𝐂𝐀𝐑𝐄𝐄𝐑 𝐒𝐀𝐍𝐃𝐇𝐈

All methods listed here are for informational and educational purposes only and are to ensure that patients do not fall victim to these healthcare disasters. Please consult with your doctor for case-specific recommendations. Because we have also listed the names of the drugs. Not only do we not want to waste patients time searching Google, we have no vested interest / vested intention in promoting any drug brand as a group). Stay safe / create safety bubbles around you / be unsatisfied / wear a mask / get vaccinated. As a hospital promoter I can say that patients who were vaccinated have very mild / moderate symptoms. Vaccines may not protect you from infection but they will definitely help save your life. Your healthcare, infrastructure is currently in disarray, let us all learn about Covid and become aware of covid so that we can ensure that there is no need to be included in the list of critical patients. And at the same time know when to knock on the door of the hospital with you and your family at home. We will make sure that by doing the right thing at the right time, reducing the rapidly growing number of patients and vaccinating there in large numbers, the third wave will not come ….

What if I have a corona ???

Common symptoms-

Fever Fatigue / limb pain dry cough

Unusual symptoms-

Diarrhea Taste and odorlessness Sore throat

ISOLATION
THE BEST WAY TO PROTECT YOUR LOVED ONES

In case of any such symptom, the 1st thing to do is ISOLATE. Being  paranoid is the best strategy.
Covid-19 is a highly contagious disease. On the first symptom,  remember to strictly isolate.

SpO2
GET A PULSE OXIMETER AND CHECK YOUR SPO2 REGULARLY

The correct technique to using SpO2:
Sit on bed/chair. Place the SpO2 monitor on the left index/middle
finger and wait for 45 seconds. The 45th second reading is your SpO2 reading.
Any reading < 92 is an indication for Oxygenation. Normal Spo2 is > 95.

Awake Proning (lying face down): For saturation below 94 to improve oxygenation.

TEMPERATURE

1. Monitor temperature by a mercury thermometer. It gives a very  accurate reading (better than digital). Normal temperature of human body is 97.56 F to 99.6 F. We consider fever only when temperature is > 99.6 F. You probably heard that the average human body temperature is 98.6 F. But in recent times temperature varies between 97.5-99.6 F

2. Create a temperature chart.

3. Fever medicines likeParacetamol/Dolo/ Crocin/Calpol should  only be taken in SOS meaning Signs of Stress (in case of symptoms)  and not regularly. But the minimum time interval between 2 doses of  any antipyretic should not be less than 4 hours.

4. In case of body pain please take Mefenamic Acid eg. Meftal 500  but only SOS (Sign of Stress). Again, for all medications please consult your doctor before taking. The purpose of this document is to  ensure that you know what options you have & can discuss with your doctor & not to self administer as different bodies react differently to medicines.

5. If antipyretics are not able to decrease the fever & within 4 hours of taking them again fever is emerging, instead of taking the medication again please do Cold Compression\Tepid Sponging & do a doctor consult.

TEST TEST TEST

1. We understand that RTPCR/other testing modalities are in short  supply. But try to arrange for an RTPCR as soon as possible.

2.  If an RTPCR is not accessible please get a RAT(Rapid Antigen  Test) done, though the false negativity is high and if the test shows  positive for Covid-19, then no further RTPCR and CT needs to be  done, but in case of negative test RTPCR/CT needs to be done. If  RTPCR comes as negative and still symptoms persist, then please  get a CT scan done.

3. CT Scan: this is a fairly conclusive test for Covid testing but should  be used as a last resort as its extremely radiation prone (X-ray) and  not accessible for all cases.

Ground Glass opacities is a diagnostic of Covid in these times.  (CORAD Score helps in Diagnosis & CT Severity Score helps in Prognosis estimation).

START THE FOLLOWING TREATMENT ON EMERGENCE EVEN IF TESTING HAS NOT BEEN DONE
1. ZINCOVIT 1xBDx10 days (12 hourly) Multi-Vitamin + Multimineral  Support.
2. Limcee chewable vitamin C tablets 1xTDSX10 days (Three  Times a Day).
3. Steam with camphor TDS (Three Times a Day).
4. Gargles and Betadine BD (12 hourly).
5. Drink a lot of liquids:
i. Lemon Juice
ii. Haldi milk
iii. Anar Juice
iv. Mausami Juice
v. Water
vi. Soup
vii. Methi seeds in water
viii. Kaadha
xi. Coconut Water

6. Have a nutritious diet with fresh vegetables, fruits, ashwagandha, amla, chawanprash, high protein diet(dal, raw paneer, soya,  milk, nuts). There is no study to show the significance of the  above food and liquid intake; this is purely on the basis of personal experience and the fact that they don’t have any side effects  and augment general immunity.

7. Pranayama and breathing exercises.

WHAT TO DO WHEN TESTED POSITIVE (MEDICATION) * ONLY AFTER CONSULTATION OF YOUR DOCTOR

1. ANTIBIOTIC
Covid is a viral infection technically there is no role of an antibiotic  but to contain any bacterial superinfection, it should be taken. Eg:  Azithromycin 500 mg OD x 5 days, Doxycycline 100 mg BD x 5  Days.

2. ANTIVIRAL
The use of a drug called Favipiravir has been recommended by  the NMPAC and has been used in the US as well. Favipiravir (oral)  medicine is given in the following way:
Day 1: Loading dose: 1800 mg x BD
Day 2 – Day 7: 800 mg x BD
The consumption of favipiravir should only be done after consulting a doctor. Favipiravir selectively inhibits the RNA polymerase  which is necessary for viral replication.

3. IVERMECTIN
Is an inhibitor of Covid-19 causative virus (SARS CoV2). It has  been shown to have 5000 fold reduction in virus at 48h in cell  structure. Ivermectin is taken 12 mg OD x 3 days. Though ivermectin as a drug is an antiparasitic and has been approved by the  FDA for the same classification, please consult your doctor  before taking this.

4. ANTITUSSIVE FOR COUGH
Cough syrup eg Benedryl; chlorpheniramine are used for symptomatic cough relief. It should be taken after consultation with  your doctor. Mucinac 600 dispersible tablets is a sugar free mucolytic medicine. It works by thinning the mucus (phlegm), making it easier to cough out. It clears the air passage and makes breathing easier and also has anti-oxidant action. To be taken after consultation with your doctor. 1 x BD x 7 days.

5. ANTICOAGULANTS
As we learned about the connection between blood clots and  COVID-19, we knew that aspirin used to prevent stroke and heart  attack could be important for COVID-19 patients *This is only for  heart / stroke patients & to be administered under proper guidance of a doctor, not to be consumed as such for mild / moderate cases without comorbidities.

6. INHALED BUDESONIDE
A steroid used to treat asthma, if given early to Covid-19 patients  with mild symptoms, scales down the need for urgent medical  care and reduces recovery time, a new study published in The  Lancet Respiratory Medicine has said.

THE CURIOUS QUESTION OF
STEROIDS?
1. Steroids are extremely effective in moderate to serious cases.
2. We preferably defer giving steroids for the first 7 days as the  virus is in its replication phase and administration of steroids may  lead to flaring up of the viral replication.
3. Both Dexamethasone and Methylprednisolone are being used.  Eg: Dexona/ Dexacort (6mg OD x 5 days) + 3mg x OD x 3 days +  1.5mg OD x 3 days. In case of methylprednisolone (Medrol 16 mg  BD x 5 days + 8 mg BD x 3 days  + 4mg BD x 3 days).
4. Steroids are never stopped  abruptly and need to be stopped
in a weaning depreciation manner.
5. Steroid administration has a lot of uses/ harms. Thus caution  should be that this needs to be administered only under the supervision of a doctor.
6. Steroids behave very weirdly in diabetes’ blood sugar level  needs to be monitored during the steroid treatment and diabetic  medication may need to be altered while on steroids.
7. In cases where fever does not subside/ CRP does not get under  control/ hypoxia occurs and steroid can be given but in consultation with a doctor.

INVESTIGATIONS
On day 7, a CT scan should be done and CT severity score should  be checked. On day 4/7/11 Covid profile should be done which has  the following tests: (repetitive lab investigations need to be done only in moderate to severe cases as per your doctors suggestion. Else, in mild/asymptomatic cases lab tests are not required unless indicated by the doctor)
1.Complete Blood Count * 2.Albumin/Globulin/AG Ratio 3.LDH *
4.S. Ferritin *
5.AST
6.ALT
7.Urea *
8.Creatinine *
9.IL6 (Semi-Specific)
10. D-Dimer *
11. CRP *
12. Procalcitonin
13. PT

ADMISSION INDICATORS
1. < 93 SpO2
2. Fever not getting under control
by antipyretics/steroids
3. Comorbidities
4. Worsening CT / Lab reports
5.  Breathlessness

SEVERE COVID CASES
1. REMDESIVIR
Though there are a lot of theories on the efficacy of Remdesivir,  but our experience at Radix Healthcare showed that Remdesivir is  effective. Though there is no conclusive evidence but in cases  where hospital admission is indicated we’re recommending Remdesivir within the first 10 days of the first symptom. Role of Remdesivir is questionable post 10 days of the first symptom. Dose  100 mg X 6 vials. Stat dose of 200 mg on Day 1, then 100 mg  every 24 hours till day 5.

2. IV STEROIDS
Steroids have proven to be life savers in case of high CRP / hypoxia. In cases where oral steroids don’t work get admitted & IV steroids should be started.

3. BROAD SPECTRUM ANTIBIOTICS
To cover for super infection / secondary bacterial infection, IV antibiotics like monocef can be started in a hospital environment.

4. TOCILIZUMAB
This is a wonder drug in serious cases. Comes in names such as  Actmera. This is an IL-6 inhibitor which has proven to save a lot of  lives in cases of Cytokinin Storm / highly elevated IL-6 levels.

5. PLASMA THERAPY
Wildly disputed theories are there for Plasma Therapy, but as the  disease is so new, for serious patients we should try each & everything. We’ve seen PT works, & a shot must be given in serious  cases.

(Note- This article is based on article of Dr Ravi Malik, CMD, Radix Healthcare, MBBS | MD MAMC, Delhi. All rights and responsibilities are towards them. We just provide this for knowledge and information purpose only.)