Page 37 - Insurance Times August 2021

more meaningful and practical, afford to miss out on cases of severe Covid 19 patients and
I have compiled various views write the risks on their books - specifically for high comorbidity
of Dr. Rahul Pandit, a Covid cases. Whether the current blood tests, ECGs, and TMTs
Expert, and a highly are good enough to predict COVID 19. Insurers don't
experienced critical care conduct CT Scans / HRCTs or MRIs in the normal course.
specialist. Dr. Pandit is In fact even 2D Echo is not a routine test.So are the current
Director - Critical Care, Fortis medical grids sufficient or are there some better Predictors
Hospitals, Mumbai. That of COVID 19?
apart, he is also Maharashtra's
COVID19 Taskforce Member & Dr. Pandit says the most important predictor for COVID19 is
member of the National the 'Clinical Hypoxia' and 'Arterial Blood Gas'. If the patient
Dr. Rahul Pandit
COVID19 Taskforce, duly has severe hypoxia on a saturation probe and it is confirmed
appointed by the Hon. Supreme Court. by an arterial blood gas test, that seems to be the best
predictor for COVID.
By now, all of us know (or at least believe to know fully well as
Google Experts) about diagnostic tests like Rapid Antigen The second test is an HRCT. A CT scan determines not only
Tests [R.A.T.], RTPCR, HRCT, CRP, etc. All these tests have the score, but what are the different patches which are being
their limitations. So let's understand more about these seen, and how it is described. It is often concluded that the
tests from Dr. Pandit, along with the importance of CT and the clinical picture may not match at a particular
Cytokines - a group of proteins, peptides, and point, but as the patient worsens, the CT does reflect the
glycoproteins that are secreted by specific cells of the clinical condition quite well & vice versa.
immune system and are a sort of signaling mechanism of
our body that control the immunity and inflammation. Other tests include MRI and ECG or a 2D ECHO depending
upon the symptoms.
Dr. Pandit starts with the fact that COVID19 is a viral illness,
having different phases of infections. So it will be interesting to see if a few tests (like SPO2 saturation
etc.) will get added in the MER along with other
Viremia Phase Cytokine Phase physical examinations by the insurers. Will HRCT,
(First 7 - 10 Days) (host inflammatory response phase) MRI, and ABG or a 2D Echo get added to the
•fever, myalgia, cough, stuffy •In addition to the CBC Test, medical grids over a period based on claims
nose, sore throat, sometimes Cytokines are also measured, viz., experience or depending on COVID impact or co-
CRP (CReactive Protein), LDH
you can have GI symptoms like (Lactate Dehydrogenase), Serum
nausea, vomiting, diarrhoea morbidities seen in the future over time.
Ferritin and IL6 [Interleukin 6].
RTPCR / Hb, NL Ratio and We all hear about Mild, Moderate, and Severe
R.A.T. White Cells & Covid. What are these in the real sense? Are
Platelet Counts these standard terminologies?
One of the things in the Complete Blood Count, which is often
ignored, but is very important for those suffering from Dr. Pandit says while the definition of COVID19 is standard
worldwide, the Ministry of Health and Family Welfare
COVID19, is the RDW, Red Cell Distribution. If the Red Cell
(MoHFW), Government of India also categorized COVID into
Distribution width is greater than 15% it is associated with
the possibility of having an infection, and may have at least three categories.
moderate or may be severe COVID19. Dr. Pandit here forewarns that comorbidities play an
important role and some patient who has existing heart
Normally for Protection and High-Risk plans, Insurers conduct disease or lung disease, maybe in a different category
medical examinations. While obviously, insurers may not want altogether, because even moderate symptoms in them will
to go on a witch hunt for COVID 19 cases and test each insured reflect like those in severe COVID19 patients.
life as it would not make sense, but an important question
that may crop up once in a while is whether the insurer can Insurance is based on prognosis and once a policy is issued -

The Insurance Times, August 2021 37