Detection and Management of Coronavirus: Your complete guide by Dr. Ravi Malik

New Delhi, Apr 29: With the pandemic raging, the healthcare system is under immense stress. In these times it is important to ensure that we do not up adding to the list of severe cases.

Dr. Ravi Malik, CMD, Radix Healthcare, MBBS | MD MAMC, Delhi in a document titled Detection and Management of Coronavirus says, our healthcare infrastructure is in a mess currently, let all of us get educated on Covid and become Covid Doctors so that we ensure that we don't add to the list of severe cases who need hospitalisation and at home can treat ourselves and our families and at the same time know when to knock the doors of a hospital. Let us ensure that there is no 3rd wave by acting paranoid, acting swift and ensuring there is mass vaccination.

Symptoms: While fever, tiredness, body pain, dry cough are the most common symptoms, diarrhoea, loss of taste, smell and sore thread are the less common symptoms.

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.

Ways to monitor:

Get a pulse oximeter and check your SPO2 regularly. Any reading 95.

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 tem- perature is 98.6 F. But in recent times temperature varies between 97.5-99.6 F.

Fever medicines like Paracetamol/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.

In case of body pain please take Mefenamic Acid eg. Meftal 500 but only SOS (Sign of Stress). Again, for all medications please con- sult 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.

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

Test: The report says that 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. While CT Scan is a fairly conclusive test for COVID-19 testing, this should be a last resort as it is extremely probe to radiation.

Do the following on emergency 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, ashwagand- ha, 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 person- al 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 only after consultation with doctor:

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.

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 consult- ing a doctor. Favipiravir selectively inhibits the RNA polymerase which is necessary for viral replication.

Ivermectin: This is an inhibitor of Covid-19 causative virus (SARS CoV-2). 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 iver- mectin as a drug is an antiparasitic and has been approved by the FDA for the same classification, please consult your doctor before taking this.

Antitussive for cough: Cough syrup eg Benedryl; chlorpheniramine are used for symp- tomatic cough relief. It should be taken after consultation with your doctor.

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 guid- ance of a doctor, not to be consumed as such for mild / moderate cases without comorbidities.

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.

Admission indicators:

1.

2. Fever not getting under control by antipyretics/steroids

3. Comorbidities
4. Worsening CT / Lab reports 5. Breathlessness

Severe COVID-19 cases:

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 Rem- desivir within the first 10 days of the first symptom. Role of Rem- desivir 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.

IV steroids: Steroids have proven to be life savers in case of high CRP / hypox- ia. In cases where oral steroids don't work get admitted & IV ste- roids should be started.

Broad spectrum antibiotics: To cover for super infection / secondary bacterial infection, IV antibiotics like monocef can be started in a hospital environment.

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.

Plasma therapy: Wildly disputed theories are there for Plasma Therapy, but as the disease is so new, for serious patients we should try each & every- thing. We've seen PT works, & a shot must be given in serious cases.

Detection and Management of Coronavirus: