30/04/2021
Some red-flags and do and don’t when taking care of those with COVID at home.
*Do’s*
a. Make a regular chart of 4-6 hourly, oxygen saturation, pulse rate, temperature, respiratory rate (this is most crucial later) and blood pressure. [ Why, if a good physician sees that, it can find a trend and predict chances of worsening early. Also, you yourself can identify the red flags, and when to seek more expert input]
b. Drink loads of water, reduce your anxiety and keep spirits high. Share your troubles with others. Important, as by sharing you can find support if needed.
c. Do not worry- the majority do not need hospitalization. If you are worried that you may need that, it is easy to predict based on the risk profile and trends as mentioned. So, believe in yourself and do the basic correctly.
d. Everyday do oxygen saturation, before and after, 6minutes walk. Normally oxygen saturation after walking should be same or high. It should not go down more than 2%
e. Do get your RTPCR and blood tests (ideally on day 3-4 of symptoms) to have a baseline and, catch up early if there are some issues early on.
f. Proning will help.
*When to take help*
a. If your oxygen saturation starts dipping below 94- that is the time steroids use will be helpful. Seek help/medical expertise.
b. If your pulse rate is consistently above say 110 or more, and you are lethargic, discuss with some of your colleagues.
c. If you have pre-existing illness then it is good to discuss with doctor, the pre-existing illness that are of concern are – diabetes , previous cancer, morbid obesity, and any rheumatological condition requiring immunosuppressive therapy.
*Next steps:*
1. If you do go down below 94%, even then it is not a cause of worry – as at that time you should be on steroids, may require oxygen to keep your levels of saturation around 94% and, tablet (or injection) for blood thinner- we call it as anti-coagulant. Most will be better at this stage with some bit of these. .
2. You should be doing proning. There are loads of information on that.
3. Please do register yourself in the portals and government systems, even though you are trying for private hospital. Good to have two sources if you need anything.
4. However, if oxygen saturation is going less than 91% off room air, or your requirement to take oxygen is increasing in flow rate- that is the time to think of more expert advise and perhaps, then is the time to think about hospitalization.
*Some Important points*
Please remember, only a few treatments that too in right time are helpful.
Steroids are very good, if given at right time. However, they can be harmful if given too early, or in too high dose.
There is a myth that Plasma therapy helps. Clinical trials have not shown benefits, especially in stage when a person is hospitalised and admitted. Theoretically, they have role only within first few days of illness.
Remdesivir is a drug which maybe of use, but timing is crucial. Do not stress if that is unavailable.
Other drugs that are useful will be Tocilizumab (alternatives are Sarilumab, Baricitinib, or Bevacizumab in that order). Those drugs are only needed for very-2 few patients, and in hospital setting.
Just remember, most of you will be okay. Only few will require help, and with proper monitoring those can be predicted and taken care about. Do not panic. Ask for help and keep your spirits high.
