Dubai: While Obesity is clearly one of the most challenging comorbidities that can complicate a COVID-positive condition, 34-year-old Filipino expatriate Melvin Cabile Masule, weighing 150kg, miraculously fought off the threat after two weeks in intensive care unit (ICU), surprising his doctors and family.
After suffering a heart condition, sepsis, kidney failure and being put on mechanical ventilation for 15 days, Masule, a school teacher, has fought his way out of the crisis and has been happily united with his little daughter and wife.
Testing positive for COVID-19
Masule tested positive for COVID-19 in the second week of December 2020. At first, Masule continued treatment at home with anti-pyretic medication. But after five days, when he started experiencing shortness of breath amidst raging fever and cough, he came to NMC Specialty Hospital Emergency at Al Nahda, Dubai.
A critical case
Dr Prashant Nasa, specialist in critical care medicine and head of the ICU who attended to Masule, recounted: “Melvin came to the hospital with a high fever of 41 degrees Celsius, dry cough that had been raging for a week prior to admission. His heart rate was 154 beats per minute and oxygen saturation was 52 per cent. The over-the-counter (OTC) medicines Melvin had been taking for a week were clearly not working. He was in septic shock with acute renal failure. He represented so many text-book complications of health characteristic of severe COVID-19. He was obese with a body mass index (BMI) of 52 and a chest x-ray indicated he had extensive bilateral pneumonia (white lung).”
Classic symptoms of severe COVID-19
The doctors were worried as initial investigations revealed high levels of infection with multi-organ dysfunction (kidneys and heart). They started with broad-spectrum antibiotics, anti-coagulants, IV steroids and other supportive measures. Soon both his kidneys failed and he was put on continuous dialysis.
Dr Srinivasa Rao Polumur, specialist in internal and primary physician for Masule added: “Melvin had hypertension, but was not taking any medicine and had so many complications. His case was challenging and we adopted a multi-disciplinary approach in this treatment to take care of all the multiple organ dysfunction that he was undergoing continuous renal dialysis.”
A tough battle
But doctors did not lose hope and as Masule continued to fight, they spiritedly waged a battle on his behalf. Slowly his kidneys started improving. His heart pumping function had dropped to 15 per cent. The doctors soon started cardiac medicines and he was stabilised, the sepsis was controlled with antibiotics.
One of the most difficult issues was making Masule lie in prone position, which is usually the best way to improve oxygen saturation. Since Masule was undergoing continuous dialysis, a prone position was not possible.
However, after his condition stabilised, Masule was made to lie face downwards on his stomach for three consecutive days, which resulted in significant improvement. Despite all the medications, Masule still showed classic symptoms of COVID-19, which were gradually subsiding. But the virus was playing games.
Twist in the tale
Just when the doctors thought Masule was out of the woods and he had tested negative six times, a seventh sample revealed he was positive again. So he could not be discharged from hospital. However, after two weeks, when his kidneys were revived and he was slightly better, he was moved to the COVID ward.
Discharged after a fortnight
Masule finally tested negative and was discharged on December 30 to enter the New Year safe and back with his family at home.
Since then, Masule has made steady progress. He was put on a strict salt-restricted renal diet that helped him shed water retention. He had to undergo physiotherapy and rehabilitation and has now lost about 30kg in the last three months. He told Gulf News: “I have been grateful to God for helping me get a second chance at life. I am now following a nutritionally balanced diet and trying to get back to normal life. I still feel very tired and fatigued, but I am working on my health. I would like to tell people not to take any of the COVID-19 protocols lightly. Please wear a mask, observe social distancing and above all, get the vaccination done.”
Extra COVID-19 precautions for the obese
Dr Dinesh Kumar Dhanwal, consultant endocrinologist, diabetologist and metabolic disorders specialist at NMC Specialty, said obese people must be given priority in vaccinations because they have a higher risk of complications if they test positive.
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Dr Dhanwal added: “Risk of COVID-19 infection is based on exposure, but the risk of severe symptoms is much higher with obese people, compared to those who have normal weight. That is because obesity is a chronic condition and obese patients have higher inflammatory markers as well as poor immune response. Obese patients have compromised lungs and therefore more and severe pneumonia and more need for oxygen and ventilation support.”
Sounding a word of caution to those who had higher basal metabolic rate (18-25 is normal BMI), Dr Dhanwal added: “Obese subjects should be more careful and must follow COVID-19-appropriate behaviour. If they do contract the virus, and suffer with persistent fever, dry cough and experience difficulty in breathing, then they must seek immediate medical advised.”