*Answers to Frequently asked questions by Covid-19 patients / Relatives*
- Fever may or may not be there, cough may or may not be there.
- Fever, malaise (weakness), bodyache, cough & cold.
These symptoms are present in >70% of patients, but covid-19 can be there in absence of these symptoms too.
- Loss of smell, loss of taste, abdominal discomfort and pain can be there as isolated symptoms as well.
Younger patients have more fever. Elderly and diabetic/heart disease patients have more weakness.
- Patient with isolated loss of smell usually have no pneumonia or mild pneumonia.
- If your initial blood report don’t reveal any other cause of your symptoms and symptoms persists beyond 3-4 days, I advise HRCT Thorax.
- Pneumonia due to covid-19 can be there even without cough/fever/breathlessness (only fever/only weakness/mild cold with loss of smell, abdominal pain can also have pneumonia but it is usually mild in them).
- It is important to do HRCT Thorax , mainly in elderly/diabetic/hypertensive patients . As per lung involvement in HRCT Thorax, your doctor can advise further treatment plan and assess severity and predict further course of disease.
- HRCT thorax can be normal in first 3-4 days of symptoms. So if symptoms persists and no other cause of same established by blood reports, your doctor may advise to do repeat HRCT Thorax in selected patients later.
- If your lab reports and CT Scan suggest covid-19 and your doctor doesn’t feel other diagnosis possibility, doing nasopharyngeal swab for covid-19 PCR isn’t required as it will not alter treatment.
- It has 60% sensitivity , so 40 out of 100 times it can be false negative too. Even if it is negative, it doesn’t mean you don’t have covid-19.
- It is indicated in admitted patient to know status of viral load and to know trend of viral load after starting antiviral treatment (FAVIPIRAVIR/Remdesivir).
Following symptoms/signs suggests admission to avoid getting more critical before admission in hospital.
- Breathing difficultly at rest or with limited activity (like going bathroom)
- Oxygen level (at rest/after 5min walk) – SpO2 <94-95%
- Generalized weakness (unable to get up from bed)
- Severe vomiting and unable to eat anything
- Persistent high grade fever not relieved after taking paracetamol as well
High risk patients e.g. elderly, diabetic, heart disease patients with CT scan moderate-severe involvement may be advised admission without above symptoms as well for better monitoring.
Younger patients may have fever upto 10-12 days , after 7-8 days frequency/Intensity may decrease but can persists upto 12-14 days and it doesn’t require admission if relieved with paracetamol.
Fever , cough, weakness, decreased appetite etc (any of them in single/combination) may persist upto 8-14 days and it doesn’t require admission.
More fever initially upto 7-8 days in younger patients is due to good immunity , your body is fighting with virus to get rid of it and you don’t need to worry for it if only fever.
My family member got covid-19 and we are living togather or my office colleague got covid-19 positive and we were working togather or I have children and I was in contact with them , what should I do? Which medicine should I give them?
- Be alert and don’t ignore if any symptoms as mentioned above. If no symptoms as of now, do not worry. It is not necessary that you may also get infection or symptoms. No test required if asymptomatic.
No need to give any medicine for prevention as well if asymptomatic.
- No medicine can prevent covid-19. But good immunity may help to get rid of virus early , so eat healthy, maintain good nutrition and hydration and follow all precautions – mask, social distancing and hand hygiene.
- Elderly , diabetic, heart disease patient can take Vitamin D3, Zinc, Vitamin C tablets but it is not mandatory and it will not prevent covid-19. Eating healthy diet, fruits, vegetables can equally helps to build good nutrition and immunity.
- Stay inside the room for maximum times. Come out only if essential. Whenever coming out, wear mask and wash hands before and after coming out.
- Can use AC but keep windows open for atleast 30-60min in morning and evening to get fresh air and get rid of recirculation of contaminated air.
- Use disposable utensiles if possible. Else use different utensils for yourself & wash separately.
- If someone else is taking care, usage of mask and gloves is mandatory for them.
- Use separate towel, napkins, cloths etc. Keep your cloths, bedsheet, curtains etc in separate bucket in hot water + disinfectant solution (dettol) for atleast 30 min and then give for washing.
- Use 0.5-1% hypochlorite solution for surface cleaning and phenyl for toilet cleaning.
- If no one is coming in room repeatedly, can change bed sheets , linen and do surface cleaning after isolation is completed and daily change is not mandatory.
- Avoid contact with elderly, children and pregnant ladies.
- Eat anything but healthy home made food, avoid spicy and fried food. Have more liquid and maintain hydration.
- If not able to take more solid food, have soup, milk, fruits, juice, dal-rice, khichdi etc.
- Drink normal/warm water(not hot), drink Green tea with honey and ginger added in it for 2-3 times a day.
- It is not proven that it will prevent or cure covid-19. It may help to slow disease progression or viral replication but that is also not proven yet. You can take it but if you develop vomiting/acidity etc, you can stop it.
- Any patient with heart disease or >60 years should have baseline ECG with normal QT interval before starting HCQ tablet.
- Practically for most of us, it is difficult to strictly follow all precautions while staying at home under isolation.
- If having only one common toilet bathroom, use bathroom in morning only after everyone else have used it and then do cleaning.
- While going for toilet and washroom, use mask and follow hand hygiene. For extra precautions, wear gloves and gown while coming out of room.
Isolation terminology is for patient who is symptomatic and suspected and qurantine is for contact of patients or family members who are asymptomatic.
- As per data till now, it is useful for treatment of mild cases only , beneficial only if given within 7 days (that’s the period during with viral replication occurs). Beyond that it may not help, but can be given if viraload high and mild symptoms. Persists beyond 10-12 days. Maximum benefit only if started earlier.
- We can not say strongly yet whether it really works or not but it is only antiviral we have right now and better than Chloroquine/HCQ that we can use in OPD patients without admission and as per available data, it may decrease disease severity and symptom duration.
- Younger patients with good immunity will recover without any medicine (HCQ/FAVIPIRAVIR).
- I prescribe FAVIPIRAVIR only if patients come within 5-7 days and specifically >50 yr, diabetic, heart disease or any other immunocompromised condition.
- I prescribe it for 7 days initially and if required, extend duration upto 14 days.
- I prescribe 1600mg BD first day f/b 600mg BD in patient <65kg weight, for >65kg weight, I prescribe 1800mg BD for first day f/b 800mg BD.
- Dexamethasone and tocilizumab are immunosuppressants and remdesivir is antiviral drug.
- None of this is magic bullet and cures or prevents covid-19.
- Many relatives of patients ask doctors to give dexamethasone or tocilizumab and remdesivir to their patients and many times due to relatives’ pressure and as doctor is already exhausted in explaining all patients, doctor has to give these drugs in patients in which it may not be beneficial. Leave decision to give or not to treating doctor only.
- Dexamethasone is steroid , so it will suppress your immune system. So it may delay viral clearance, prevent natural immune response to reinfection and predispose to secondary infection as well, so it should not be taken without your physician consultation. Same for tocilizumab, it should be used only after trial of dexamethasone and only in Cytokine storm and moderate hypoxia, not first line therapy.
- I usually prescribe dexamethasone only if hypoxia (oxygen level <94%), disease duration beyond 7-10 days and if inflammatory markers (CRP, Ferritin, IL-6) are significantly elevated. Dose should be upto 10mg dexamethasone/day as well, high dose may be detrimental except in selected cases upto 20mg/day can be used.
- If patient is admitted, also check if viral load is high, moderate or low. If high viriloid , it should not be given and if need to be given due to Cytokine storm , should be given along with
- High inflammatory markers in initial 7-10 days is usual as your body is trying to get rid of virus , there will be elevation in Cytokine levels. There should be balance between both – inflammatory response and immunosuppression. Over inflammatory state and immunosuppression both are harmful. So using it at right time in right dose can be helpful but not blindly in all patients.
- It is wrong belief that once patient is on ventilator, patient will die.
- Mortality rate is high once severe ARDS and patient is on ventilator. Ventilator itself doesn’t mean patient will die. Many times magically after putting patient on ventilator, they improve and come out of ventilator in 5-7 days as well.
- Ultimately if patient is provided good Intensive care and supportive care & if patient’s general condition, immunity and nutrition status is good, although it will take time but patient will recover.
- Always consult ICU specialist (Intensivist) and have faith in them whenever your patient is in ICU.
- We have saved several patients of severe ARDS as well in our ICU without any magic drugs & with only good Intensive care , many patients who remained on ventilator even for 2-3 weeks as well and 1-3 months in ICU and now living normal life. So patience of relatives and doctor both is very important in such cases.
- <10% cases develop severe ARDS and they are critical , so our focus should be more on prevention of disease or prevention of disease progression. So I urge everyone to follow simple
measures as advised repeatedly – mask, social distancing and hand hygiene.
- Don’t get trapped in alternative therapies, they may not have beneficial effects but may have untoward side effects as well.
- Last thing I would request everyone is don’t consult multiple doctor for same problems and waste your as well as your doctor’s time. Have faith in your doctor. Consult doctor in whom you have faith rather than running to 2-3 different doctors and forwarding reports to different doctors daily.
- All physicians are working harder and exhausted already , so do not call them for minor issues repeatedly and don’t call for second or third opinion.