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\begin{document}

\title{A case report of critically ill COVID-19 ICU patient recovery from acute
respiratory distress syndrome, acute heart failure, kidney disorder, and
Churg-Strauss syndrome}



\author[1]{Md. Rabiul  Awal}%
\author[2]{Md. Imran Hasib khandakar}%
\author[3]{Ayesha  Chowdhury}%
\author[4]{Md Shariful Islam}%
\affil[1]{Japan Medical Center }%
\affil[2]{Japan Medical Center, Bangladesh}%
\affil[3]{Japan Medical Center, Dhaka}%
\affil[4]{UW-Madison}%


\vspace{-1em}



  
  \date{May 28, 2024}


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\selectlanguage{english}
\begin{abstract}
During the COVID-19 pandemic, a 32-year-old front line health-worker
tested positive for COVID-19 in RT-PCR and was admitted to the Japan
East West Medical College Hospital in Bangladesh. In the ICU, the
patient was in coma for 5 days. The Patient's condition was improved
after taking fresh frozen plasma.%
\end{abstract}%



\sloppy


\textbf{Introduction:}

A new strain of coronavirus named severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, Hubei
province, China, in December 2019. Since then, the virus spread all over
the world rapidly and became the reason for millions of deaths in the
world. The disease caused by SARS-CoV-2 was termed as Coronavirus
Disease 2019 (COVID-19) and was declared a global pandemic by the World
Health Organization on March 11, 2020 {[}1{]}. Severe COVID-19 patients
suffer from severe critical illness with pneumonia, acute respiratory
distress syndrome (ARDS), and multiorgan failure {[}2{]}. This novel
coronavirus disease had a dangerous impact on patients, families,
healthcare systems, and communities due to the lack of accurate medicine
and vaccines, especially in the year 2020 and 2021. To decrease the
transmission of the virus, a heavy lockdown was implemented in almost
all the nations of the world and global economic activities were in
turmoil.

The SARS-CoV-2 virus spreads from person to person through small
respiratory droplets and mutates over time. There are several variants
of SARS-CoV-2 developed from several mutations. Alpha, Beta, Gamma,
Delta, and Omicron variants are remarkable variants of SARS-CoV-2. The
Delta (B.1.617.2) variant first emerged in India at a time of low
vaccine coverage and was the most dangerous among all the variants of
the globe due to high transmissibility, the severity of illness, and
death rate {[}3{]}. In May 2021, the delta variant of SARS-CoV-2 was the
most dominant variant in maximum countries of the world {[}6{]}. The
poor recovery of COVID-19 patients suffering from heart failure,
diabetes, hypertension, malignancy, and chronic kidney disease has been
reported {[}5{]}. In this case report, we will discuss how the patient
recovered from severe COVID-19 symptoms after about six months' rest and
treatment.

\textbf{Case presentation (Disease diagnosis and treatment):}

Md. Rabiul Awal is a patriotic Biotechnologist who started his unpaid
work without fear of death in the COVID-19 detection laboratory in the
Shahjalal University of Science and Technology, Sylhet, Bangladesh on
the behalf of DGHS (Directorate General of Health Services) of
Bangladesh Government from the very beginning of the COVID-19 pandemic.
During a high surge of the Delta variant of Coronavirus, when he was
working as a scientific officer in Japan Medical Center located in Dhaka
city for COVID-19 detection, he got infected with COVID-19 with the
symptoms of fever (99\selectlanguage{ngerman}°F) and headache on 22th April, 2021 and medication
was started with rivaroxaban, Paracetamol, Zinc Sulfate Monohydrate,
Colecalciferol (Vitamin D3), Vitamin C, Montelukast Sodium, Fexofenadine
Hydrochloride, Ivermectin and Doxycycline Hydrochloride. Doses of the
medicines were maintained as prescribed by the consultant physician. At
the same time, the patient started to suffer from body ache, weakness,
cough and remittent fever (101°F-105°F). On 26 April 2021, fever
decreased to 99°F but dyspnea started. The SpO2 of the patient fell down
and that was nearly 85\% in the pulse Oximeter after 1:00 am of 27 April
2021.

At 11.15 am of 27 April 2021, the patient was admitted in the Japan East
West Medical College Hospital in COVID-19 Cabin Block. On examination,
his SpO\textsubscript{2} was 90\% with 15 L/min O\textsubscript{2} by
NRBM, BP was 140/70 mmHg, Pulse 121 b/min, RR 30 br/min, Temperature
99.5 °F. After admission the patient's condition gradually deteriorated
therefore at 12.30 pm on 27 April 2021 patient was shifted to ICU and
patient was put into HFNC immediately. Despite giving 80 L/min
O\textsubscript{2} through HFNC, the patient could not maintain
SpO\textsubscript{2}. Then NIV was given with 100\%
FiO\textsubscript{2}, but the patient's SpO\textsubscript{2} was not
maintained, and gradually the patient became drowsy and disoriented. ABG
could not be performed due to failure of locating arterial lines. So
mechanical ventilation starts at 11.30 pm. Here all relevant
investigation was done and patient was diagnosed as a case of Covid-19
pneumonia (critical) with ARDS (corrected) with Type 1 respiratory
failure (corrected), with acute heart failure with Myocarditis,
pericarditis and pleural effusion, with AKI (corrected) with
Hyponatremia, and with Churg-Strauss syndrome (CSS). Conservative
treatment was given with mechanical ventilation. Patient's
SpO\textsubscript{2} and FiO\textsubscript{2} improved gradually after
taking two-unit of Fresh frozen plasma and bevacizumab injection. After
5 days of mechanical ventilation, extubation was done on May 2, 2021 and
the patient was put into HFNC. Thereafter, the patient's condition
improved rapidly and a HRCT was done which showed 68\% involvement. His
2nd RT-PCR was done on May 5, 2021 and which was COVID-19 negative. As
his condition was stable and improving, he was shifted to Medicine IPD
on May 8, 2021. The patient was discharged from the hospital with advice
on May 13, 2021, when his health was better and fit for discharge. After
the COVID-19 infection, the patient suffered about 6 months from the
post COVID-19 symptoms with diabetes, psychotic disorder, panic,
anxiety, weakness, extrapyramidal side effects and erectile dysfunction.

\textbf{Tables of laboratory findings is given below:}

\textbf{A few test that was done on 27 April 2021 (Hospital Day 0/
Sickness Day 6):}\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
Test & Result & Normal Range\tabularnewline
1. Troponin-i & 4.09 ng/ml & \textless{}0.11 ng/ml (Normal), 0.10-0.40
(Risk group), \textgreater{}0.40 ng/ml or above( For AMI)\tabularnewline
2. Serum Ferritin & 3296.7 ng/ml & 20-40 ng/ml\tabularnewline
3. LDH & 594 U/L & 313-618 U/L\tabularnewline
4. INR & 1.09 & -\tabularnewline
5. Blood Group & B (+ve) & -\tabularnewline
6. Chikungunya Ab, Dengue Ab, Dengue Ag NS1, HBsAg, HCV-Ab, Syphilis, MP
& Negative & -\tabularnewline
\bottomrule
\end{longtable}

\textbf{RT-PCR, HRCT, CT Brain, ECG and X-Ray:}\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
Test & Result & Date and Hospital or Sickness Day\tabularnewline
1. RT-PCR & Covid-19 Positive & 22 April 2021 (S 1)\tabularnewline
& Covid-19 Negative & 5 May 2021 (H 8/ S 14)\tabularnewline
2. HRCT & 68\% Involvement & 4 May 2021 (H 7/ S 13)\tabularnewline
3. CT Brain & Mastoiditis & 4 May 2021 (H 7/ S 13)\tabularnewline
4. ECG & Sinus tachycardia & 27 April 2021 (H 0/ S 6)\tabularnewline
& Sinus bradycardia & 3 May 2021 (H 6/ S 12)\tabularnewline
& No regional wall motion abnormality & 11 May 2021 (H 14/S
20)\tabularnewline
5. X-Ray A/P view & Bilateral pneumonia & 28 April 2021 (H 1/ S
7)\tabularnewline
6. X-Ray P/A view & Inflammatory changes in both lungs & 2 May 2021 (H
5/ S 11)\tabularnewline
& Inflammatory changes in both lungs & 5 May 2021 (H 8/ S
14)\tabularnewline
& Showing mild inflammation & 11 May 2021 (H 14/ S 20)\tabularnewline
& No abnormal findings & 15 June 2021 (S 55)\tabularnewline
\bottomrule
\end{longtable}

*** H means Hospital Day and S means Sickness day.

\textbf{(C) A table of several tests those were done in several time:}\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
Dates & 27 April 2021 & 28 April 2021 & 02 May 2021 & 03 May 2021 & 07
May 2021 & 11 May 2021 & 15 June 2021 & Normal Range\tabularnewline
Day & H 0/S 6 & H 1/ S 7 & H 5/ S 11 & H 6/ S 12 & H 10/ 16 & H 14/ S 20
& S 55 &\tabularnewline
Hemoglobin & 14.4 g/dl & 13.6 & 11.1 & 11.9 & 12.4 & 11.2 & 13.6 &
12-60\tabularnewline
WBC & 18860 & 16630 & 31500 & 25630 & 15560 & 22580 & 11360 &
4000-11000\tabularnewline
Neutrophil & 90\% & 87\% & 77 & 80 & 89\% & 85\% & 44\% &
40-75\tabularnewline
Lymphocyte & 7\% & 9\% & 15 & 15 & 7\% & 12\% & 51\% &
20-40\tabularnewline
Platelet & 186000 & 250000 & 530000 & 450000 & 364000 & 387000 & 340000
& 1.5-4.5 lac/cumm\tabularnewline
ESR & 90 mm & 98 mm & 78 mm & 30 mm & 29 mm & 25 mm & 30 mm & 0-10
mm/1st hour\tabularnewline
D-dimer & 5.19 \selectlanguage{greek}μ\selectlanguage{english}g/ml & 2.22 \selectlanguage{greek}μ\selectlanguage{english}g/ml & 3.87 \selectlanguage{greek}μ\selectlanguage{english}g/ml & 2.1 \selectlanguage{greek}μ\selectlanguage{english}g/ml & 0.59 \selectlanguage{greek}μ\selectlanguage{english}g/ml
& - & - & \textless{}0.5 \selectlanguage{greek}μ\selectlanguage{english}g/ml\tabularnewline
CRP & 77.4 mg/L & 78.5 mg/L & 16.9 mg/L & 22.1 mg/L & 16.1 mg/L & 3.8
mg/L & 4.1 mg/L & \textless{}10 mg/L\tabularnewline
Pro-BNP & 4037 pg/ml & - & 16561 pg/ml & - & 760.6 pg/ml & - & - & Heart
failure likely: \textgreater{}125 pg/ml.\tabularnewline
Serum Electrolyte & Na-132, K-3.9, Cl-99, ECO\textsubscript{2}-21 &
Na-142, K-4.2, Cl-103, ECO\textsubscript{2}-25 & - & Na-132, K-3.8,
Cl-96, ECO\textsubscript{2}-32 & Na-137, K-5.0, Cl-101,
ECO\textsubscript{2}-25 & Na-136, K-3.9, Cl-103, ECO\textsubscript{2}-23
& - & Na (137-145), K (3.5-5.1), Cl (98-107), ECO\textsubscript{2}
(22-30) mmol/L\tabularnewline
Serum Creatinine & 1.42 mg/dL & - & - & 0.71 mg/dL & - & 0.62 mg/dL & -
& (0.66-1.25) mg/dL\tabularnewline
Interleukin-6 & 114.9 pg/mL & & & & & & & Up to 7.00
pg/mL\tabularnewline
RBS & 8.5 mmol/L & 10 mmol/L & 6.9 mmol/L & 6.8 mmol/L & 6.2 mmol/L &
6.0 mmol/L & 5.8 mmol/L & (3.9-5.6) mmol/L\tabularnewline
\bottomrule
\end{longtable}

*** H means Hospital Day and S means Sickness day.

In case of Covid-19 pneumonia with acute respiratory distress syndrome
with type 1 respiratory failure, Monas, Mucomist DT, Paracetamol,
Linezolid, Dexamethasone sodium phosphate, Piperacillin +Tazobactam,
Albumin human 20\% and Nintedanib were prescribed by consultant
physician. The details laboratory tests including RT-PCR, Biochemistry
examinations and others tests were described in Table 1A, 1B and 1C.
Oxygen inhalation and Nebulization with windel plus was also used and
the patient was kept in awake prone position for 6-8 hours as breathing
exercise during staying in ICU. For Acute heart failure with myocarditis
and pericarditis, Bisoprolol, Propranolol Hydrochloride, Digoxin,
Enoxaparin, Ramipril, and Furosemide antibiotics and steroid were used.
In case of acute kidney infection with Hyponatremia, Intravenous (NaCl)
was applied. For Churg-strauss syndrome treatment, Prednisolone was
prescribed. In case of Diabetes treatment\textbf{,} Actrapid\selectlanguage{ngerman}® HM,
Sitagliptin, and Glimepiride were used. Quetiapine and Haloperidol were
given for the treatment of psychotic disorder like hallucinations and
disorganized thinking. For panic, depression, anxiety and extrapyramidal
side effect, Mirtazapine, Carbidopa and levodopa, Trihexyphenidyl
hydrochloride, Sertraline hydrochloride, Procyclidine Hydrochloride, and
Clonazepam were given. Besides, when the patient's condition developed
more critical ARDS, Inj. Bevacizumab and 2 units Fresh frozen plasma
were also given\textbf{.} As antibiotic, Inj. Meropenem, Tab.
Moxifloxacin and Cap. Cefixime were prescribed. During staying in ICU,
the patient also faced with Conjunctivitis, Fungal Infection and mouth
ulcer. In case of Conjunctivitis, Cyst tear eye drop and Optimox eye
drop were used. For fungal Infection and mouth ulcer, Voriconazole and
Micoral® oral gel were used respectably. As food supplements, Vitamin-C,
Vitamin B complex + zinc, Multivitamin \& Multimineral {[}A-Z gold
preparation{]} were used. Doses of the all medicines were maintained as
prescribed by the expert physician.

\textbf{Discussion:}

Fever, cough, weakness, vomiting, runny nose, sneezing, headache, body
ache, feeling very unwell and shortness of breath or dyspnea are the
common symptoms of Covid-19 {[}7, 8{]}. In case of severe Covid-19,
dyspnea of the patient develop into acute respiratory distress syndrome
with Type 1 respiratory failure and the patient needs to treated
carefully with intensive care unit (ICU) support. Acute respiratory
failure is one the most common cause of death in case of Covid-19
patient {[}9{]}. In Bangladesh, 15.53 \% of them were severely ill in a
random sample of 103 RT-PCR confirmed case of Covid-19 {[}10{]}.

In this case study, the patient's suffering condition can be divided
into three stages. 1\textsuperscript{st} stage (Mild to moderate
condition): where the patient suffered from fever and cough for 5 days
and shortness of breath for 1 day. 2nd Stage (Covid-19 pneumonia Severe
Condition): In this stage, the patient was in coma for 5 days and
suffered from ARDS with Type 1 respiratory failure, acute heart failure
with myocarditis and pericarditis, Churg-Strauss syndrome (CSS), Kidney
disorder with Hyponatremia, Oral ulcer, Conjunctivitis and diabetes. 3rd
stage (Post Covid-19 symptoms): In this stage, he suffered from diabetes
for about two months and psychotic-disorder, erectile dysfunction,
panic, fear, anxiety, and extrapyramidal side effects for about six
months. About all the symptoms of three stages were observed in the
review article of Hassan S \emph{et al} . and Cascella M \emph{et
al.}{[}8, 11{]} without extrapyramidal side effects and erectile
dysfunction. The patient suffered from Covid-19 (mild to moderate
condition) from 22 April 2021 to 26 April 2021; Severe condition from
27April 2021 to 2 May 2021 and later he suffered from Post Covid-19
symptoms for about 6 months.

During admission in Japan East West Medical College Hospital (now SHIP
International Hospital), the patient's blood sample was tested for
Chikungunya Ab, Dengue Ab, Dengue Ag NS1, HBsAg, HCV-Ab, Syphilis and MP
and those showed negative results. Therefore, it was confirmed that the
patient was suffering from Covid-19 (that was tested on 22 April 2021).
Increased level of white blood cell, neutrophil, lymphocyte, ESR,
D-dimer, CRP (C-reactive protein), Pro-BNP, Serum creatinine,
Interleukin-6, Random blood sugar, Serum Ferritin, LDH (lactate
dehydrogenase), Troponin-I, INR was observed in the severe condition of
the patient and the similar increased level of results were discussed in
Al Noman et al. and Hassan S et al. {[}10, 11{]}.

Covid-19 pneumonia with acute respiratory distress syndrome with type 1
respiratory failure was confirmed with X-Ray, HRCT (High-resolution
computed tomography) and severe shortness of breath. Acute heart failure
with myocarditis, pericarditis and pleural effusion was detected by
irregular heartbeat, X-ray, HRCT, ECG, and other laboratory tests (such
as- Pro-BNP, D-dimer and Troponin-I). Kidney disorder was investigated
by serum creatinine and serum electrolytes. Diabetes was detected by
Blurred vision, urinating more often and being thirstier and measured by
RBS (random blood sugar) and HbA1c test. Churg-strauss syndrome was
confirmed by clinical symptoms such as- rash, gastrointestinal bleeding,
body pain and loss of strength.

\textbf{Conclusion:}

Due to COVID infection, the patient became very much weak and lost weigh
about 13 Kg in 12 days after infected with COVID-19. With proper
medication, diet (fish, chicken, pigeon and egg soup; green vegetables,
seasonal fruits and cow's milk) and home rest, he gained back weigh
after 7 month of infection. At last, it can be concluded that, after
strong struggle with diseases, the patient recovered from COVID-19
disease with the blessing of the Almighty.

\textbf{Abbreviations:}

ICU = Intensive Care Unit, IPD = Indoor Patient Department,
SpO\textsubscript{2 =} Peripheral capillary oxygen saturation, HFNC =
High flow nasal cannula, FiO\textsubscript{2 =} fraction of inspired
oxygen, HRCT = High-resolution computed tomography, ARDS = acute
respiratory distress syndrome, DGHS = Directorate General of Health
Services, NRBM = non-rebreather mask, BP = Blood Pressure, mmHg =
millimetres of mercury, RR = Respiratory rate, NIV = Non-invasive
ventilation, ABG = Arterial blood gas, CSS = Churg-Strauss syndrome, LDH
= Lactate dehydrogenase, INR = International normalized ratio, ECG =
Electrocardiogram, CRP = C-reactive protein, RBS = Random blood sugar,
ESR = Erythrocyte sedimentation rate, BNP = brain natriuretic peptide.

\textbf{Acknowledgement:}

The author and patient, Md. Rabiul Awal could not forget the management
team of Japan Medical Center, Badda, Dhaka, Bangladesh (Yoriko
Matsumoto, Chief Operation Officer; Shunsuke Takei, Chief Technical
Officer; Md. Rasel Miah, Human Resource Manager; Mr. Rashed Jaman,
Business Dept. Manager and others); they managed hospital cost of the
patient. He is also grateful to other colleagues (Mr. Rajib Kayal, Mr.
Mahedi Hasan Ridoy, Mr. Golam Rabbani, Ms. Anny Khatun and others of the
Japan Medical center for their supports.

\textbf{Author's contribution:}

The first author, Md. Rabiul Awal (S.O.) wrote the manuscript with the
help of Dr. Ayesha Chowdhury and Md. Shariful Islam (S.O) from the
record of medical reports. Dr. Md. Imran Hasib Khandakar revised and
edited the manuscript.

\textbf{FUNDING INFORMATION} :- The authors have no financial
disclosures.

\textbf{CONFLICT OF INTEREST} :- The authors have no conflicts of
interest or financial disclosures.

\textbf{DATA AVAILABILITY STATEMENT} :- Patient- specific identifying
information was omitted, and no patient information was altered or
falsified in an at-tempt to maintain anonymity. Consent was obtained
from the patient's next- of- kin for permission to publish.

\textbf{CONSENT} :- Written informed consent was obtained from the
patient to publish this report in accordance with the journal's patient
consent policy.

\textbf{References:}

\begin{enumerate}
\tightlist
\item
  World Health Organization. Coronavirus disease 2019 (COVID-19)
  pandemic.
  https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
  Accessed 15 May 2020.
\item
  Mayer, K.P., Sturgill, J.L., Kalema, A.G. et al. Recovery from
  COVID-19 and acute respiratory distress syndrome: the potential role
  of an intensive care unit recovery clinic: a case report. J Med Case
  Reports 14, 161; 2020.
\item
  Islam, Salsabil, Towhidul Islam, and Md Rabiul Islam. New coronavirus
  variants are creating more challenges to global healthcare system: a
  brief report on the current knowledge.~Clinical Pathology~15; 2022.
\item
  Ying Liu, Joacim Rocklöv, The reproductive number of the Delta variant
  of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2
  virus,~\emph{Journal of Travel Medicine} , Volume 28, Issue 7, October
  2021.
\item
  Sattar, Yasar, et al. Coronavirus disease 2019 with acute respiratory
  distress syndrome mimicking heart failure exacerbation: time to
  rethink.~Cardiology Research~11.3; 2020: 196.
\item
  Hart, William S., et al. Generation time of the alpha and delta
  SARS-CoV-2 variants: an epidemiological analysis.~The Lancet
  Infectious Diseases~22.5 (2022); 603-610.
\item
  Richardson S, Hirsch JS, Narasimhan M, et al. Presenting
  characteristics, comorbidities, and outcomes among 5700 patients
  hospitalized with COVID-19 in the New York City Area. JAMA. 2020;
  323(20):2052-2059.
\item
  Huang C, Wang Y, Li X, et al. Clinical features of patients infected
  with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;
  395(10223):497-506.
\item
  Ng, M. K., Ngo, J., Patel, A., Patel, D., \& Ng, K. K. (2020). A Case
  report of rapidly lethal acute respiratory distress syndrome secondary
  to coronavirus disease 2019 Viral Pneumonia. Cureus, 12(5).
\item
  Al Noman, A., Islam, M.S., Sana, S.~et al.~A review of the genome,
  epidemiology, clinical features, prevention, and treatment scenario of
  COVID-19: Bangladesh aspects.~Egypt J Bronchol~15, 8 (2021).
\item
  Hassan SA, Sheikh FN, Jamal S, Ezeh JK, Akhtar A. Coronavirus
  (COVID-19): A Review of Clinical Features, Diagnosis, and Treatment.
  Cureus. 2020 Mar 21; 12 (3):e7355.
\end{enumerate}

\textbf{Supplements:}

\textbf{A table of vital signs recorded in ICU:}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Day (Date)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Vital signs}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Body temperature (°F)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Blood pressure (mmHg)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Heart rate (beats/ min.)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Respiratory rate (breath/min.)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Oxygen Saturation (\%)}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
27 April 2021 (H 0/S 6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98.4\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
90/52\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
152\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
94\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28 April 2021 (H 1/ S 7)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
98\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
100/65\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
140\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
76\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
94/65\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
124\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
89\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
29 April 2021 (H 2/ S 8)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.2\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
95/62\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
105\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
90\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
106/62\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
30 April 2021 (H 3/ S 9)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
98.4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
98/56\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
91\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
106/72\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
71\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
01 May 2021 (H 4/ S 12)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
98\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
112/60\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
81\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
23\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
96\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
123/74\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
72\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
02 May 2021 (H 5/ S 11)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.6\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
122/72\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
88\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
92\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
128/72\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
72\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
96\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
03 May 2021 (H 6/ S 12)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.1\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
134/86\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
67\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
94\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98.4\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
125/78\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
99\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
04 May 2021 (H 7/ S 13)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.6\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
134/86\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
65\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
96\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
133/80\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
70\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
23\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
99\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
05 May 2021 (H 8/ S 14)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
127/81\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
61\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
26\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
96\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97.8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
129/76\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
76\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
06 May 2021 (H 9/ S 15)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
12:00 AM\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97.1\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
120/80\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
86\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12:00 PM\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
97.8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
122/78\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
78\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
95\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

*** H means Hospital Day and S means Sickness day.

\selectlanguage{english}
\FloatBarrier
\end{document}

