Now that you are in the middle of the second Covid storm, here is a list of important information for treating physicians and patients regarding Covid management.
1) A majority of Covid positive patients would not need to get admitted. These are the ones who have no chest complaints like bad cough or feeling of shortness of breath. They can stay at home and be managed with paracetmol and/ or oral antibiotics. They need to stay in isolation until they have no fever for more than 5 days or 10 days have already elapsed since they first had fever. They don’t need any repeat Covid test.
2) Those who test positive and have respiratory symptoms and low saturations need to go to hospital ASAP. Again after they have recovered fully they don’t need repeat Covid test and it is very important to make sure that they have adequate oxygen saturations ( more than 94%) on room air and no significant dip in Oxygen saturations on ambulation. If they have low oxygen saturations but have no fever and are ok otherwise they can go home on oxygen to continue till saturations return to normal range at rest and on ambulation.
3) Remdesivir is not a life saving drug and has shown no benefits in reducing mortality in severe Covid infection cases. We didn’t use it in the second wave in our trust.
4) All admitted patients should be given a double dose of LMWH prophylaxis.
5) Injectable dexamethasone needs to be given to all admitted cases who need supplemental oxygen.
6) Tocilizumab should be given to admitted cases who need higher levels of supplemental oxygen and have severe ARDS.
7) HFNO ( high flow nasal oxygen) is recommended for those whose oxygen demands are very high and not maintained by conventional nasal or mask administration.
8) NIV is a step further if HFNO doesn’t work.
9) If patient is young and has severe ARDS then early ventilation is the best way to manage such patients.
10) For those patients who have tested positive and have only fever, there is no need for CT chest, Interleukin 6 tests. All they can do is a full blood count, CRP and a chest X-ray. Fever can stay for up to 10 days even, so don’t panic as long as there are no chest complaints.
11) No role for vit C, Ivermectin & Convalsecent plasma. Vit D can be given to those who have checked their levels and found them to be low. Otherwise there is a risk of hypervitaminosis D.
12) If you have symptoms of Covid and rapid test is positive, it confirms Covid. No need for RT-PCR. If you have symptoms of Covid but rapid test is negative then only we need RT-PCR.
13) Disease severity markers should be asked for only those patients who need admission and include trends in serum Ferritin, CRP & D-Dimer. IL-6 levels are not a routine test even in hospitals.
14) For those Covid patients who present with on going or worsening shortness of breath even after weeks or months after they had Covid infection we need CT-PA and Echocardiography as baseline tests. CT-PA will also give us lung window thereby obviate any need for a CT-CHEST and we essentially need to rule out complications like pulmonary embolism, pulmonary fibrosis and cardiac complications like myocarditis.
15) Radiologists should desist from reporting fibrosis for Ground Glass reticulations earlier on as these changes are reversible and can only instil anxiety in our patients.
Lastly, it is better to avoid Covid infection in the first place by masking, social distancing and frequent hand washing. Vaccination is the only real hope to get over this pandemic. The complication risk from vaccination is much less than the risk of complications from Covid infection. Mind You, even mild Covid infection could give an alarming complication.
(Th author is Consultant of Respiratory and Internal Medicines at UHMBT NHS, UK. Views are his own)
