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Newly wed doctors trounce coronavirus together and donate plasma

July 5, 2020

Dr Ankit Jitani and Dr Ekta Jajodia from Ahmedabad, who had to reconcile to a small temple wedding during lockdown, were struck by covid-19, recovered and are back on duty helping other patients. They also describe their experience of donating plasma. Read on: 

Ekta and I had been in a long-distance relationship for over two years. I was a Clinical Hematology post-doctoral trainee at NRS Medical College, Kolkata, while Ekta, now my wife, was pursuing a post-doctoral fellowship programme in Molecular Hematology at Christian Medical College, Vellore.

We had been eagerly looking forward to moving to the same city, getting married and starting our lives together. By the end of 2019, things had started to fall in place- I took up a job as a consultant at the Apollo CBCC Hospital in Ahmedabad while Ekta took up a position at Unipath Speciality Lab as a Molecular Pathologist. Finally, after so many tormenting years of being apart, we were in the same city; we couldn’t be more excited for what was ahead of us- a lovely wedding on 4th May, followed by a two-week honeymoon.

Then struck the Covid-19 outbreak. Our lives changed.

Ahmedabad is one of the worst hit cities in India. Ekta’s primary responsibility at her lab became testing for SARS-CoV2. Although I was not directly involved in providing care to patients who tested positive for Covid-19, the stress at work had increased for the both of us. As doctors, we develop an emotional endurance to seeing the sick, the frail and death every day. But you never think you would require to prepare yourself for something like this: hundreds of thousands of deaths across the world, millions of poor out of work, with no food and an uncertain future, all in a matter of a few months.

After weeks of grueling work schedules and on top, news of dire misery all around, Ekta and I thought we deserved a day-off and we made the very best use of it- we got married on fourth of May; in a temple within my hospital premises, attended by only a couple of friends who helped us live stream it to our family and friends all over the world. We were back to work, the very next day.

The severity of the spread in Ahmedabad kept rising at an alarming rate and along with it, the number of tests being conducted, which meant Ekta was busier than ever. We would return home exhausted, mentally and physically, but connected in spirit with millions of healthcare workers across the world- the first line of defense in humanity’s fight against this pandemic.

The First Symptoms

In one of these days I woke up with a mild sore throat that I felt throughout the day. Later in the evening when I returned from work, Ekta mentioned that she smelled her perfume but could not sense the redolence of the notes. Suspecting we were infected, I decided to not step out of the home the next day, while Ekta went to the lab to get tested; the same evening we found out that she had tested positive. I assumed myself to be infected as well and as the next order of our business, we informed everyone we had come in contact with in the last one week; most of them were healthcare workers. Everyone went into self-isolation but upon testing, thankfully, all but one tested negative. The positive colleague remained asymptomatic for the next two weeks.

The very next day I got tested, the report was positive, no surprises there! We did a baseline complete blood count and routine biochemistry tests and all the reports were normal. We remained isolated at home, monitoring our temperature, SpO2, heart rate and blood pressure every 6 hourly (perks of being doctors, we had all these instruments available at home). The medicines and groceries we required were supplied by our hospital colleagues and society guards.

We started on hydroxychloroquine (therapeutic dose), Azithromycin, Vitamin C supplement and multivitamin, while drinking 3-4 litres of fluid. Some of the drug used were off-label at that point in time as no concrete evidence was available. Next day, both of us started to experience headaches, but it could be brought to control with acetaminophen.

(Patients Tip: Please discuss treatment options with your doctor) 

We were always in touch with a doctor at Apollo Hospital over the phone and updated him frequently about our symptoms. On the third day, her anosmia (lack of smell), dysgeusia and headache persisted with no new symptoms. I developed a low-grade fever (maximum spike of 100oF) well controlled with acetaminophen. On day 4, my fever persisted, reaching upto 101oF but still responsive to acetaminophen while she had no new symptoms besides really nagging headaches.

On Day 5 the fever had reached 102oF at night. I was on 4gm acetaminophen per day in 6 divided doses, but the fever wasn’t touching the baseline. The drug brought the temperature to 100.5oF which re-spiked after 2 hours. The temperature had stopped responding to acetaminophen. By then we were very anxious. That was one hell of a night!! There was mild cough, but SpO2 remained 95% and above in room air.

On day 6, we did the second round of routine blood tests. Ekta’s reports were normal. My blood counts, coagulation profile and routine biochemistry were unremarkable but CRP increased to 35 mg/dl, and serum IL-6 was 30.2 pg/ml. Fever pattern remained the same, but there was anxiety and I had lost patience. We wanted to take an NSAID in the form of Ibuprofen or Naproxen but there was limited access to drugs as both of us were isolated.

Taking the circumstances into account, we decided to get hospitalised. We got admitted to the same hospital where I work. In the hospital intravenous paracetamol did not help much. After discussion with the critical care team, Tab Naproxen was started (1000 mg/day in divided doses) which helped miraculously in controlling the temperature. The temperature returned to baseline after 48 hours. We were also started on prophylactic LMWH, a blood thinner, as excessive blood clotting is described as a harbinger of complications in COVID-19. Rest of the medicines remained the same. All these while the oxygen saturation remained close to 95% and there was a mild increase in cough. We were doing regular steam inhalation. There was close monitoring of blood counts, biochemistry and coagulation profile in the hospital.

On day 8, my CRP reached 105 mg/dl and serum IL-6 was 28 pg/ml. Along with the persistence of low-grade fever (below 101oF) which responded to Naproxen, there was a further increase in cough. Chest X-ray remained unremarkable and SpO2 more than 95% at room air. A similar pattern persisted for the next 2 days, and after the 10th day of infection (and 8 days of fever) my fever subsided, however the cough remained. At this same time, she started regaining her sense of smell.

We were kept under observation in the hospital until I remained afebrile (no fever) for 72 hours (those were early days of COVID management in our hospital, we were the first two patients). As we were getting better clinically, we couldn’t wait to get back to our home or at least step out of our hospital room which was cut off from the outside world. Even the health care workers who entered our room in the PPE suits were fully covered and unrecognizable.

It is likely we were still COVID positive but having not seen anyone other than each other in these seven days in the hospital, was making us go berserk; binge-watching Netflix shows would not entertain us anymore. We could not wait for the ‘honeymoon’ we would never have asked for, to end, so that we could go back home!

To pass time, we indulged in grooming ourselves with the limited supplies we received from the pantry. On one occasion Ekta made a face pack with the turmeric powder provided with the milk to drink and applied it on her face. A few minutes later when the consultant on the rounds visited, he had almost prescribed a liver function test; we informed him how she got the “icterus”.

On the 8th day we were discharged from the hospital. To avoid fomite contamination, we were not given any hard copy of the documents related to our treatment. The hospital ambulance driven by a PPE covered driver drove us home. The housing society apprehension was taken care of by the discharge summary of the hospital.

After reaching home, I immediately rang the government doctor of our locality, who reached with her team within 15 minutes. We were advised to continue to be in isolation for a week longer. Although we were mentally prepared for it, we were unsure about how to get the essentials. Thankfully e-Commerce and door step delivery from the grocery stores came to our rescue, which had started to operate by then. However, we had to manage the chores ourselves, which was tiring as we continued to feel weak and the slightest of exertion would increase our heartbeat to 140 bpm (normal 60 to 100) which would settle down with some rest. We ensured that we are adequately hydrated always.

On the 18th day of isolation, a repeat RT-PCR test for SARS-CoV2 was arranged by her lab. This is not recommended, however I treat cancer patients and come in regular contact with them, so I wanted to be very sure about my status before I resumed work. Also, we wanted to be convalescent plasma donors, to help those who are battling COVID with severe symptoms. Those who recover from COVID-19 can donate plasma after 28 days of initial symptoms or after 14 days of 2 consecutive negative RT-PCR reports taken 24 hours apart.

After the 1st sample was tested negative, Ekta resumed her work immedietely. It was amusing that she herself signed out our 2nd sample negative report! I resumed work only after I had received both the negative reports; thanks to the quick turn-around time of her lab, which is approximately 8 hours.

Both Ekta and I couldn’t be happier to be back to work, for which we are ever grateful to the doctors and the healthcare staff at Apollo Hospital for taking care of us. It is incredibly strenuous and uncomfortable to be in the PPE suit at a stretch for 6 hours and more, we salute them and all healthcare workers across the globe for their continued efforts, commitment to their patients and conviction to win this battle against COVID-19.

The number of test samples in Ekta’s lab continues to increase, while she ensures they are able to maintain the rapid turn-around-time of reporting. As for myself, I now visit the same ward where I was once admitted as a patient, whenever any COVID-19 patient develops hematological complications.

We were ready for plasma donation after 2 weeks. The blood bank assessed our antibody titre and few other tests as par guideline for blood donation. An advantage of plasma donation was it helped us to know our antibody titre (as this test is not yet commercially available). Fortunately, our titre were good. Some recovered patients may not have an adequate antibody response and sufficient antibody titre which may predispose them to reinfection.

Plasma was collected through an apheresis machine. The procedure took 60 mins. The apheresis process filters out the required blood component (plasma in our case) and returns the other cellular component of blood back to our body. Total of 450 ml plasma was collected; of which 200 ml each will be used to treat two patients battling COVID-19 and 50 ml will be frozen at (-80oC) and stored for research purposes. This procedure was totally safe, and we felt a sense of contentment after the donation for having made a small contribution in the fight against COVID-19. The frequency of plasma donation ranges from 1 to 4 times per month per recovered individual based on the study design and blood bank policy, and donor fitness. The healthcare workers ensure that all recovered patients are informed and encouraged for plasma donation.

Much have changed since our ordeal with COVID-19. There has been a continuous increase in case load as well as inflow of information in COVID-19 management. With accumulating experience among those treating COVID-19 and the healthcare system getting overwhelmed with each passing day, patients with our kind of symptoms are now managed successfully at home. But the symptoms may not be the same for all, and elders and individuals with co-morbidities remain at high risk of complication, thus prompting need for hospitalization.

I am incredibly fortunate to be married to Ekta, with whom we fought our own little battle against COVID-19 and won. As the world continues to fight against it, with a concerted effort of the administration, healthcare workers and particularly the general population at large, I remain positive that we will win this war. By winning one small battle at a time!

Stay safe, stay healthy and be positive!

Dr. Ankit Jitani (DM, Clinical Hematology, Consultant Apollo CBCC, Ahmedabad)
Dr. Ekta Jajodia (Post Doc, Molecular Hematology, Consultant, Unipath Speciality Lab, Ahmedabad)

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