As the second wave of the coronavirus has severely hit the country, there is a lot of confusion and controversy related to the rational use of medicine to combat it. Referring to various recently peer-reviewed journals, live experience of national and international consultant physicians, and my own experience, I am sharing a few evidence-based facts.
Covid Infection has 2 phases:
a.) Viral Phase (May last up to 5-7 days) followed by
b.) Inflammatory/Cytokine Phase
Warning Symptoms (When to consult doctors and hospitals):
1.) If fever/cough lasts for more than 5-7 days (mild/moderate/severe)
2.) Sweating at night
3.) if SpO2 (Oxygen Saturation Level) rapidly falls 2-3% below baseline after a 6-minute walk (for age up to 60 years) and 3-minute walk (for 60 years and up)
4.) Sudden tiredness and decreased appetite
5.) Difficulty in breathing (patients start speaking in fewer words than a complete sentence)
Basic mandatory test that can check if the condition is worsening to check the severity of inflammation after rt PCR is positive:
1.) CRP
2.) HRCT
Additional tests (ESR, CBC, RFT, LFT, D-dimer, IL-6, PT/INR, Chest X-ray) can be done in Hospital settings, while isolated patients at home can refrain from such tests to minimize exposure.
Basic prophylaxis that we are aware of:
1.) Tab. Vit.C 500 mg po BD for 14 days;
2.) Tab. Zinc 20 mg po BD for 14 days;
3.) Tab. Shelcal 500 mg po OD for 14 days;
4.) Tab. Azithromycin 500 mg po OD/ Cap. Doxycycline 100 mg po BD for 5 days (No role on Covid)
5.) Tab. Ivermectin (0.2 mg/kg body weight) PO OD for 3 days;
6.) Tab. Paracetamol 500 mg/1 gm po TDS/QID( based on severity);
7.) Pronal exercise to maintain the oxygen level of the body.
Added rational drugs alongside prophylactic drugs:-
1.) Inhaled Steroids (Preferably MDI Budesonide 800/400 mcg BD through inhaler/spacer) if fever and cough are present within the first 5-7 days.
( Note:- Do not take your Covid lightly if fever subsides after 3-5 days since current practices and outcomes have shown that the second week of isolation is more dangerous than the first week. So, maintain strict isolation for 2 weeks regardless of whether you are symptomatic or asymptomatic.
2.) Oral Steroids (Preferably Tab. Methylprednisolone 8-16 mg po BD) if symptoms persist beyond 7 days
3.) Injection Dexamethasone 8mg iv OD is found to be a mainstay and first line of management to counter inflammatory response during moderate to severe cases
4.) Anticoagulants like Low Molecular Weight Heparin (Enoxaparin) are safer options to combat thrombosis in the lung and heart for critical cases.
Controversies and Black Marketing:
1.) Injection Remdesivir
2.) Tablet Favipiravir
3.) Convalescent Plasma Therapy
4.) Injection Tocilizumab( Most Recently)
Common people and the media seem to believe these drugs are life-saving drugs, which is entirely baseless. No paper, scientists, or even consultants have claimed them to be ‘life-saving drugs.’ Recently conducted clinical trials have shown that Inj. Remdesivir, Tab. Favipiravir and Convalescent Plasma Therapy reduce viral load and decrease hospital stay but have no role in reducing patients’ mortality.
Similarly, Injection Tocilizumab is an immunosuppressant that is only given in the critical stage if there is a cytokine storm. These drugs mentioned above and therapy must be judiciously administered only by trained doctors in hospital settings. Else, there is a high chance of secondary infection, and patients may die with it. So, there is no point storing them at home.
You can manage your symptoms, and 90 percent of infected patients need not be hospitalized if they follow this basic protocol under the guidance and supervision of their doctors. Thermometer, pulse oximeter, sanitizer and masks are mandatory to be kept with themselves for all infected cases. For any queries, feel free to email me. Stay safe, stay motivated.
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