With over 50% of the active Covid-19 cases in Delhi under home isolation, a team of experts from All India Institute Of Medical Sciences recently discussed the sequence of treatment for mild and moderate patients — from the role of oxygen therapy to usage of antiviral drugs. Among the cases discussed was that of a 35-year-old woman with fever, sore throat and breathlessness, who was rushed to the hospital only when her oxygen saturation was found to be 67%. Once there, she tested positive for Covid-19.
However, with no uneasiness and discomfort, doctors concluded she might have what is called a case of ‘silent hypoxemia’ — a condition in which a patient does not appear to be short of breath but the oxygen levels are considerably below normal. This, doctors believe, requires close monitoring among patients under home isolation. In Delhi, of the 10,667 active cases, 5,372 are under home isolation. Those under home isolation are provided a pulse oximeter by the state government for continuous monitoring of oxygen levels.
“Typically in Covid, patients come with hypoxemia without many other clinical features. Therefore, it is important to monitor these patients very closely even if they are under home isolation,” Dr Monish Soneja, additional professor in the Medicine department at AIIMS, said at the National Grand Rounds on Covid-19 held this week.
On Saturday, the capital reported 1,404 new cases of coronavirus, taking the total number of cases in the city to 144,127. The death toll in the city was reported at 4,098, with 16 more deaths recorded in the last 24 hours. The city performed 5,500 RT PCR/CBNAAT/TrueNat and 19,092 rapid antigen tests in the last 24 hours. Delhi is conducting 61,489 tests per million population.
Talking about the treatment for mild cases and usage of drugs such as ivermectin, doxycycline, hydroxychloroquine or multivitamins, the experts said that not enough data has been generated with regards to the usefulness of these drugs.
AIIMS director Dr Randeep Guleria, who moderated the session, said, “We still do not have enough data as far as any of these drugs is concerned in mild cases. Although there are a lot of physicians all over the country trying different combinations of ivermectin and doxycycline, HCQ with azithromycin or other combination of multivitamins, vitamin C and zinc. We really do not have evidence to suggest that any of them make a difference. We know a large number of patients will improve on their own. Monitoring them is very important so that they don’t go from stage 1 to stage 2.”
Experts also discussed the use of antiviral drug Remdesivir if the patient is in the early stage of the disease. “There are a lot of questions being asked on whether we can use it a little earlier because it is an antiviral drug. I think we need more data for it. But not having data doesn’t mean that it cannot be used or it may be harmful. We need to have more studies as far as that is concerned,” said Dr Guleria.
Discussing about oxygen therapy, the doctors concluded that it is the backbone of treatment. “If we can do it properly, you can get away and may not need to ventilate the patient. But the focus on adequate oxygen should be very high,” said Dr Guleria.
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