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Ready Referencer on All Apprehensions on Corona

Note: The undermentioned GUIDELINES & RECOMMENDED COVID PROTOCOLS are for General Information Purpose only. Although, the undermentioned GUIDELINES & RECOMMENDED COVID PROTOCOLS are based on an Informative & Authentic General Consensus of Qualified Medical Practitioners and ICMR on Corona, and are intended to provide accurate and useful information, but nonetheless, the Readers are strictly instructed to consult their respective Doctors/ Medical Help, before relying upon these guidelines.

Q. What are the common symptoms of COVID-19 infection?

A. Common symptoms include:

• Fever, tiredness/fatigue, difficulty in breathing, headache, body ache, throat pain, running nose, cough, vomiting, loose stools (diarrhea), redness of the eyes
• Most patients have mild illness, and can be managed at home

Q. What are the common symptoms in children?

A. Children generally have a mild illness, and rarely need to be hospitalized. Common symptoms include:

• Fever, sore throat, cough
• Small children may have loose stools, vomiting, abdominal pain
• Older children can complain of headache, body ache and tiredness

Note: Severe disease is uncommon in children

Q. Who are the people at high risk?

A. Those who:

• Are elderly, i.e., above 60 years old
• Are overweight/obese
• Have diabetes, hypertension
• Have pre-existing diseases of lungs, liver, heart or kidney
• Are on cancer treatment or immunosuppressant medicines

Q. What is the Standard Protocol for COVID 19 positive adults as well as presumptive positive patients:

A. The Recommended Standard Protocol for COVID 19 positive adults as well as presumptive positive patients:

1. Strict isolation and finger Oximeter (in right hand middle finger) readings at rest and after 6 min walk thrice a day; should remain above 94%. All positive patients in the same house do not have remain in different rooms. The danger period in which oxygen level (Oximeter reading) may fall is generally from day 5 to day 11 since onset of first significant symptom, and rarely earlier or later.
2. Normal diet; no restrictions. Increase protein intake; reduce carbohydrate intake. Also, patient with chronic illnesses like diabetes and kidney disease should follow disease specific dietary restrictions.
3. Remain well hydrated if febrile, or if you have loose motions. For those with severe heart or kidney disease should be drinking fluid within limits ( 1 to 2 litres per day, as may have been advised by their specialist doctor).
4. There is no specific treatment for COVID 19/Corona virus infection. Only symptomatic treatment is needed.
   • for fever, keep a systematic record on paper. Avoid taking even Paracetamol 650 mg if fever is below 102 and is not bothersome. Take maximum One Tablet, Six hourly. In some patients the fever may not ‘break’ for two weeks or longer. Please don’t worry if fever is the only symptom. Dolo-650 is also given if a patient has severe body ache, headache, severe throat pain, severe eye pain.
   • Sore throat: warm saline gargles or betadine gargles, thrice a day.
   • Throat irritation, sneezing or running nose: Tab Levocetirizine (Levocet) or Cetirizine (Zyrtec): One tab once a day and any home remedies. Another option is to take Tab Allegra (120 mg tablet) for runny nose, congestion or stuffiness, sneezing, itching, swelling, and watery eyes.
   • Dry Cough: steam Inhalation and Tab Montair LC; one tab per day ; Wet Cough (with phlegm/sputum): Bro-Zedex Syrup, 1 or 2, teaspoons thrice daily, as long needed. Steam inhalation can be harmful if not done properly; avoid it.
   • Loose motions:
     • Take Electral Oral Rehydration Powder, as many times as needed;
     • Tab Imodium 2 mg: two tablets first day, one tablet next three days. Preferably avoid it as it can have some significant side affects.
     • Also take simply home made ‘dahi’ or yoghurt or probiotic Enterogemina once a day for 5 days.
     • Eat light meals such as kitchdi with dahi, banana, daal, coconut water, etc.
5. General immmunity boosters:
   • Vitamin C 1000 mg, twice daily for 15 days.
   • Vitamin D supplementation (tablet Tayo 60 K; once a week for seven weeks, if needed. Do blood test for Vitamin D before starting it.
   • Tab Zinc 50 mg (Tab Zinconia) for 15 days
6. Continue all medicines already being taken for chronic illnesses like high BP, diabetes, thyroid illnesses, asthma, cancer, arthritis, etc

Q. What tests should be done?

• Diagnosis of Covid-19 infection can be confirmed by an RTPCR (Real Time Polymerease Chain Reaction) test
  • Sample should be given as early as possible in the disease, preferably the day of first symptom. Viral load is higher earlier, so the chances of accurate results are higher. This will also reduce the spread of infection.
• If during the 2nd week of illness, the patient deteriorates, then other tests (such as blood test/X-ray/CT scan etc.) are required to find out how severe the illness is. The medical doctor with whom the patient is in touch with should be able to guide if/which tests are required.
• In RTPCR Test, the CT Value indicates the number of cycles of polymerease chain reaction, required to detect the presence of virus. Higher the CT value, lesser is the probability of the infected person to spread this virus further. The CT Value lesser than 35 is considered as corona positive.

Note: The person should isolate himself/herself and take all necessary precautions while the RTPCR test results are awaited

Q. What are the Type of Blood Tests which are recommended to be done?

A. If the Corona Symptoms are there, and there is a delay or difficulty in conducting RTPCR Test, then following Blood Tests may be done:

It is suggested that following blood tests be done on empty stomach only if baseline information on inflammation and coagulation markers in the blood is considered necessary.

• CBC (Complete Blood Count)
• CRP (Higher C-Reactive Protein indicates body’s natural reaction to any virus or infection, and indicates presence of infection in body, not necessarily corona CRP values from 1-5 are considered as normal)
• LFT (Liver Function Test)
• KFT (Kidney Function Test)

Those with co-morbidities (such as obesity, diabetes, high BP, asthma, kidney disease, liver disease, smokers, chronic chest diseases, history of lung tuberculosis, etc) should also do:

• Ferritin
• LDH
• D-Dimer
• Interleukin 6

Those with diabetes also do:

• Fasting blood sugar
• HbA1C

Those who are taking Thyroxine for hypothyroidism should also do:

• Thyroid Function Tests.

Q. When is HRCT Test is recommended?

A. HRCT Test should be done only as per the advice and supervision of a qualified Doctor. 

Those with normal oxygen levels (above 94) on room air or low flow oxygen don’t need HRCT. If assisted ventilation is required HRCT may be needed. CT score being done these days may have interpretation issues, and hence do not get alarmed. Usually, CT Scores from 1-9 indicate mild infection, from 9-15 indicate moderate infection and 15-25 indicate severe infection.

• • HRCT Indications:
    • COVID RT-PCR negative patients who are having severe cough or very high fever for five days.
    • COVID RT-PCR positive admitted patients with deterioration in clinical parameters, when course of further management is unclear.
    • Symptomatic patients who are not getting access to RTPCR with wait time of upto 5 days from onset of breathless, respiratory distress, or severe cough with or without sputum
    • Not to be used as a screening tool on self-diagnosis basis.

• Much more important than blood tests or HRCT findings are the oxygen saturation level as seen in the finger oximeter at rest and after six minute walk. Focus on your oximeter readings, which should normally be above 94%. *Check Oximeter readings in the middle finger of your dominant hand. Do so at least thrice a day. Check both at rest and after walking around the room for six minutes.
• The oximeter reading remains above 94% in the vast majority of patients. Those with past history of lung problems, very elderly or smokers (even social smokers) may ‘normally’ have oximeter readings which are up to 5% lower (between 89% and 94%) than others. Normally such patients may become serious especially if their oximeter reading falls after 6 minutes of moderate exercise by more than 4% or 5%. However, if the reverse happens (Oximeter reading improves after 6 min walk) then it is reassuring that no reason to worry. In fact, it means that it is all the more important to not keep lying down in bed all the time but to walk around the room/apartment as much as the patient can.
• When lying in bed the patient should lie on either side or on the stomach (prone position) for 30 to 45 min at a time a few times a day. This improves significantly oxygen supply to the lungs and that should improve the oximeter reading by as much as 3% to 5%.

Q. When should a person be isolated?

• The moment a person experiences first symptom, he/she should be isolated immediately
• Anyone who has come in contact with a Covid +ve person should stay separate (quarantine himself/herself) and be watchful of symptoms for 7 to 10 days.

Q. What is important while isolating a COVID +ve patient?

• One should stay in a separate room (This is most important. But if not available, stay more than 6 feet away from others and in that case, all should wear a mask and should not have food together)
• Use separate bathroom, if possible (else, clean well every time after the use by a Covid +ve patient)
• The patient should wear mask all times (preferably double mask)
• Room should be ventilated i.e., windows that open outside of the house should be opened
• No one should enter that room (wear a double mask, if urgently/temporarily required to be in the room)
• Food should be served separately outside at the door of the room (anybody taking care of a Covid +ve patient should wear a double mask)
• Patient should eat within the room and wash the utensils with soap and water
• Those with Covid +ve in a family can stay together (even in the same room)

Note: Double mask means - a surgical mask inside and then a cloth mask outside. N95 mask is more protective than a double mask. Isolation does work well to reduce spread of infection within the family and outside. It needs to be done with rigor and meticulously.

Q. How to look after child if one/both parents are COVID +ve but child is not?

• A small child will be most comfortable with parents. If one parent is Covid -ve/does not have symptoms, the child can stay with him/her. If both are Covid +ve/have symptoms, the child should stay with them. Sending the child elsewhere may lead to spread of infection to others. The child should not be in the care of the elderly or those at high risk.
• If the child can be taught to wear a mask, he/she should be encouraged to wear a mask, if above 2 years.

Note: Children usually stay with mothers/parents for practical reasons. They should not be sent to the home of grandparents.

Q. How to prevent elderly/those at high-risk at home from exposure?

• Keep them separate as much as possible and reduce physical interaction with them. Avoid going close to them without masks.
• Anybody who frequently goes out to work/play and interacts with others outside, should avoid contact with them (as well as others in the family).
• They should be immediately isolated/separated whenever a case occurs in a household.
• They should be vaccinated.

Q. How to go about domestic helps/drivers?

• Firstly, they should be told clearly that if they are not well or have any symptoms, they should inform you and not come to work.
• When they are coming, they should wash hands and wear a mask
• When they are working, try not be around at that time and if possible do not enter into that space for 20-30 minutes
• With drivers in a same cab, open windows and all should wear mask

Note: Please also make them aware about symptoms, precautions, monitoring etc. so that they know how to manage it.

 

Q. Which mask should be used?

• In the current situation, Double Masking with double or triple layered Surgical Mask and N95 mask without valve is most recommended, and unlike the first wave, cloth mask may not prevent infection.
• Cloth mask can help only in preventing the saliva of an infected person to reach any other person. But cloth mask will not completely stop spread of a viral infection. One should not rely on cloth mask if Covid +ve patients are at home.
• Mask should not be removed while talking.
• Cloth mask should be washed daily (one should have more than one and rotate). Surgical mask should not be reused.

Q. What should be monitored and how?

• Body temperature with a thermometer; 3 times or when needed
• Oxygen saturation (most important); 3-4 times in a day
  • To be measured with a pulse oximeter which should be purchased. Normally it is above 95 per cent.
  • It can be repeated while sitting, lying down prone (it may improve; this may be helpful if oxygen value is borderline)
  • If after 6 min of walk test (walking in the room or isolation area) the oxygen saturation level falls by 5 per cent or more, it is a danger sign that lung disease may happen. Please consult doctor/hospital in such case.
• Breathing rate (number of times) and breathing difficulty (discomfort in breathing)
• Oral intake, urine output should be as in healthy times.
• Alertness
• Blood pressure, pulse rate (in case of hypertensives)
• Blood sugar (in case of diabetics)

Note: Try to keep a written record. This will help your doctor to quickly assess if any change in treatment is required. Monitoring of the elderly and those at high risk needs to be done very carefully. They can deteriorate rapidly and should be taken to hospital at the slightest sign of deterioration.

 

Q. What kind of food should be eaten?

• One should eat nutritious food (adequate intake fruits and vegetables) at normal/regular timings
• Take plenty of fluids

Q. Does steam and gargles help?

• Steam and gargles can help if there is nose block and throat pain

Q. Should one exercise?

• One should take adequate rest and do routine exercises to the extent what is possible with body ache
• It is good to walk within the room or isolation area
• Breathing exercises should be done

Q. Is there any posture that can help when Oxygen saturation is low?

A. Saturation can improve by sitting, by lying down prone (on the stomach), or by breathing deeply. Please contact your doctor or hospital if saturation is falling.

Q. How to stay mentally healthy?

• Follow regular routine
• Stay in touch on social media with near and dear ones (friends/relatives)
• Do not listen to negative news
• Develop a hobby that you like

Q. Who can continue to stay at home?

A. Anybody who has a mild disease, with oxygen saturation more than 95 per cent, normal breathing, and is able to eat and drink well can stay at home
Note: The patient should remain in touch with his/her regular/family doctor while staying at home and update about symptoms and results of regular monitoring

Q. When should one go to hospital?

• If the oxygen saturation level falls (most important criteria)
  • Below 95 per cent (in case of high-risk people as mentioned above)
  • Below 90 per cent (in the case of healthy adults), though a fall of 5 percentage points is of concern.
• In case of difficulty in breathing or fast breathing (in adults, more than 30 times per minute is considered fast)
• If unable to eat and drink
• If feeling very drowsy
• Fever persisting over a week or recurring

Q. How does vaccination help?

• Available vaccines can prevent serious disease. Whoever is eligible should get themselves vaccinated.
• When going for vaccination, wear a well-fitting mask and do not remove
• Make sure that the 2nd dose of vaccination is of the same brand. Take vaccination certification of the 1st dose along or inform about the vaccine which was given earlier.

Practical Case Study

I am running fever for 3 days, and my RT-PCR result for COVID 19 is positive. What all should I do? Which tests and what medicine should I take?

General Care:

Strict isolation at home.

All positive patients in the same house can live in the same room.

Monitor your temperature six hourly. If temperature rises above 101, take tab paracetamol 650mg. Temperature, only above 101 is considered high temperature.

Monitoring blood oxygen level by pulse oximeter, 6 hourly. If reading 94 or higher, nothing to worry. If reading drops <94, start deep breathing exercises (Pranayam). Lie on your tummy (not on your back) for as long as you can; this will make your oxygen level better. If not getting better, see if you can do a six minute walk test.

* Please note that the period in which oxygen level may fall is generally from day 5 to day 11 from the date of onset of first symptom. If lying in prone position or six minute does not improve level above 94%, then supplemental oxygen is needed.

Normal diet (Patient with comorbidities need to continue to follow illness specific dietary restrictions).

Drink sufficient fluids (Patient with comorbidities need to adjust fluid intake as needs to be for each specific comorbidity).

Blood Tests:

Normally, no blood test is needed in mild cases. In those with severe symptoms (high fever, severe diarrhoea, severe fatigue etc.), the following tests may be done (fasting) as baseline:

CBC

CRP

LFT

Treatment:

There is no specific treatment for COVID 19 (Corona virus infection). Only treatment for relief of symptoms is needed.

For fever/body pains/headache: Paracetamol SOS.

Sore throat: warm saline gargles.

Throat irritation, sneezing or running nose: Tab Levocetirizine (any brand): One tab once a day.

Dry Cough: Tab Levocetirizine 5 or 10 mg; one tab per day

Wet Cough (with phlegm/sputum): Ambroxol Syrup (any brand), 1 or 2, tea spoons thrice daily.

Loose motions:

Take Electral Oral Rehydration Powder, as many times as needed;

In severe diarrhoea, Tab Imodium 2 mg as needed (Not to be given to those above 65 years)

Also take Curd, at-least once a day.

Eat light meals, high protein.

General immunity boosters: a. Tab Zinc 50 mg (Tab Zinconia) for 15 days. Tablet Vit C 500 mg for 15 days

Those with co-morbidities such as obesity, diabetes, high BP, asthma, kidney disease, smokers, chronic chest diseases, history of lung tuberculosis, etc):

Continue all medicines already being taken for chronic illnesses like high BP, diabetes, thyroid illnesses, asthma, cancer, arthritis, etc

They may also do the following tests, in addition (on advice of your doctor): Serum Ferritin, LDH, D-Dimer, Interleukin 6. These tests are NOT a must.

Those above 70 years of age or who have diabetes, hypertension or kidney disease, also do KFT.

Need for HRCT chest:

For Covid positive patients, HRCT is needed only in selected cases. It is NOT to be done as a screening tool. Those, with normal oxygen levels on room air or low flow oxygen don’t need HRCT.

HRCT Indications:

COVID RT-PCR negative pts who are having severe cough or very high fever for more than five days. In such cases CT helps in diagnosis of COVID.

COVID RT-PCR positive patients with deterioration in clinical parameters such as falling oxygen levels more than 4% from normal level.

Symptomatic patients who are not getting access to RT-PCR with wait-time of upto 5 days from onset of symptoms such as fever or breathlessness.

Those in severe shortness of breath, or have severe cough with or without sputum, with or without positive or negative RT-PCR/Rapid antigen.

Note: CT score being given on CT these days, may have interpretation issues, and hence do not get unduly alarmed. Let your doctor take a call.

Steroid (Cortisone): Steroid is an important medicine, but is a double-edged sword. Hence, it has to be used with care.

Steroids Should NOT be used within 7 days from first symptom (fever or any other symptom), when virus is flowing in the blood (viremia), it can cause virus to grow faster, and thus prove harmful.

Steroid in puff form should be used If symptoms (fever and cough) are severe, particularly after five days - no tablets or injections.

Oral / injectable steroids to be used (under direction of a doctor):

If severe symptoms (Cough, high fever) persist beyond 7 days. It suggests excessive inflammation. If SPO2 is maintained, one may add low-dose oral steroids. (eg. Dexamethasone/ Methyl prednisolone / Prednisolone).

If the patients are worsening (usually happens after 7 days, may happen earlier rarely), when spO2 is dropping below 94%. Here steroid is given to counter lung involvement (excessive inflammation). One may need to double the dose in severe cases. Steroid given in diabetics and those with high blood pressure, need monitoring of blood sugar and blood pressure. Steroids for 5 days do not need tapering.

Note: The above GUIDELINES & RECOMMENDED COVID PROTOCOLS are for General Information Purpose only. Although, the above GUIDELINES & RECOMMENDED COVID PROTOCOLS are based on an Informative & Authentic General Consensus of Medical Practitioners and ICMR on Corona, and are intended to provide accurate and useful information on corona, but nonetheless, the Readers are strictly instructed to consult their respective Doctors/ Medical Help, before relying upon these guidelines.

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