Dr Shashank Joshi, an endocrinologist, is Dean, Indian College of Physicians, Mumbai, speaks to Anuradha Mascarenhas:
As novel coronavirus disease cases continue to rise, only the most needy would be admitted in hospitals. Cities like Mumbai are already facing a shortage of hospital beds. This is likely to become even more acute in the coming days. In such a situation, most of the infected people, those who do not require immediate medical attention, would have to recover at home.
But home recovery does not mean just remaining confined within your home and waiting for the quarantine period to get over. Some good practices followed during home quarantine can expedite the recovery process, while protecting other people in the family. Even simple things like the right diet, eight hours of sleep, adequate hydration, and maintaining a positive attitude can help in the recovery process.
While the general norm is to prescribe 14-day quarantine for infected people, whether at home or in an institutional facility, it would be better if patients are able to give themselves some more time to recover. I would say a mandatory 28-day quarantine is ideal, because not only is the recovery better, but it is also safer for the family, caregivers, and the community in general. At home, extending the quarantine period is possible. Even those in institutional facilities, once they are released, should try to extend their quarantine period by following the same norms at home.
Vulnerable individuals, like those over 55 years of age, or those with pre-existing ailments like hypertension, obesity, diabetes, chronic obstructive pulmonary disease (COPD), kidney or liver disease, or those consuming immunosuppressants or steroids, of course, need to be treated with special care, in consultation with medical experts. Constant monitoring of oxygen saturation levels in these patients is very important. In fact, oxygen saturation monitoring must be a standard practice in the case of other patients as well. People should preferably keep a pulse oximeter at home, and regularly check the oxygen saturation levels. If it dips below 92 per cent and the patient complains of breathing difficulty, a red alert needs to be sounded and medical advice sought.
Anything that boosts immunity is helpful, and is advisable to practise. Sleeping in a prone position, with face and chest down, helps the patient. As rains are coming, patients are advised to avoid fast food and ice-cream, as these can lead to sore throats. Alcohol consumption also needs to be tempered. In large quantities, this can depress the immunity. Yoga and simple exercises can be helpful.
Patients with normal ECG can be prescribed a five-day course of hydroxychloroquine (HCQ) with azithromycin along with vitamin C, vitamin D and zinc supplements. Of course, patients need to check with their doctors and not self-medicate. Those who believe in alternative medicine should take the advice of Ayurveda or homoeopathic experts. However, people in vulnerable groups, those with co-morbid conditions, or those showing symptoms of the disease, should preferably avoid these.
Family & caregivers
It is extremely important that family members and caregivers who come in close contact with the patient are able to protect themselves, and do not get infected themselves. All these people can also be prescribed HCQ once a week for three weeks in accordance with the ICMR protocol and in consultation with a doctor. HCQ acts as a good prophylactic (preventive medicine) and has been prescribed for healthcare professionals who are handling Covid-19 patients in hospitals as well.
It is important to remember that even the asymptomatic patients (those who do not have any symptoms of the disease) are equally capable of transmitting the virus, and therefore family members and caregivers at home need to strictly follow social distancing norms. It is advisable that patients are not served food in the same utensils that are used by other members of the family. Preferably, disposable utensils should be used to serve food to the patient.
The virus usually stops multiplying in the patient’s body only after the tenth day, and until then it can easily be transmitted. That’s why in many cases patients are allowed to be discharged after the tenth day. However, the danger does not get over immediately. The patient in home quarantine needs to be checked upon routinely in the second week after infection as well. If there is any unusual variation in oxygen levels, or any other warning signs are noticed, immediate medical help needs to be sought.
No need to panic
In fact, oxygen level is one of the most crucial parameters to be monitored. Routine pulse oximeters available in the market do a decent job, and these can be used to monitor the levels every day, from the day of the diagnosis to at least the 14th day. The levels can be checked after a brisk walk of six minutes. That’s a very good test, actually. If the oxygen saturation level drops below 92 per cent after this brisk walk, then the patient needs medical attention, and arrangements should be made for hospitalisation to enable nasal ventilation.
It’s a smart virus, but it is possible to effectively manage it, until we are able to find a cure or vaccine to keep it at bay. In the meantime, we will have to learn to live with it. It is important not to panic or get worked up. In most cases, all that the patient would need to deal with is isolation and quarantine, and a little bit of sickness. But sound mental and emotional health can also help in a better and quicker recovery. So, fear needs to be discarded. (Read the latest updates on vaccine development)
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This article first appeared in the print edition on June 10, 2020 under the title ‘While recovering at home’.
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