Coronavirus | Opeds and editorials

Tips for managing COVID-19 at home: the dos & don’ts

Ambulances carrying COVID-19 patients line up waiting for their turn to be attended to at a dedicated COVID-19 government hospital in Ahmedabad, India, Thursday, April 22, 2021. Indian authorities scrambled Saturday to get oxygen tanks to hospitals where COVID-19 patients were suffocating amid the world’s worst coronavirus surge, as the government came under increasing criticism for what doctors said was its negligence in the face of a foreseeable public health disaster. (AP Photo/Ajit Solanki)

Ambulances carrying COVID-19 patients line up waiting for their turn to be attended to at a dedicated COVID-19 government hospital in Ahmedabad, India, Thursday, April 22, 2021. Indian authorities scrambled Saturday to get oxygen tanks to hospitals where COVID-19 patients were suffocating amid the world’s worst coronavirus surge, as the government came under increasing criticism for what doctors said was its negligence in the face of a foreseeable public health disaster. (AP Photo/Ajit Solanki)

The second wave of COVID-19 infections in India has turned into a public health emergency, and it has become difficult for most people to even access the healthcare system . Finding a hospital bed has turned almost impossible in many parts of the country, and if one does manage hospital admission, critical supplies like medical oxygen are hard to come by. Healthcare personnel have been trying to do their best under these trying circumstances, but they are now stretched to the breaking point. Amid this, a plethora of guidelines and lack of concordance across recommendations put forward by different States add to the confusion.

Various drug cocktails with unproven or marginal benefits are being used widely. To address the confusion, the India COVID SOS team, a group of volunteers from across the world, including India, has developed clear guidance in various Indian languages to help in home-management of patients. This is not intended to be a substitute for medical care but rather a way to assist people with mild to moderate symptoms safely at home.

 

Moderate illness

Starting with the basics, if one develops symptoms of COVID-19, like fever, sore throat, dry cough, headache, body aches, and loss of smell or taste, they should try to get tested. Given the high number of cases in India, if a person has one or more of these symptoms and lives in a highly affected area, they are very likely to have the infection. However, if testing is unavailable, they must assume that they have COVID-19 and should stay home, keep the windows open for ventilation, and follow other tips. Most importantly, avoid panic. It is important to remember that over 90% of people with COVID-19 recover fully without needing hospital care. A pulse oximeter can be used to check oxygen saturation levels three to four times a day, or more often if there is difficulty in breathing.

There is some evidence that a steroid inhaler may be helpful for people over the age of 50 years. If available, an inhaled steroid (budesonide) may be used twice a day for five to seven days. If oxygen levels are at or above 92%, hospitalisation, blood tests or a CT scan are not needed. Further, oral steroids, intravenous Remdesivir, or plasma may not be beneficial for such patients. In fact, taking oral steroids at this stage could actually be harmful.

In case the oxygen levels are less than 92%, one must reach out to a doctor and follow their recommendations. Our suggestions at this stage apply only if an individual cannot reach a doctor or find a hospital bed.

 

The most important treatments at this point are oxygen and oral steroids. Dexamethasone is the most commonly used steroid medication, usually given at a dose of 6 mg per day for five days. In case dexamethasone is not available, there are several alternatives.

If a patient has diabetes, it’s important to monitor their blood sugar while on steroids, and if it is higher than normal, the doctor must be informed. They should also stay in touch with a doctor and seek urgent help if oxygen needs increase to more than four litres a minute.

Also read | COVID-19 patients with sedentary habits more likely to die, finds study

Unproven methods

Most other treatments that have been tried for COVID-19 have shown no benefit. This includes widely prescribed treatments such as ivermectin, hydroxychloroquine, vitamin supplements, antivirals, and antibiotics. Convalescent plasma has not lived up to its initial promise and several trials have failed to demonstrate significant benefit with routine use. Collecting, testing, and administering plasma adds more strain to an already overburdened healthcare system and uses up valuable resources. Similarly, recent data indicate that Remdesivir has a limited role in COVID-19 treatment, and patients should not seek admission to hospitals solely to receive this drug.

Most people will recover completely at home. Staying home if the symptoms are mild will help save hospital beds, oxygen, and other supplies for seriously ill patients. This also means that doctors, nurses, and other medical staff can do a better job of taking care of critical patients. However, worsening symptoms must not be ignored and a patient should not delay going to the hospital if needed.

What else can individuals do? Wearing a mask, avoiding crowds, and washing hands are some ways through which people can prevent the spread. Getting vaccinated is the most important step. COVID-19 vaccines are safe and highly effective at preventing severe illness and death from the infection. One can still get COVID-19 after vaccination, but typically, the illness will be mild.

 

The grave humanitarian crisis sweeping through India can be controlled only by large-scale public health measures. Curfews and lockdowns will work if implemented carefully. Mass gatherings should be prohibited. Large-scale vaccination drives are essential. Celebrities from the film industry, social media influencers and sports stars should promote vaccination, the use of masks, and physical distancing. Testing needs to be scaled up and test results should be reported in a timely manner. Medical supplies, including oxygen, should be made available, not just in healthcare settings but also to persons at home. Tools for triage of patients and accessible dashboards listing available resources are the need of the hour. At this point, many of these things are being cobbled together by volunteers. But an organised response would be much more effective.

Acknowledging the crisis

Finally, much of the reporting of cases and deaths has been coming from media rather than government sources. Indeed, since the beginning of the pandemic, responsible science reporters have been the best sources of information, not just in India but around the world. We need robust data. In order to deal with the problem, it is important to acknowledge the enormity of it.

 

India is facing an unprecedented public health crisis. The number of new cases being reported each day is higher than it has ever been in any country. As bad as the situation is currently, it could get much worse. We have seen that deaths from COVID-19 increase when the healthcare system is overwhelmed. But the damage can be greatly minimised by the measures described above: a combination of prevention and appropriate management.

The massive spread can be arrested by following safety protocols and through rapid vaccination. If the vast majority of patients who can be treated safely at home stay home, so that hospital resources can be directed to critically ill patients who truly need them, we will be able to manage the crisis better. All eyes are on India and the actions we take now can help us turn the corner in the next few weeks.

The author is an Infectious Disease physician and Chair of Infection Prevention and Control, Mayo Clinic, Minnesota, U.S.


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Printable version | May 22, 2022 10:04:08 pm | https://www.thehindu.com/opinion/op-ed/a-pragmatic-approach-for-covid-19/article34425675.ece