Covid Treatment : Summarized!

Thanks to Dr Ramakrishna Chaitanya, anaesthesiologist, Medical College, Hyderabad for helping me with this!

Hi I’m Dr Deeksha & today am going to give you summarize treatment to help you recover with covid!

1. Having symptoms, fever high grade, cold, sore throat, cough, malaise at this time of Pandemic should be taken as suspected covid.
2. Day 2 to Day 5 of symptoms to get the Real Time PCR and more likely to come positive. (at present so called gold standard)
   No ROLE FOR ANTIGEN TEST NOW…
3. HRCT Chest & Xray Chest advisable on Day 4 – 5, acts as a supportive evidence or to pick up early ground glassing.
4. If test comes negative then though welcome news, watchful for next 7 to 10 days and repeat the test if symptoms worsens.
5. If test comes positive then self quarantine, ideally
   Separate room
   Separate toilet
   Self Care
   Self hygiene
   If separate toilet not possible to flush the toilet thoroughly by disinfectant may be household phenyl after its use by infected person
   Monitor SPO2 twice a day daily. Should be more than 95%.
   To do six minute test twice a day
   Rest SPO2 – > 95%
   Walk for 6 minutes in a room itself
   SPO2 after walk if equal or less than 93% – likely to have hypoxia

To get hospitalized for further management
Medicines symptomatic
Paracetamol 1gm qds
No need of NSAIDs
Vit C
Zinc
One can take antiviral as
Favipiravir
Lopinavir
Ritonavir
Of late Favipiravir recommended
But then to do basal LFT, ECG

6. No role of Prophylactic Antibiotics in home Quarntined positive patients.
7. Investigations during quarantine
   CBC
   CRP
   Xray Chest
8. Investigations during hospitalization in first 5 days
   Besides
   CBC
   CRP
   Xray Chest
   D-dimer
   LDH
   Ferritin
   Creatinine
   LFT
   To watch for N:L ratio
   More than 3.5
   Warrants Antibiotics
9. During hospitalization medicines given
   Favipiravir / Lopinavir / Remdesivir
   Doxy
   Ivermectin
   (Doxy & Ivermectin no proven role but can be used on OPD basis treatment)
   Vit C high dose 1.5 gm
   Zinc 50 mg minimum
10. Day 7, Day 8
    IL6 test
    To detect cytokines storm
11. From Day 6
    In covid patient with Hypoxia
    Antiviral
    Remdesivir added
    D6 to D10
    Five days
    200 mg IV First day
    100 mg IV for next four days
    Availability is issue but available at major hospitals
    Cipla & Hetero are manufacturing and hopefully availability will not be issue in next 2 weeks….
    Remdesivir only five days
    Creatinine clearance should be checked for
    The thumb rule in use of antiviral is
    Early to start is always better…..
    Informed Consent required for use of Remdesivir as well Favipiravir
12. Another important drug is use of steroids
    Methyl Prednisolone is the drug of choice
    1mg/kg/BW BD for 5 days IV

Indications
Rise in inflammatory markers…
CRP high
Ferritin high
But to give under the cover of broad spectrum Antibiotics
To check for that Procalitonin levels are done if high suggests underlying sepsis the Antibiotic cover is important higher ones of course IV

13. Use of Dexamethasone instead of MP if issue with cost and availability of MP
    Use of Dexamethasone has its value at Hospital
    Strictly not to be used on OPD basis for first five days of symptoms
    Don’t Start Dexa or any steroids just because one has diagnosed with Covid..It may have detrimental effect if started before time.
    Of course as General Practitioners we should not use it.
14. Low Molecular Weight Heparin is another drug added on Day 5 of symptoms in view of hypoxia / who requires Oxygen
    Inj Clexan 40mg / 60 mg once a day continued till discharge and continued at home or replaced by oral anticoagulant for a week and repeated test of D dimer is important. If normal then it is stopped.
    Sometimes if D dimer is relatively too high then higher therapeutic dose is used of Inj Clexan
    Reason of using it – as micro vascular thrombi – pulmonary embolism – is one of the complication
    LMWH in all patients irrespective of D dimer
    Prophylaxis or Therapeutic doses depend on D dimer levels
15. Treatment of Hypoxia
    HFNC
    High Flow Nasal Canula delivery of Oxygen as high as 40 to 60 lits with closed mouth
    in prone position
    All the time nursing in Prone Position and CARP protocol has good outcome
    Importance of prone position
    Heart, anterior mediastinal organs falls forwards….
    Better aeration of lungs
    Posterior lobe involvement becomes lesser
    NIV/CPAP not recommended
    NIV has got its limitations including
    P SILI (Self Induced Lung Injury) and difficulty in prone nursing
16. If on HFNC
    Drowsiness……
    PCO2 increases…..
    ABG not achieved as desired…
    PaO2/FiO2 ratio < 150 on HFNC
    To shift to ventilator…
17. Cosmetic Ventilators are just automated AMBUs and don’t have any role .
18. If clinically
    Hypoxemic
    Fever with chills increases
    Tachycardia
    indirect evidence of cytokine storm
    Recognize cytokine early. Monitor labs frequently
    Confirmed by
    CRP increase
    IL6 increase
    Ferritin increase
    LDH increase
    WBC rise
    Tocilizumab (anti IL6) /Eculizumab (anti CD6) injection to be used
    Timing is very important
    Not early Not late
    D8 to D12
    3 digit CRP
    10 to 12 times rise in IL6
    IL6 reports sometime takes two days
    But as CRP too high better not to wait for IL6 report otherwise it will be too late
    Rule out infection before giving it, send Procalcitonin
    Of late cytokine storm is seen in 3rd week too
    D16/D17
    Only one dose of Tocilizumab
    No role for second dose
19. Sudden death in Covid causes
    Acute Coronary syndrome
    Pulmonary embolism
    Microthrombi
20. Antibody test for surveillance
    For plasma donation
    High tires 1:1024
    Quantitative
21. Late complication
    Early to say
    But may be fibrosis of lung….
22. IVIG only if suspecting Infection Induced HLH
    LDH/Ferritin in 1000s
23. Plasma donation must be encouraged . Committe like ZTCC should be formed for monitoring it’s use..
24. All frontline Health Care Provider should take HCQ Prophylaxis weekly till the end of Pandemic .There is no other proven prophylaxis avilable besides HCQ..
25. We are nowhere near Herd immunity
26. DONT LET YOUR GUARDs DOWN especially in common areas, canteen, chambers when with someone….
27. GOOD Basic Supportive Care and Tender Loving Care is the key for favorable outcome.

1. Dr Deeksha Singh
2. OBGYN PT
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