Updated: May 18, 2021 8:18:58 am
If you or your family has tested positive for Covid infection, do not panic. The following information about home management of Covid-19 infection, including a vital self-monitoring chart, will decrease the chances of going to the hospital unnecessarily, assures Prof Pankaj Malhotra, Department of Internal Medicine, PGI, as he answers questions on the issue.
Coronavirus Disease (COVID-19) is an infectious viral disease. Common symptoms can be fever, which may last for 3 to 10 days, cough, with intermittent bouts, sore throat, loss of taste, smell, etc. Patients with pre-existing significant heart, lung, kidney problems, uncontrolled diabetes, obesity or immuno-comprising conditions can develop severe infection and must be in contact with their family physician.
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If my test shows I am Covid positive, what should I do? Do I need to contact a doctor immediately?
If you or your family member is tested positive for Covid infection, do not panic. It is a self-limiting illness in 85-90 per cent of patients. But you still need to be in contact with your family physician or Covid helpline. The Covid monitoring chart, which will also work for patients with co-morbidities, will greatly help you and your doctor to know the progress of your infection. Maintain it strictly and share with your doctor.
When is it that I need to be concerned about and contact a hospital?
If you are maintaining the monitoring chart and are in contact with your doctor, they will guide you if you require hospitalisation. You have to be in touch with your doctor closely if oxygen levels are consistently below 94 per cent.
What are normal saturation levels even when I am Covid positive, and do I need to be concerned if my oxygen levels fall below 94?
Normal oxygen levels are above 94 per cent. Single aberrant reading (below 94%) can happen because of problems with batteries or oximeters. Some people have a baseline oxygen level of 90-92%. If the oxygen readings are below 94%, recheck batteries and oximeters. Recheck oxygen saturation on fingers of your other hand or on your healthy family members (to see whether it is working properly). Early warning sign is oxygen levels falling below 94% on a 6-minute walk test. If oxygen levels are falling below 94% then contact your family physician or Covid helpline.
We are facing an acute oxygen shortage, with many patients being given oxygen outside hospitals. Please share some insights on the need\benefits of early intervention of oxygen therapy
There is no need to panic as 85-90 per cent of patients with Covid infection recover on their own. The monitoring chart can give you warning signals early enough if you will require oxygen later on. As mentioned earlier one or two aberrant readings below 94% on rest does not matter and you need to recheck the readings especially if you are otherwise feeling healthy. There is no benefit of giving oxygen if levels are above 94%.
Are we also seeing a rise in silent hypoxia in this wave and is that one of the causes of more critical cases in younger patients?
That’s why it is important to monitor your oxygen levels at least 4-6 times a day especially on a 6-minute walk test. If you cannot perform a 6-minute walk test, check oxygen levels after one minute stand-sit test.
Are home oxygen concentrators recommended? What about nasal prongs?
Oxygen concentrators are helpful if there is minimal requirement of oxygen (6-9 liters/minute). Oxygen through nasal prongs is given if the requirement of oxygen is minimal. Use these under physician supervision.
We have seen many patients passing away because of Chronic Obstructive Pulmonary Disease (COPD). Are patients with pre-existing COPD more prone to Covid and does Covid take a serious toll on these patients?
The severity of Covid can become higher among patients with co-morbidities/pre-existing illnesses like COPD, heart disease, kidney disease or among cancer patients. These patients can fall in the 10-15 per cent category where chances of complications are higher. These patients need to be in touch with their family physician regularly. A strict monitoring of oxygen levels 4-6 hourly can help in prevention of complications.
Many patients are going for CT scans on their own and some doctors are also recommending these? When is a scan recommended? Can it be harmful in the longer run? Please elaborate.
CT scans are not recommended for patients with mild disease (whose oxygen remains 94% or above). Unnecessary CT scans can cause harm to the patients.
Many doctors are prescribing investigative blood tests to many patients with mild Covid-19 as these they say could provide early warnings of possible complications, although the tests are not included in standard guidelines for mild illness. What are your views?
At the beginning of the pandemic in 2020, doctors were worried about this new illness and were prescribing blood investigations even in mild patients. The doctors now understand that patients with mild illness do not require any blood tests and neither the treatment gets modified based on these blood tests. The results of blood tests create more panic among patients as well as doctors. Most patients recover on their own and therefore these tests are not recommended in mild illness.
If I do not have symptoms, yet I am positive, when can I be considered infection-free? Do I need an RTPCR after 14 days to confirm I am negative, or a blood test?
You are asymptomatic positive but you can still transmit infection to others up to 10-14 days. So, you need to isolate for a minimum of ten days. There is no need to get a repeat RT PCR test or blood test after ten days as viral replication ceases after 9-10 days, though low-grade fever or some other symptoms can persist beyond that.
My fever is persisting after six days, it is not subsiding with paracetamol, what to do?
Fever can persist up to 10 days. You can use Tab Combiflam or Meftal, 2-3 times if fever is not coming down with Dolo. A low-grade fever (below 100) can persist for a few more days and generally no medicine is required.
What about persistent weakness and/or throat irritation and cough?
Weakness can persist up to 2 weeks. Concentrate on proper diet and adequate water/fluid intake. This will go away gradually.
If oxygen saturation is more than 94% then there is nothing to worry about. Throat irritation and cough can persist for a few more days. You can try lozenges.
I have a mild cough, throat irritation, should I get tested for Covid?
Ideally yes, however, if you are not able to get testing done, isolate yourself and take precautions. Get in touch with your family doctor or Covid helpline.
What have been the crucial learnings in this one year of Covid-19?
We need to discipline ourselves and prevent infections. If we discipline ourselves to follow Covid appropriate behaviour (proper fitting face mask, frequent hand washing/use of sanitiser, maintaining distance from others), we can prevent the spread of infection.
Ours is a developing country, still in the phase of building the health infrastructure. We should learn more about prevention of infections and for that we need to discipline ourselves, like the Indian Army. We can definitely win this war if we follow Covid appropriate behaviour.
This article first appeared in the print edition on May 17, 2021 under the title ‘Covid is a self-limiting illness in most, monitor symptoms to check progression’.
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