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Investigations in Covid-19. The Rationale

The investigations we perform on a patient with Covid-19 form a substantial portion of the hospital bills – yet several patients don’t understand, or perhaps partly comprehend, the rationale of conducting them. So, today we elucidate the logic behind performing specific tests once you are a suspect or confirmed patient of Covid-19.

Covid-19 has hit the entire world at unimaginable proportions. It was widened the economic inequality gap and has pushed many economies toward a downward spiral that will take them years to recover. Initially thought of as respiratory disease, Covid-19 causes chaos in organs and systems beyond the lungs. The investigations we perform reflect that. Because many of these aren’t conventional, they poke deeply into your pockets, rendering the disease costly to manage regardless of the hospital setting.

When you present with symptoms highly suggestive of Covid-19, we perform tests to confirm so. They can be rapid antigen tests (RDTs) or the highly sensitive reverse transcriptase-polymerase chain reaction (RT-PCR) test. None of these is cheap unless you get it done from a public health centre. Once you test positive for the SARS-CoV-2, we assess whether you have mild, moderate, severe, and critical Covid-19. The assessment involves both history and examination findings. And investigations, for which there’s chronology.

We commence with a chest computed tomography (CT) scan, preferably a high-resolution CT scan (HRCT), to ascertain the extent of the disease within the lungs. It is a costly investigation for irrefutable reasons – finite availability. Since there’s the use of contrast media, your kidneys must be functioning within the endorsed limits. To assess this, we take blood samples for renal function tests: another test! The HRCT will assess Covid-19 pneumonia severity, and it will guide us on a treatment plan to enable you to recover from the disease. Depending on the extent of the disease, you do follow-up scans as the clinicians see fit.

How your body responds to the virus is depicted in several blood tests. A complete blood count (CBC) estimates the various cells – white blood cells, red blood cells, and platelets with their differentials. The degree of rising or fall in any of these prompts a pattern of treatment. For example, when your white blood cells are outside the normal ranges, it may depict sepsis. We proceed to do procalcitonin levels to confirm the presence of sepsis.

Covid-19 causes intense inflammation, the level of which predicts the prognosis of the disease. A few blood markers assist us to ascertain the degree of inflammation. They include c-reactive protein (CRP), d-dimers, fibrinogen levels, and others. The latter two also allow us to assess the risk of blood clots forming within the vasculature. It is not uncommon to get pulmonary embolism as a complication of Covid-19.

It is also not uncommon to present with elevated blood sugar levels and the known Covid-19 symptoms. It, therefore, becomes imperative that we check your glucose levels to ascertain this. We begin with random blood sugar (RBS) test. If the sugars are high, we check for the levels of glycated haemoglobin (HbA1c). Recent studies have depicted that hyperglycaemia predicts a worse prognosis if left untreated among patients with covid-19.

The inflammatory processes that occur during Covid-19 don’t spare the liver and biliary system. So, to assess the level of damage, we do liver function tests. These guide us on the degree to which we utilise the various medications commonly available to manage Covid-19: specifically, the drugs which carry a substantial risk of hepatotoxicity. Acute liver injury is associated with worse outcomes: we do not want to catch it very late if it has occurred.

As you can tell, the list of investigations is enormous. And depending on the disease, we can add several others, for example, an extended electrolytes panel that includes calcium and magnesium on top of sodium, chloride, potassium, and chloride levels. While you stay in the hospital, the prevailing conditions may warrant we redo several tests to depict the disease progress. Every time we do so, it costs you money. Many of these tests aren’t conventional. The laboratories that perform them are limited in number; hence they carry exorbitant price tags. The repeated investigations throughout the disease process leading to a rise in hospital bills, regardless of whether you are in a public or private setting. Managing Covid-19 isn’t a conventional feat. We talked about the various treatments you can get to pull through. We’ve noticed how pricey they can be, an example, tocilizumab: a staggering 7 million Uganda shillings or more per dose.

Only a few of us have had the severe form of the disease. The rest may lament how the disease only kills a few. A general saying goes; the dead are few if none of them is your relative. Be wise, get the jab, diligently adhere to the SOPs. Stay safe.

IAmDrSsekandi

Dr A. M. Ssekandi is a medical officer, researcher, content creator, author, and founder of ssekandima.com. He does private practice with a public touch. He is a certified digital marketer. He has earned certificates in Understanding Clinical Research and Writing in Sciences from the University of Cape Town and Stanford University respectively. He also has a certificate of Good Clinical Practice from https://gcp.nidatraining.org/

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