Consensus guidance of AIIMS-trained specialists

Read this from AIIMS summary a good guidance

Looking at overall confusion and panic in society, and even doctors, we a group of AIIMS-trained doctors has tried to summarise what seems reasonable.

( on the treatment of COVID 19

Q-1: I am running a fever for three days, should I go for RT-PCR/Rapid Antigen Test/CBNAAT?

In the current situation ( April 2021), it is presumed you have Covid 19 infection. Treat accordingly. If available, get the RT-PCR test done for COVID 19. Only if the RT-PCR test facility is not there, Rapid Antigen Test or CBNAAT may be done.

Q-2: I am running a fever for 3 days, and my RT-PCR result for COVID 19 is positive. What should I do? Which tests and what medicine should I take?

(A) General Care:

1. Strict isolation at home. All positive patients in the same house do not have to remain in different rooms.

2. Monitor your temperature six hourly. If the temperature rises above 101, take tab paracetamol 650mg.

3. Monitoring blood oxygen level by a pulse oximeter, 6 hourly. If reading 94% or higher, nothing to worry about. If reading drops <94%, start deep breathing exercises (Pranayam). Lie on your tummy (not on your back) for as long as you can; this is likely to improve your oxygen level. If oxygen level not getting better, see if you can do a six-minute walk test(see below).* 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 the first symptom. If lying in a prone position or six-minute does not improve level above 94%, then you need to see a doctor, and you may need supplemental oxygen.

4. Normal diet (Patient with comorbidities needs to continue to follow illness-specific dietary restrictions).

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

(B) Blood Tests:

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

(a) CBC, (b) CRP, (c) LFT.

(C) Treatment:

There is no specific treatment for COVID 19 infection. Only, treatment for relief of symptoms is needed.

(a) For fever/body pains/headache: Paracetamol SOS.

(b) Sore throat: warm saline gargles.

(c) Throat irritation, sneezing, or running nose: Tab Cetirizine (Zyrtec): One tab once a day

(d) Dry Cough: Tab Montair LC; one tab per day

(e) Wet Cough (with phlegm/sputum): Bro-Zedex Syrup, 1 or 2, teaspoons thrice daily.

(f) Loose motions:

• Take Electoral Oral Rehydration Powder, as many times as needed;

• In severe diarrhea, Tab Imodium 2 mg as needed.

• Also take Curd, at least once a day.

(g) General immunity boosters:

a. Tab Zinc 50 mg (Tab Zinconia) for 15 days.

E. 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. You have to go by the advice of your treating doctor. You may be advised to do the following tests by your doctor -: Serum Ferritin, LDH, D-Dimer, Interleukin 6.

Just to repeat, those above 70, and those with diabetes and other co-morbidities, go as per your doctor's advice.

F. Need for HRCT chest: Those with normal (>94) oxygen levels do not need HRCT of the chest. It is to be done only if oxygen consistently remains below 94, or there is severe breathlessness. CT score being done these days may have interpretation issues, and hence do not get alarmed. Abnormal blood tests alone are NOT a reason to do CT.

G. Note:

(A). Please do not give/take Fabiflu (Favipiravir) Doxycycline, Ivermectin, or Azithromycin. None of these has any proven role. These may harm the patient as all medicines have side effects. The most common side effects of most drugs are nausea, vomiting, abdominal pain, loose motions.

(B). Steroids (Medrol/Dexona) are prohibited and dangerous for those having normal oximeter reading. Only those who need more than 3L/min supplemental oxygen support should receive a short course for five days. The early start of steroids (practiced by some) in our opinion, can make the condition worse.

(C). Neither Inj Remdesivir nor convalescent plasma is of proven value. So do not worry too much if these cannot be arranged. Neither of these will change the final outcome.

(D). Much more important than blood tests or HRCT findings is the oxygen saturation level as seen in the finger oximeter. This is the key to the management of Covid 19.

*Disclaimer: This is the simplified and basic guidance for patients and their family doctors. It is based on the consensus of five AIIMS-trained specialists with over 40 years of practical experience of each. Every patient should take treatment for COVID 19 as per the instructions of a competent doctor.

** How to measure oxygen level: Put the oximeter on the right (dominant) hand’s middle finger. First, cross-check the functioning of the finger oximeter by test readings on other members of the family/caregiver. Check both at rest and after walking around the room for six minutes. Those who cannot walk for six minutes should try and walk for three minutes at least.