One more patient has died in Kerala soon after he was declared COVID-19 negative. Sixty-eight-year-old Sasidharan Pillai of Thrikkaravu, near Kollam, died in Parippally Medical College on June 23. According to the Medical College bulletin, Pillai died of cardiac arrest.
He is the third COVID infected person in Kerala to die of 'cardiac arrest' right after testing negative. Pillai, like the other two, has not been included in the list of COVID deaths in Kerala. On April 18, it was 85-year-old Beerankutty of Keezhatur in Malappuram. On May 4, it was 73-year-old Padmanabhan of Kulathupuzha in Kollam.
All three had died in the hospital where they were admitted for COVID-19 treatment; Padmanabhan and, now, Sasidharan Pillai in Parippally Medical College and Beerankutty in Manjeri Medical College.
Sasidharan Pillai had returned from Dubai, where he and his wife were on a visiting visa to be with their son, on June 14. The official government release said his samples were taken at the airport itself. Thrikkaravu ward member Anil Kumar said Pillai's samples were taken after he complained of breathlessness, two days after his return. "He was taken to the hospital for swab collection and brought back. By the time he returned, he was declared positive and he was promptly shifted to Parippally Medical College on June 18," Anil Kumar said.
On June 21, he was put on ventilator. Pillai had underlying medical conditions like diabetes. He had also undergone two angioplasties, one in Kerala and another in Dubai in early March. On June 22, his serum samples were sent for testing to Alappuzha Virology Institute. Next day evening, it came back negative. By then his heart condition had worsened and he suffered a fatal heart attack.
Case of COVID relapse
It is said Pillai had tested positive for COVID-19 while in Dubai itself. The infection was confirmed on April 12 and he underwent treatment. However, three repeat tests carried out on April 21, 23 and 25 threw up negative results. Pillai testing positive once again, after he landed in Kerala, looks like a relapse, a rare occurrence.
Doctors say the Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test done on his sample in Kerala could have probably picked up the remnant viral litter that was still present in his body, long after the infection had lost its sting. If this was true, the difficulties he faced after landing could have been the result of a weak heart and diabetes, not COVID-19.
Doctors also speak of another possibility. The positive result in Dubai could have been a false positive as the city in the United Arab Emirates uses the unreliable antibody tests, and not the more accurate RT-PCR tests. If so, he had actually caught the virus just before he took off and symptoms began to show two days after return. Then, it goes without saying, his underlying conditions were aggravated by the virus.
COVID-19: straw on the camel's back
Still, though it is true that Sars-CoV-2 fires up dormant morbidities, the government policy is not to account the death under COVID-19. The Health Department's stand is that the person would have died even if she was not infected.
There was also the strategic angle. It is said that to contain the virus, a definite policy distinction had to be made. “Once a person is free of the virus, for the proper understanding of the pandemic, it would be strategically wise to remove the person from the list of COVID-19 cases. At the most, like any viral infection, Sars-CoV-2 would have intensified pre-existing morbidities in an individual. But after the virus has left the body, it cannot be blamed for issues that were present even before its intrusion,” a top health official said.
The official's argument can seem compelling in the case of Beerankutty and Sasidharan Pillai. Both were chronic heart patients, and had other serous conditions. In the case of Beerankutty, there were urinary tract and kidney issues. Pillai had diabetes.
As for Padmanabhan, he did not have any pre-existing medical condition. Like Pillai, he died barely a day after two consecutive tests showed negative. He did not have any heart problems. Nor did he hold the common basket of ailments like pressure, cholesterol or even sugar.
Virus and heart attacks
Studies have revealed that COVID-19 patients could all of a sudden develop heart trouble. In a study of Wuhan patients published in The Lancet, it was revealed that only less than half had pre-existing conditions like diabetes, hypertension and cardiovascular diseases, and some of them had gone on to develop cardiovascular problems after the virus strike. More than 10 per cent of the patients, the study said, had developed acute cardiac injury after the virus attack.
Another study by doctors of Zhongnan Hospital of Wuhan University, Wuhan, Hubei, has also affirmed that cardiac injury can be part of coronavirus-induced harm. In other words, Sars-CoV-2 could both irritate pre-existing heart problems and weaken a strong heart.
