A veteran doctor shares his observations after decades of curing poor patients from Mumbai slums
Dr Lalit Kumar Anande | May 4, 2020
In slums like Govandi in Mumbai people live in tin and tarpaulin structures of 5x5 feet or a maximum 8x10 ft. These duplex homes with open toilets have no windows, kitchens and bathrooms. Even bringing in a dead body is difficult because there is no space for passage in narrow alleys. These people are hard-working migrants. In Dharavi where population is about 10 lakhs (officially), in normal course a cold or cough would not cause much concern but if the person has coronavirus, it raise an alarm.
Since January, I have been speaking to general practitioners in the area who have been saying that cases of influenza, common cold and fever have boomed and there has been a jump in numbers of patients coming to their clinics. In February they said the same and cases of influenza, malaria, fever and dengue is supposed to be a good season for GPs. As coronavirus cases rose they stopped their general practice. BMC doctors too reported a large number of patients with common cold, cough and fever. As large parts of Mumbai now are in Red Zone these people are already exposed to coronavirus. While the government has been setting up large numbers of quarantine facilities, it is a giant experiment.
Allegedly, all these areas have a large number of TB patients who are immuno compromised and have some or major part of their lungs damaged. Hence, these people were the most probable candidates to have increased mortality due to Covid Pneumonia, yet nobody died. Rather their health has improved. When Covid-19 should have led to an increase in the death rate and the numbers should have multiplied, there is an overall decline in the number of people dying. In the month of April there were 102 deaths (3.4%) in Group of TB Hospital and till 2nd May till 12.30 pm there were 3 (1.5%) deaths. As against this, till September 2019 the average rate was 4.06%, in 2018 the death rate was 3.92% and in 2017 it was 4.51%.
In our hospital we are using GenXpert test which is a PCR based test. This test confirms the patients exposure to TB bacilli. If a patient says that 20 years ago he had TB, I will want a microscopic test to confirm the presence of TB bacilli or a culture test to check bacilli growth. At Group of TB Hospitals we are being referred many COVID positive patients stating that they have TB + Covid and hence these patients cannot be kept at other hospitals as they will infect others with TB. (The referring hospital only does Covid tests and not sputum AFB test to prove TB). After we saw they were not active TB patients at all and had only Covid, we had to divert these cases. Luckily I have managed to hold on to one Covid patient in my hospital who apparently was referred as TB with Covid. Upon going through his case history papers I saw that he was no more a TB patient and had completed his treatment.
A 22-year-old female patient came directly to our OPD with complaints of cough, fever, giddiness, loss of appetite and headache for the last seven days and was admitted in Ward 16 on suspicion of Covid. She had prior history of TB in 2016 and had completed her treatment. Her x-ray taken on April 25 revealed old lesions with bilateral mid zone pneumonia. An earlier x-ray dated April 11 taken at Sion Hospital showed she had left upper lobe old cavity with lower lobe old fibrotic lesion and similar picture on the right side. Her Covid test of April 28 showed she was positive. Sputum for AFB (TB) turned out negative for on March 2. In view of the above, the patient is an old case of PTB but has not been diagnosed active PTB. Hence she is currently only a Covid positive case. As she is not on any anti TB medication, for the last two days I have started her on IV doses of 12.5 grams of Vit C. + Inj Vitamin D3.
Some days back a district TB officer called saying that a patient who is on TB treatment for last three months has been diagnosed Covid positive and no hospital was ready to take him. I told him to confirm if he was really positive and asked for his sputum report. I was told his sputum was positive and he was category 1 drug sensitive TB. I took it as an opportunity to treat the patient and immediately told my fellow doctors to arrange a vacant ward. I wanted to immediately give him 6 lakh IU of Vit D3 injection. When the patient came, we came to know that he did not have TB. His x-ray taken just a day earlier revealed he was not a TB patient but in fact a Covid positive patient. He had been misled by the doctor who thought his x-ray gave the impression that he had TB and so he was sent to TB hospital.
There is evidence now that the virus is shed through stools. While our government machinery is doing its best to fight the virus we have limited resources and no medicine for Covid-19. At present patients who test positive are kept in isolation wards and recover on their own. For those who land in the ICU, I strongly recommend that their intestines should be made sterile and the only way to do that is by administering ozone therapy. It is the cheapest treatment we can give to a Covid-19 positive patient.
Giving mega doses of Vitamin C in the quantity of 3000mg-5000mg and Vitamin D6 to the entire population is important. I have using Vitamin D tablets for TB patients with wonderful results. Our farmers, labourers and others who live on roads absorb a lot of sun and have excellent Vitamin D count and therefore safer as compared to those confined to their rooms. Vitamin C intake is abundantly available in oranges, limes and gooseberry. For Vitamin D daily sun bathing for half hour or Vitamin D tablets to the level of 70ng-80ng should be taken. It is the drug that stops Covid-19 radiological changes in lungs like water accumulation and pneumonia and I have been giving it in mega doses to my poor TB patients with wonderful results.
Even among patients who had cavities in lungs, their health improved and cavities became smaller within three months. For fresh TB cases I recommend doses of Vit D3 every alternate day for the next four months and after a gap of three months or so I prefer to check them through CT scan and not x-ray. My patients who were totally drug resistant have shown improved health with weight gain from 35 kg to 85 kg and their ESR levels came down from 114mm/hr to 5-10mm/hr. Their radiological picture has not increased by a millimeter. In two cases, their culture came negative. And in spite of them having no choice of anti TB drugs (since they were resistant to all anti TB drugs) they all have survived for the last five years.
In April a helper in one of my hospital wards with about 100 patients had fever and was referred to KEM hospital for Covid test. He was asked to self-quarantine at home and his report few days later came positive. This left everyone scared in the ward as he had fever for five days before he reported to the doctor. As many as 45 ward boys and 24 nurses were sent into quarantine in my hospital. His wife too turned out positive. Surprisingly, patients who were exposed to him are all safe and they are all TB patients.
A vaccine can make you immune to a particular virus. If you get exposed to a virus you get herd immunity. Moreover, vaccines contain a certain type of mercury based ingredients which is a major cause of autism in young kids, a term I never heard while studying medicine. It was only after 30-40 years into my career that I started hearing about children getting autism because of increased use of vaccine. My advice to all those who are exposed to coronavirus is to take Vitamin D3 thrice a week for the first week to boost your D3 levels and later to take the maintainence dose.
As a doctor, despite going by my pharmacology books, when I saw children dying of tuberculosis I was heartbroken. I started questioning myself as to why despite giving scientifically and clinically approved medicines to these children there was one failure after the other. After a lot of questioning and self-introspection I realized that it is not antibiotics but something else. My research led me to the fact that the answer lies in immunity on which you cannot get patents unlike vaccine. With India’s mere 1.5% health budget we have been fighting for increasing TB budget.
In our programmes at places like Govandi, Kurla and Ghatkopar I have been extensively recommending lemon water (for cheap natural Vitamin C) to everyone to boost immunity. Now everything related to TB has been taken over by Corona. However, nutrition plays an important role in both diseases and if not in natural form then supplements must be given to both TB and Corona patients.
For admitted TB patients I initially recommend an IV 12.5 grams mg dose of Vitamin C. If the patient does not show improvement in 24 hours, I increase it to 25000 mg and if he gets better I maintain the same dose for next 10 days. Nobel laureates like Linus Pauling and great physicians like Dr Frederick Klenner advocated use of vitamins long ago. Mega vitamin men Dr Thomas E Levy and Dr Andrew Saul, despite much criticism, are holding many seminars on the same topic these days. Dr Judy Anne Mikovits, an American Researcher, and Shiva Ayyadurai, an Indian American scientist and engineer, too are recommending doses of Vit C and D.
Dr Anande is Medical Superintendent, Group of TB Hospitals, Mumbai. He spoke to Geetanjali Minhas.
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