am Dr Bhavna, hearing the marketing for Manipal Hospital's Bangalore. Welcome you all to the session of post-COVID Cardiac Care. So, before we get on to the session, I would just like to introduce the speaker for today's session is Dr Ranjan Shetty, who is the HOD and consultant of interventional cardiology. Doctor, I hope you are online. Welcome on board. So, just to give a short summary of Dr Ranjan Shetty. So, he's been working with Manipal and his expertise lies in the left atrial appendage devices in Southeast Asia and also he's been doing the transiotic valve implantation and also numerous complex coronary intervention and his numerous device implantation and the structurally disease heart interventions, the left atrial appendage closure, TAVI. So, there are quite a few procedures which makes Dr Ranjan Shetty the expert in Manipal Hospital. But today's session is basically focused on what could be the likely complication that each one of us can witness post-COVID. And there's especially extensive care that needs to be taken for all the COVID patients and we have Dr Ranjan Shetty with us. Welcome, doctor. Thank you, Bhavna. Thank you very much. Yeah, over to you, doctor. I think I'll unmute and the question and answers probably we will be taking at the end of the session. So, you can kind of have multiple languages because we have people who are requesting that in case if it's in Canada, is that okay? So, I've told them, you know, doctor's expertise lies in various languages including I hope Bengali also is okay with you. So, we would have English, Kannada, Hindi, Bengali. So, people can feel free, whatever questions they have. And end of the session, we do have, you know, the number that will be given to you. If you may require any kind of queries, if you may have, please feel free to reach out to us. And the number will be displayed, say, about five minutes for you guys to kind of, you know, take it down and reach out to us. And not wasting much of time. It is over to you, doctor. And I would request all of you to kindly mute your mic and over to Dr Ranjan Shetty. Thanks again and for you being in the session. Thank you, doctor. Thank you. Thank you, Bhavna. Thank you for wonderful introduction and thank you for taking trouble and organizing this on a Sunday. This is, I think, one of a kind meeting where we are directly reaching out to all the people, all people directly. So, Bhavna, I need sharing option for the slide. I think you may have to make me a co-host or something. Not able to share my slide, yeah. Yeah, I think. So, Deepak, can you just give the access of sharing screen? Yeah, yeah. Or, doctor, if you can mail it to us also, we can probably do it. We can, yeah, yeah. No, it's not much. It's just a very simple slide. If you can, I'll put it. Otherwise, I think we can have a discussion. No problem. So, Deep, will you be able to kind of share, give the option? Yeah, doctor, no, you can share the screen. You did that. No, sir. Yeah, yeah. Thank you. Thank you. Still not yet, but I think soon I'll get the, yeah, you have to make me co-host, so Deep. Yeah, if not, it's okay. If you can't, there's no issues at all. Okay, good. Now I think I can do it. Okay, excellent. Yes. Thank you, Bhavna. Thank you once again, and I hope all of you can see my screen. You can just click on the screen. Yeah, you can, no? Yeah, yeah. So, I can see some lots of familiar names. Welcome all, and thank you for joining on a Sunday morning. I know how difficult it is to, you know, be, you know, coming online on Sunday. Thank you for doing that. So, what we are going to do is we are going to discuss a little bit about COVID, how it affects heart, and how do we take care post-COVID? You know, these are some topics. There are no, you know, if you have doubts, either you can chat, you can type in, or I'll be ready to answer your question. So, all of us, by this time, definitely know what is COVID, and we know what it is. Now, how does it affect heart, and is it a lung disease, is it a heart disease? You know, these are the questions which we are, you know, answering. But I have a disclaimer in the beginning itself. Please do not panic. The disease is not that bad. You know, when we discuss, you will feel it is very bad, and you know, that everything is going to happen to all of you, but it's not true. It's a mild disease in a very, very, you know, in a significant majority. It's a very, very mild disease. In a small percentage, it can become severe. But luckily, now that we are in advanced stages of pandemic, we understand how the disease goes on. We know how to treat it. There are lots of treatment which are available now. So there's no need to panic. And one more advice probably which you need to give your friends and everybody, if there are symptoms, please get yourself tested. You know, neglecting, hiding is not the way to treat it, because there are very effective therapies which are available, which could make a lot of difference in this disease, and not all of them needs to be hospitalized. But it's very important people test it and be under a guidance of a proper doctor. That's important, you know. Now it's a multi-system disease. And if you see that the disease itself uses a receptor called ACE2 receptor. The receptor of COVID is ACE2. That is angiotensin 2. This receptor is abundantly found in lung and throat. It's also abundantly found in the heart muscle and blood vessel. So it's not surprising that obviously it's a multi-system disease, not just the respiratory disease. It's not blood bone as you think. It's not in the blood most of the time. It has specific predilection to different organs and has it produces. Cardiovascular wise, it is believed that the significant percent of people will have some sort of cardiac involvement, but in majority it's going to be okay. The cardiac involvement could be some sort of arrhythmia, myocarditis. It can also produce MI and sometimes clots can form in the leg and this clot could embolize and go to lung and produce some problem. So the two three things what we should understand here, you know, I like discussing this part actually. This disease has to be split into multiple small stages and then we need to manage it. So if you realize initially it is the virus which comes, you know, the virus which comes to the person. Three to four days there are no symptoms. In some of them it may not have any symptoms forever. In a small person, you know, in significant people on fourth or fifth day of the acquiring disease, they tend to get some sort of a fever and some sort of muscle pain. Two to three days after this in majority just goes away. There's nothing. It's like a flu or it's even milder than flu. People don't even realize they've had a problem especially people who are very active physically, people who are exercising, you know. These are the people who have seen actually they just don't realize they have issues, you know. And I think once we discussed about what is known as physiological age. It's not about the age as a number. It's about having physiological anger age group. People who look anger actually do very well with this virus. Small percentage again tend to have disease for a long time, you know. They continuously become febrile. This could happen both in age and old. They continuously become febrile. They are tired. They are fatigued and the fever is just not stopping. So by seven to eight days when this happens, that's when the body's response takes over. And now the body is angry because the virus which is supposed to disappear is not disappeared. Its particles are still, you know, hindering around the body and that's where the body's response takes place. This typically occurs in the second week, say eight to fourteen or eight to fifteen days. So it is then that the majority damage comes, you know. The majority death and majority complication, ICU, all that occurs in that period. Not in the beginning, you know, not in the virus period. It is that the response of body becomes uncontrolled at this time and that uncontrolled response again produces damage to blood, heart, lung and all the system, you know. That's when the lungs look very bad. That's when people require ventilator, oxygen therapy. So I hope you are following. So the treatment in the first initial period is to suppress the viral replication. So there are drugs like Remdesivir, I'm sure all of you know these names. It was Ebola drug which is shown to have some effect in this. So the first week, the drugs are like Remdesivir which reduce the virus itself. The second week, actually the drugs are like steroids and interleakin 6 where you are targeting the body's immune mechanism. Second week, you are not targeting the virus. Any error in treatment, you know, the first week to suppress the body's immunity. Second week, you are trying to suppress virus will not work and may be harmful. So timing of therapy in this disease is extremely important and it is something which we should understand. What happens in this? The SARS-CoV-2, this is the virus which effect goes through the ACE receptor, produces changes in the lungs, demand mismatch, produces changes in the blood, producing clotting and bleeding and in heart, it can produce heart attack, can produce arrhythmia, can produce blood clots, can produce heart failure, can produce myocarditis. Again, just to emphasize, does not occur in all people, occurs in some people, especially later on, you know, not by the virus itself, later on. It occurs in the second week, that's what happens with this virus. So I hope most people have understood, you know, there are obviously doctors here and even, I hope most people have understood. So anybody who is immunosuppressed to start with, very elderly who don't have any immunity, these people are at higher risk to start with, but later, remember, later even younger people behave bad later because that's the body's response. That time it's not the older, it's the anger which behaves bad. So even lung, whenever we say hypoxia, all of them may not be direct lung involved. It could actually be because of the clots which are formed and there are clots in the leg, there are clots in the lung and it was seen that people who had bad outcome tend to have many, many clots. So there is thrombus, there is inflammation and there is hypercongulability which occurs in this condition. So blood itself is involved. It's not that the virus is in the blood but the blood pathways are involved. So lots of clotting occurs, hence D-dimer, that's one of the marker. If someone, if anyone of you have undergone this, you know, had this disease, you realize doctors keep checking this, D-dimer. If the D-dimer becomes higher, that's a marker of clotting and then we give blood in order to prevent clotting in this. So, you know, it's, you know, see, one way, India got disease around two to three months later and Karnataka actually got two to three months later after India. So we got around four months of, you know, added time which did help us. You know, we are more prepared and we understand the disease better and initially at least the pickup was, the curve was little flat initially which also gave so many people who have recovered. So it's not, I mean, some of the things in this disease are inevitable but time itself gives some, some advantage. What are the warning, what should the patient of COVID do? If they are at home, please keep checking pulse of, you know, look, look at symptoms, whether fever is continuing, whether the person has become extremely tired, breathing difficulty. There is also entity called happy hypoxia where the saturation will be low but people may not know. So it's important, even fever, some of them don't perceive it. So it's important to test these things and understand, you know, these are the things which are happening. You know, treating the blood clot actually led to lots of life saved. It's very important to pick up people with blood clot. It's not about picking up the clot. It's about understanding that these people are thrombogenic and we need to do. So D-dimer is a very effective test and we will also discuss what happens after, you know. What should we do after? Now this today's session, if I understand Bhavna, it is mainly to discuss with people who have recovered. Right Bhavna? Is it, it's mainly for... Yes, yes doctor. Yeah, it's mainly people who have actually come out of the disease. No, yeah, yeah. So people who have come out, I want to congratulate all of you for going through it. We all understand it was not easy for you, especially the isolation, the social stigma. So we are all very happy that most of you know, you are all recovered well. And you should be the ambassadors now telling people how to take care of themselves. Now again, little bit what we want to discuss with you again, I'm being very clear. This is the third time I'm going to repeat this. Do not be over scared. It's not about panning. I'm not trying to help you, but definitely not create panic. Now post-COVID, what are the things which we know can affect? So how long this, this lasts? It's a new disease. We don't want you to be scared. But next, you know, up to say four to six weeks post-COVID. Most people, there are studies which showed there could be little bit residual heart involvement in the sense heart muscle could be slightly inflamed. And if you do MRI, some of your MRI could show some change. We're not recommending MRI to any one of you. What's important is take care of yourself. Start exercise slowly. You know, don't start running marathon. I know most of you are feeling like it who have the mild disease or come out and feel invincible. I understand your feeling. What's important not to overdo things. Do slowly. Do some walk. Don't, don't take rest. Do some walks, walk around, play around. But don't do very competitive sport and don't give yourself enough time. There should be warm up. There should be cool down. You know, this, you don't have a point to prove this is for four to six weeks after that do everything which is fine. The second thing, typically post discharge, what we do is we get some blood test done for you, which includes D dimer. D dimer, as I discussed, is a blood product. It's the marker of clotting in your blood. So D dimer, what can be done is if D dimer is very high, we give blood thinner. A little stronger blood thinner, but it's only for four to six weeks. If D dimer is moderate, we give the same blood thinner at a lower dose, all the tablets now. And if D dimer is normal, we don't give all this therapy. So there are ways we can help you. There are ways we can monitor you. If any one of you can get ECG and Eco, please get one done. Most doctors also got recovered, made sure they got one ECG and one Eco done. And that's been, you know, we could pick up some subtle cardiac changes. And we also have a monitoring, Bhavana obviously will explain to you that for post COVID people, we do have a monitoring package where we do monitor them for 15 days. They have consultation with cardiologists. They have consultation with, you know, physicians or primary doctors. We also do a three day whole term because arrhythmia is something which is common. So three day ECG continuous monitoring is done for this patient. There's a consultation with me before you do it and after you do it. And we'll be happy to answer. No, we are with you. The point we are trying to make is, you know, these are difficult times. But you will be, you know, if, if you can talk to one of us, you are, you can all your symptoms. All I want to show is in this time of recovery also, not just the disease, even in recovery, personally, all of us are with you. And that's, that's the point. And we're happy to take question, but please don't panic. Go back to your life. Do everything which you want to do, but gradually treat yourself as if you had a heart attack. You know, after heart attack, you don't do so many things. Just treat yourself as if you had a heart attack that for the short period. There's one more lung sequelae of this disease that is where the lung gets little fibros. Fortunately, it is coming down because we are able to treat this disease better. And that requires some sort of a lung rehabilitation. So putting all this together, my advice to most people is people for some reason they get scared and they neglect the disease. If there are symptoms in your near ones or anybody, please get it tested. You know, enroll yourself to one of the programs which many, many hospitals have now and have a doctor with you who can, who can actually help you. So I'll be happy to take any questions. Bhavna, anything else? Yes, doctor. Before we proceed to question and answer, so there are multiple questions being asked by the audience. Oh, already asked. Does this pose COVID, you know, whatever the complications you just mentioned. Yes. Is it to all or do you actually have certain incidents for, you know, in terms of age or, you know, I mean, or probably they have. Correct, correct, correct. I think it's a very, very valid question and I'm happy somebody asked it. It's not for all. See, as we discussed that COVID can be classified into mild, moderate and severe. Mild are people who have had one day fever, two day fever at home, didn't even realize there are issues. These people need not worry. Typically nothing happens to them. It's those moderate ones. Moderate means typically they had seven to eight days fever or little more. They felt tired and they were hospitalized for a short period or a long period. They had some sort of hypoxia. These are the ones which we have to be a little more careful. But always be, you know, in touch with your doctor so that they can get those blood tests like D-dimer, do one ECG and ECO and, you know, just to be sure. There are Western studies which show that even milder people could have some cardiac involvement. But most of these studies actually have not led to a bad event. You know, there is some involvement, but it recovers on its own most of the time. Very, very small example where people had very mild disease and had problems. One more word of caution which I wanted to, you know, tell here also children, you know, children luckily don't get a bad disease at all. Fortunately, because they don't have ACE receptor, they remain really asymptomatic. But if there is any child who has got this disease, one month later is a time when you have to be a little careful. One month later, almost exactly a month later, if any of them gets high grade fever again, any rash, you know, that could be a very specific manifestation of post-COVID. Fortunately, it's not too much. In US, you know, out of one lakh, you know, out of, you know, we just don't know how many children got involved because the cases were very high. But there were 157 children. In Manipal Hospital, we have had five children who came back, you know. Initially, they are very, they are just not sick at all. But one month later, if they are fine, don't worry. But if there is recurrence of fever, that is something which you should be careful. I hope I answered the initial part. Very mild disease typically nothing happens, but be careful. Moderate disease is where we are worried. Severe disease anyway, most of the time, you know, we always take care of severe disease because they are admitted for a long time, they are ventilated, you know. I think those are the people who are more likely to go into lung related problem. But it is the moderate disease, you know. 8 to 10 days fever, little hypoxia, requires steroid, hospitalized. These are the people where I would actually advise and they have to be a little more careful. So I think we'll now open for questions. Yeah, there is also one question by a person. I think, high CRP, worry especially, what is the level of, do you know, what is the, what about 800, yeah. So I think it's a very interesting question. Higher CRP means higher inflammation and it needs to be respected. That means virus is starting to, you know, bring some havoc. So these people, if they are in second week of illness, they will require some steroid or some immunosuppressive therapy. D-dimer, it depends on your lab, it varies. I think the way you are going, 800 is not very high. More than 5000 is high, less than 500, it depends on nanogram, picogram, you know, depending on that. Our labs give different from this lab. So this is a moderate level D-dimer. If it is in the same patient, elderly, I would actually give the blood thinner in a prophylactic dose. Okay, prophylactic dose. Anybody else, yeah. Someone not able to unmute, I think Bhavana. No, we've given the access now. Yeah, you've given the access, good, good. Excuse me, doctor? Yeah, yeah, yeah. Chandramma? Doctor Chandramma la. Yeah, I was talking. I was coming, he was coming. I was coming, he was coming. So I was coming. You are not asking me, I was coming, I was coming, I was coming. I would like the others to mute the mic when she is talking please. It is a very good question and it is very important. Around 70-80% of the patients are suffering from COVID-19. All the patients are suffering from COVID-19 for 4-6 weeks. But most people with moderate disease are suffering from severe symptoms. It is very important to mute the mic when she is talking. She is suffering from 4-6 weeks. It is very important to mute the mic when she is talking. It is very important to mute the mic when she is talking. Hello doctor, my name is Ravi. I was the one who put that question. My mother was admitted to SSNMC hospital in Rajarajaswari Nagar about 8-10 days back. She is 72 years old. She was discharged after 6-7 days because she was not having any breathing difficulty. They said home care can be taken. We had initially tested her for CRP levels. It was 36-37 life. Subsequently when we tested her a couple of days back it came to 66. Whereas the D-dimer which was 1680 in the initial that came down to 800+. So what does it indicate? CRP high level is a cause for worry. And D-dimer is coming down is something we can take so there is nothing to worry about. What about her symptom? Does she have any symptom? Is she feeling tired, fatigue, fever? No, no fever. No tiredness feeling per se. So she is feeling perfectly okay and she is able to eat and all properly. There is no such difficulty. Then what I would advise is D-dimer is still high. I would actually advise the blood thinner for this patient. Not too much. You know that moderate dose. Ecospirin is the tablet advised by the doctor which she is taking one a day. Okay. Ecospirin should continue but I would also add one more. A blood thinner for a short period. Maybe two more weeks. But I wouldn't give steroid to her right now. The only treatment would be a moderate blood thinner. Not Ecospirin, something which is a little more moderate than that. How long she needs to be on medication like this? I think for her it's already two weeks I have gone. So two more weeks and if possible get one ECG Ecodone. At least I am getting one ECG Ecodone just to be sure. Okay. Thank you doctor. I appreciate it. Thanks a lot. Yeah, yeah. Chandrasekhar. Namaskaram. Namaskaram. Sir, I didn't know anything about it. I just got discharged from the hospital. Yes. I was sick for two days. You were sick? Yes, I was sick for two days. When did you get discharged? I was discharged from the hospital in 2018. In 2018? In 2014. You have to do a blood test. You have to do a D-dimer. There is a joint pain in the post-viral. But there is a D-dimer blood thinner. You have to do an inclementary marker. There is a short-core steroid in the post-viral. Because this is not a virus. This is a post-virus. So there is a role in the blood thinner, steroid and the SCQ tablet. But you have to do a test. Okay, I will do a D-dimer. You have to do a D-dimer and a CRP. You have to do a D-dimer and a CRP. You have to take a little blood for the SCQ. What is the short period? Just information. We have one post-COVID consultation. They will get in touch with you for the consultation. Especially Dr. Ranjan Shetty post this session. As I told you earlier, there will be a number display. We will engage with you whatever test is done. We will be guiding you accordingly. Any related to the post-COVID case? You can ask. Individual medicines can be prescribed to you whenever we get in touch with you. Is that okay, doctor? Sure. Your voice is a little slow. Especially here. I don't know whether they could hear it. Just check whether they heard it. We heard it. Then it is perfectly okay. She added everything. It is perfectly okay. Doctor, one more question people have. I am aspirin as of now. Because of aspirin, I am not advised to take any other NSAID. Is this true? People are not advised to take any other tablets? I think it is a very interesting question. Yes, it is true. With aspirin, we don't give any NSAID. As such, the message I want to give is don't use too much NSAID. NSAID is a type of medicine. Don't take too many of them. There is no reason for you to take any other medicine. Paracetamol or dolo, that is it. Don't take too much. Even COVID is not the case. Non-COVID time. Better medicine is better. Dolo, paracetamol is better. Good morning, sir. Good morning. My name is Govind Rajalu. I am a CKD patient. I have recovered from post-COVID. I was discharged on 22nd of this month. What should I take care of? Since I am a CKD patient, I am already at the risk. When you say CKD, are you on dialysis? Yes, sir. I am on dialysis. One more thing, I was transplanted. I am again on dialysis. But I think, Govind Rajalu, you are doing very well. It is good to know stories like yours where you have come out of all this. I think more important is to be careful. About this disease, we are not sure about reinfection. We think it may not be severe. So be careful. You have come out of it, but wear your mask properly. Even when you go, take all precautions. Make sure you never get reinfected with this. But you have done well. I am very happy to do this. Since you are already under nephrologist care, I am sure they will take care of your medicines very well. They will advise you what you need to take. But please be careful. Stories like this are very encouraging for people. I can be the brand ambassador, sir. Anytime you can call me, sir. Yes, Bhavna will definitely call you. No doubt about it. I can come anywhere, sir. I can encourage people also, sir. That's what we want. We want this spirit, not to be scared. But make sure you take medical attention properly. Make sure that whatever post-care is needed, you have to monitor yourself well. But not be panicked. This panic actually stops you from taking medical attention also. I am sure Govind Raju took proper medical attention in right time. Followed all advice. If at all, I don't want to scare you. But you are one of the highest-risk people who had COVID. But you have come out so well. Thank you very much, sir. Sir, you have come out of it. It's not a post-viral. It's an antibody-antigen reaction in the body. So, at this time, muscle pain, joint pain, lack of sleep, lack of vision, headache, all these things are there for 4 to 6 weeks. So, do one new test. We will identify which of them is producing a problem. And if we treat it properly, then everything will be fine. Okay. Is there any difference between the two? No. Typically, these are recovery tests. Okay, okay, okay, sir. That's a question. Doctor, how long does immunity last? Usually, for a recovered patient? Okay, this is an interesting question. What we know is that there are two types of immunity. One is the cell-mediated immunity. The other is the blood immunity, the humeral immunity. So, if you study the humeral immunity, it will reduce in 3 months. So, in China and in Italy, it reduced in 3 months. But the cell-mediated immunity will last for a long time. I don't know. Because SARS-1 came in 2003. Now, it's been 17 years. Cell-mediated immunity for the person who has a headache is the same. It doesn't have a re-infection head. In India, the total list of cases is 40 lakh cases. It's a recovery case. But it's only re-infection for 3 generations in India. So, re-infection won't stop. But most likely, it needs care. But it shouldn't panic. Because it's difficult for anyone to behave with re-infection. Because the re-infection is bad. The re-infection is very bad. Whereas, many other influences say it's not bad. It's better. So, you don't know the direction of it. So, you need to take care of someone. You need to take care of masks. You need to maintain social distance. You need to take care of everything. But if I have to guess, re-infection may not be bad. But it's just a guesswork. Yesterday, you know, a COVID-recovered patient. How long he should take care of himself with his family members so that he doesn't, you know, transmit the virus to others. Okay. That's a good question. Transmission beyond 10 days is very unusual. If you start the job, it's very unusual. But if you leave it for 10 days, the chance of you transmitting to one more person comes down drastically. If you're doing an RT-PCR, it's positive. But that RT-PCR is a dead virus. Because in an RT-PCR, there is no live virus or dead virus. If you're doing a virus culture, it's not live. So beyond 10 days, transmission risk is markedly less. So I would say that's why the government has come up with a 17-day rule. 17 days from the initial diagnosis, test positive bandhru, chance of transmitting is very, very less. Thank you, doctor. And what is the food diet as a vegetarian one should follow? I think healthy meal is what we should all follow. So healthy meal includes lots of protein, lots of fiber. Carb, we don't recommend at all now. Carbohydrate has to commit to this. It's the sweetest to commit to this. I personally believe exercise is a big role. Okay. So too much might be needed because of post-COVID. But in 20 minutes every day, yoga, stretching, exercise, and you try it out. If you have symptoms, the moment you start doing exercise, you have electromagnetic energy. That day you are much, much better than other days. So make sure you exercise. But over-mard bed yesterday. Doctor, I use this opportunity to thank Manipal group. I recovered from your north side hospital. Thanks a lot. Very nice. You should thank Bhavna for all her work. Hello, doctor. Good morning. Good morning. Doctor, I'm speaking on behalf of my parents. Both of them were admitted in Manipal hospital and were discharged on 29th of July. Okay. Currently now my father is still experiencing difficulty in breathing. Like at times he gets heart breathing. And also he's not able to walk. But the thing is that he also suffers from Parkinson's. So I'm not sure whether it's because of that or because of the after effects of COVID. Yes. So it's definitely possible. See if they have gone undergone to a moderate disease, it's possible there is a cold post-COVID effect. It's possible. So gradually we need to bring him back. Although he has Parkinson's, we need to make sure he exercises well. Some exercise what is possible. We need to make sure. And he may be one of the ideal patients who require that post-COVID care. So there is around 15 days. One or the other doctor is in constant touch with you. We have people explaining to you what to do. And some tests will be done. So these are the people who are ideal to have post-COVID care. Even once it is done for 15 more days. Okay. And also my mother, she is still getting sputum generally during the night and in the early mornings. Correct. See both of them need to undergo an ECG to be sure heart is fine. That is the first thing. Okay. And then we have to, we may have to do some tests to see if there is any infection, you know, super-added infection, not COVID now. So they could have some super-added infection. So many people require one more course of antibiotic post-recovery typically at this time. Some of them we are worried about the clot. So we have to check whether they are on blood thinner enough. You know, all these manifest in almost the same way. So it's very important we keep them on a loop. These people should be under constant care. For my father, we got an ECG done. When we came for a checkup to Manipal hospital, we got an ECG done. So that was normal only. Okay. But we still need a little more. It's not just one ECG. You are getting my point now. So next two weeks is little, you know, we just have to be a little more careful. Okay. And doctor, since he is diabetic as well, do we have to do any tests to check about blood clotting? Yeah. Blood clots. Yes, blood clots. I'm sure he may be already on that. If you have discharged from Manipal hospital, we have a set protocol. He may be already on. I mean, they would have looked at D-Dimer and based on that, they would have advised you already. No. I don't think they have given any medicine as such. Medicine. Yeah. I think we can ask Bhavna to just get in touch with you and we will review your parents. Definitely. We will review them. Definitely. Thank you so much, doctor. Thanks. Doctor, good morning. Good morning. Dr. Nange, actually you said a lot of proteins, but I have uric acid. Okay. How to, what is the other thing which I can take? Andhra, uric acid has joint pain, sir. Andhra, Bharta, sir, doctor, one month, two months, one silly. I have this problem. You see, for uric acid, there is a lot of genetic element in most diseases. That's what we have to do. Diet is just one component of that. So, what are you going to do? If uric acid hurts, it's better to take that febujet and ton tablet. Yeah, take it for four, five days and it reduces. Yeah, take it continuously. Okay. Make sure your uric acid remains down. You take the food you want. Because proteins are their own benefit. Medicine continues. At least one year. Leave it in between. Okay. That fluctuation will increase. I should continue for one year. One year. We obviously take advice of a doctor who is following you. One year. But food doesn't heal. Food, no problem. That's not a problem. One and a half times it will be discharged. Okay. Then you should be fine. That is a period when you are completely recovered. But uric acid is a bit better. Try to keep it down. It is around 5.5 and finally there. So that's the one. Thank you doctor. Okay. There's another question. Yeah. The person asks, he's from an apartment. So this is about 150 complexes. So I have just recovered from COVID. Although it has been 15 days that I've got discharged from the hospital. How do I check the immunity level of others? Are they susceptible or not? Okay. Technically, she's worried about others in the building. She's asking, is there any immunity check that we can do? How do you think people can really know if I'm susceptible to infection or not? Okay. See, I mean as a rule, it's a new virus. Anybody who has not had a disease is susceptible. There is no natural immunity to this virus. The way you respond to the virus varies. For example, if there is a positive patient without mass coughing, it's very likely everybody in the room will get it. So natural response in their infection varies. But how you come out of it is something which is very mild symptom. And you know what happens to the small percentage. But typically everybody is susceptible to this virus. That's what we should understand. First, second, it is possible some people in your community or wherever they are in would have got asymptomatic disease or mild symptoms if they didn't realize. So in the room, antibody tests are going to be done. So anybody with a higher antibody, more than 10 antibody tests, then their chance of getting reinfection is lesser. But how long will it last? And whether it is a long-lasting thing for them, we don't have answer to that question. So typically my advice is anybody who has had not had a disease should assume that they are susceptible. Like when I go to hospital, I go thinking I am very susceptible to this. And I take all precautions. Mass coughing, mild symptoms. Only here you are able to see my face. In the hospital, you won't be able to see my face because it's always covered with mask. So that is the precaution. And wherever you let your guard down, that is where you'll get it. Generally, you will not be able to see my face. But where you think your friend, he's my friend, I can have a coffee together now without mask, no need of social distancing or drink together, that's where you'll have problem. But 100% of people are susceptible. And it's a very highly infective disease. Luckily, not highly morbid or mortality, that is lesser. But infectively, probably it's higher than many other diseases. We know very few diseases are more infective. For example, chicken pox, measles are more infective. 95% generally Bharata. But if you get exposed, 60 to 70% people will get it. If you get exposed without social distancing, without mask, 60 to 70% will get it. So naturally, do whatever you want to do. But don't be very confident of natural immunity. It doesn't exist for this. It's a new virus. Good morning, Gopi. Good morning, Gopi. I am Aarti on behalf of Chandrakant Halbavi. He's my father. He was tested positive and he was in Manipal Hospital. He recovered and he came back one week back. That is 29th August. Now he's fine. But his creatinine was 2.0, like 6 months back. During this course of COVID-19, it went up to 3.6. Now it has come back to 2.0. When we checked with the doctor, he said it should be 1.5 or 1.6. Other than that, if it is 2 or something, it's a little high. So what can we do to reduce it or what does it affect? No, this is a baseline CKD map. Yeah, understood your question. This is a baseline kidney disease which could be because of its diabetes or hypertensive status. So you need to be on regular check-up with your nephrologist and manage it. Regular check-up. Luckily for the patient, which is very fortunate, COVID has not let us scar, you know, not worsened it. He was 2, he went up, but he came down to 2. Now you can forget COVID, but manage its baseline kidney disease. Okay, sir. Thank you, sir. One more question, sir. Is it because of creatinine that he doesn't get sleep? Like he gets up early in the morning, 3 o'clock? That is post-COVID, yeah. Is it always or only now? No, it was earlier also. Earlier also. Then I think what we need to do is we need to do a sleep hygiene. You know, sleep at a particular time, get up at a particular time, not have, you know, then use, you know, eat 2 hours before sleeping, no caffeine, you know, these kind of things. And if he actually ends up getting early, he could try doing some exercise and, you know, utilize the time. Not take it as a disease. If you sleep at 10, you get up at 3, you still have 5 hours of sleep. So utilize it like a proper this and no afternoon sleep. That's important. Yes, sir. Yeah, I used to do the exercise and all. Yes. Thank you. One more thing, like after COVID, he had slight chest pain or towards the, like, while deep breathing, he gets a pain, but normal breathing, he's fine. Okay. This could be a pleurotic pain, which is common after COVID, but better to evolve it, you know, moment you have any symptom, that's one message. Any palpitation, any pain, please get yourself evaluated post-COVID. It could be nothing. Again, it's nothing, but get yourself evaluated in, you know, if possible. Yeah. Thank you, doctor. Excuse me, sir. Yeah, yeah, yeah, yeah. Yeah, this is Chandramma. Yes. Sir, just I want to know, she is my mother-in-law. Okay. The D-diver test should be done again, sir, for her. Yeah. When was she discharged, Chandramma? Oh, it was almost one and a half months, sir. Then not needed, not needed. Beyond this time, one and a half months later, these things are not important. You have to manage her other things, but D-diver may not be needed. She is diabetic, so I just asked for that. Yeah, yeah, manage the diabetes, meet the diabetic doctor, regularize other treatment, but D-diver won't be needed this later. And she is not able to have the food properly. Intake is not. Correct. I think it's better to talk to a diabetic doctor and adjust all the medicines. Okay. No, no, no, no, no, no, no, no. She is not having properly. Correct, correct. But meet the diabetic doctor, they will adjust the medicine and accordingly they will sort out your issue. Oh. Okay, then why she is not having, because of diabetic? Yeah, you need, yeah, you need evaluation. So beyond this period, beyond six weeks after COVID, it's not COVID, which is producing all this problem. Thank you so much. Okay. We have last nine minutes, anybody else or probably we could just wind up with the more information on packages. So two questions maybe we can take as of now, anybody else? Yeah, hello. Yeah. Good morning, doctor. Good morning, good morning. Yeah, this is regarding like my mother was positive. I admitted to Manipa Natsan, she was like came out very well and everything was a little bit weak. Okay. She was feeling like weakness in her body and after like one week she was okay, she's okay now. Okay. So maybe she had a little fever and now she's okay. Like any, because of this, because of weather changes or like. When was the COVID, sir? COVID discharge is how many days back? About I think almost 15 days back. Okay, then still better to evaluate once. You know post COVID if it is within two, within one month make sure you get yourself rechecked because there are people where antigen antibody reaction takes place around two months time. So also possible clots can form. So don't neglect it, Hanumesh. Just make sure you show it to some doctor. Okay. Okay. Thank you, thank you so much. Okay. My both. Hello. Yeah. My both parents were admitted to my father. My father is perfectly okay. Okay. Okay. But make sure some check up if there is any fever. Don't neglect it. Okay. Okay. Okay. Okay. Okay, Hanumesh. Hello. Yeah. Yeah. Sir, I was about to say that. Sorry, sir. I don't think I should do this. I just want to test the material. Correct. You have a post viral syndrome, Chandrasekhar. Post viral reactivity there. Blood test model. I think you will either require a small course of steroid or a secube. You are going into your younger person, right? So immune reaction is more than that. The typical joint pain, it's like serum sickness. Lots of people have it, especially younger ones. So you are going to short course of steroid or a secube definitely break out. Once we do that, you will feel like full energy. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay, ma'am. I have one last question, boss. We are 11 noon. So... Ya, ya. Please tell. Please tell. Ravi, who is it? Namaskaram. Yes, Ravi who is it? Yes, please tell. Yes. Okay. He says treatment doesn't do any harm to the patient. My leg hurt. I'll get it treated like bone houses. Okay. Self-pity. How long is he going to be getting COVID in India? I was admitted to the hospital on 19th July. There is not much problem, you are feeling good, nothing to worry. There is a lot of swelling, redness, you need to recover. There is a lot of swelling, you need to recover. Don't worry. Thank you, sir. Hello. Yeah, please, yeah, tell me. My husband was admitted to the hospital last month. I have no queries. I just want to thank all the doctors who attended him. They took very much care about my husband. One thing is that he was almost 5-6 friends with Corona. But he was almost at home. They recommended him to Manipal Hospital. He waited for 1-2 days and came. And they are all satisfied. And from their side, I just thank you all those who attended him. Thank you. Thank you for this kind words. Thank you. Same from me also. Actually, I am ex-Manipal Hospital. Yeah, Port Road. Thank you for all your trust in our system. Yeah, we are happy we could help some of you. Yeah, yeah, thank you. Thank you. I think we come to the end of the session now. So before we conclude, I think there is a display of phone number where all of you can. Yeah, yeah, I got it. Yeah, so this is exclusive consultation that we want to kind of hand hold you. You know, any kind of complaint that you have post this. We can definitely have a consultation with Dr. Ronson Shetty. The team will be in touch with you. And I think a few names, although I will not be able to pick up, but one of it was Chandrasekhar. Chandrasekhar, definitely we will be in touch with you to understand what are the tests that you require. And also we have come up with an exclusive care, you know, for all post-COVID patients, as I mentioned earlier. So, you do in the CHIC package, which will help you to, you know, get through the symptoms. Of course, we have designed an exclusive package. So it is not that you have to, but doctors will be explaining in case if you need those package and whatever your symptoms are, we are always there to, you know, hand hold you and get through this term. So sure to reach out, our team will be reaching out to you. But yes, definitely in case if you have any queries, you can dial in to this number and let us know. And thanks once again to all of you for having joined the session. As Dr. Ronson Shetty mentioned, he gets only one day in a week. That too on Sunday. And thanks, doctor. Thanks to you that, you know, you've really taken your time out and you're highlighting on the post-COVID care complications. So thanks to you.