Precautions & Treatment
Pbn. Dr.(Prof.) Manju Kaushal ABVIMS, Dr. RML Hospital, New Delhi
COVID – 19
• Corona virus disease (COVID-19) is an infectious disease caused by a newly discovered virus.
• Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment.
What is a VIRUS?
A virus is a submicroscopic infectious agent (tiny germ) that replicates /survives only inside the living cells of an organism.
When infected, a host cell is forced to rapidly produce thousands of identical copies of the original virus.
Viruses exist in the form of independent particles, or virions.
Virion consists of (1) the genetic material, i.e. long molecules of DNA or RNA (2) a protein coat, that protects the genetic material (3) an outside envelope of lipids.
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• Thereisanewkindofthisvirus(COVID-19)spreadingaroundtheworldthat cause respiratory tract infections in humans
• It’s called a corona virus because “corona” means “crown” in Latin. And the virus looks like it’s wearing a spiky crown.
• Coronaviruses(CoV)arealargefamilyofvirusesthatcauseillnessrangingfrom the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
• Anovelcoronavirus(nCoV)orCOVID19isanewstrainthathasnotbeen previously identified in humans.
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From WHERE it came?
• The virus was first found in a city in China, called Wuhan in December 2019.
• Thevirusactuallycomesfrombats.Fromthere,it hopped into another type of animal, who gave it to humans.
• Research shows that this mystery animal is a pangolin, a scaly animal that eats ants.
• Pangolins are wild animals. Their scales are used for medicines in China & flesh is used for meat.
How does the Virus get into Human cells?
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• The virus enters cells using its special spikes protein on its surface that attaches to the host cell surface receptors
• An enzyme on host cell activates the spike protein, which allows the virus to enter the host cell
• Once inside cells, the virus makes lots of copies of itself
• These copies break out of cells and then infect othercells
• At a certain point, there are so many virus particles being produced that our normal cells can’t work properly
•itbreaks,and we get sick
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How does it make people sick?
• Viruses make people sick by killing human cells or making them not work properly.
• The coronavirus enters the host cell by activating the receptors on the cell surface. These receptors are specifically present on cells in the nose and lungs.
• If the virus grows too much in the lungs, it causes infection causing difficulty in breathing. This is called pneumonia.
Our Body Defense Mechanism
• Our body has an army to fight germs like viruses & bacteria. It’s called
the immune system.
• When a virus enters our body, the immune system attacks the virus.
• When we get fever, headache or runny nose, it is caused by reaction ofimmunesystem,againstthevirusanditis good!
• These symptoms are signs that your body is fighting the virus.
• Most people who get COVID-19 just have symptoms like cough, fever or body ache.
• Some peoples’ immune systems may not fight hard enough. Other peoples’ immune systems may fight too hard, hurting their own cells. Both of these things can make people sick.
• On average it takes 5–6 days for symptoms to show from when someone is infected with the virus. However it can take up to 14 days.
How will I know if I got it?
• Dry cough, Runny nose
• Aches and pains • Sore throat
• Loose motion
• Eye infection
• Loss of taste or smell
• A rash on skin, or discolouration of fingers or toes
• Difficulty breathing or shortness of breath
• Chest pain or pressure
• Loss of speech or movement
How to confirm, if I get infected?
• There’s a special test (RT-PCR) to see if you have COVID-19.
• In this test they stick a Q-tip up your nose and throat and take a sample and send for testing.
• The results come in a day or two.
How to stop getting infected?
• Youcanstoptheinfectionbyfrequently washing your hands with soap and rubbing your hands together to clean all your fingers, under the fingernails, back of hand and between the fingers.
• You can sing your favorite song or play your favorite tune that lasts for about 20 seconds, while you wash hands properly.
• Keepasafedistanceof6ftbetweeneach other.
• Trytokeepyourhandsoffyourfacesono rubbing your eyes or nose or putting your hands in your mouth. That way, if there is any virus on your hands, you won’t let it enter the body and make you sick.
• Remembertocoughorsneezeintoyour elbow.
• Always wear a face mask properly covering your nose & mouth.
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Coughing & sneezing etiquettes
Spread of CORONA Infection
When infected person coughs, sneezes, or talks, droplets with the virus fly into the air and the person who is in close contact (within 1 m) can breathe those droplets into their lungs and get infected.
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• Occur through surfaces and objects used by the infected person.
• Whenyoutouchsurfaces(countertopor doorknob) that someone who has the virus has coughed or sneezed on, and then touch your nose, mouth, or eyes and get infected.
• The virus can live on surfaces like plastic and stainless steel for 2 to 3 days.
• Virus can live in the air for up to 3 hours. When you breathe air that has the virus floating in it, it gets into your lungs.
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• Studies suggest that virus particles can be found in infected people’s poop.
• Infection can spread through contact with an infected person’s stool.
• If that person uses the bathroom and doesn’t wash his hands, they could infect things and people that they touch.
• When some people who don’t show any signs and do not know they’ve been infected can give it to others.
• When someone gets the virus without any known contact with a sick person (cause is unknown).
How to protect yourself?
• Limit your contact with other people.
• Standatleast6feetawayfrompeople. (Social distancing)
• Wear a face mask.
• Frequently wash your hands with soap & water.
• Use hand sanitizer containing more than 60% alcohol.
• Cover your cough or sneeze with tissue or cough or sneeze in your elbow.
• Clean and disinfect all counters, knobs, and othersurfaces thatyouandyourfamily touch several times a day.
• Wear gloves & mask while dealing with pets.
• Pets should be kept indoors as much as possible.
• Throw used tissues & trash in closed bins.
How to disinfect vegetables and fruits?
• Washyourhandsfor20secondswithwarmwaterandsoapbeforeandafter preparing fresh vegetables and fruits.
• Gently rub them while holding under plain cold running water. Avoid hot water, which can provide a pathway for microorganisms to get inside the item.
• DOconsiderabakingsoda/PotassiumPermanganatebathifyouwanttotake it a step further.
• Dry the washed vegetables and fruits with a clean cloth or paper towel to further reduce bacteria that may be present.
How to disinfect houses of COVID-19 patients?
• 70% Ethyl alcohol to disinfect reusable dedicated equipment (e.g., thermometers) between uses.
• Sodium hypochlorite ( 0.5% ) for disinfection of frequently touched surfaces in homes or healthcare facilities.
Which is the right mask for use?
Cloth Mask- If used by pt. his infection cannot spread. If normal person comes in close contact to +ve pt. wearing cloth mask, it does not protect him from infection.
Triple layered surgical mask
• Disposable after 3-6 hrs • Bestmask
N-95 Mask- Good for those health workers, doctors, nurses & paramedical staff who work in labs or work in areas of aerosol generation
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How to use / Reuse Mask?
• Triple layered surgical mask are disposable & should be disposed after 6-7 hours.
• Cloth mask can be washed with soap & water & reused.
• N95 mask generally used by Doctors & health staff – Keep 5 masks & use one each day for 5 days. Put dates on the masks. After 5 th day, use the first mask again. Virus does not survive after 3 days, so mask can be reused after 5 days.
• Mask should completely cover the nose, lips and chin, and should perfectly fit on the nose bridge, so that no air passes between mask and skin.
Who is at risk for corona virus? • Older people ( people over 60 years old).
• Those with underlying medical conditions such as heart disease, diabetes, chronic respiratory disease, and cancer.
• Chronic, heavy smokers.
What is the recovery time for corona virus disease?
• Most infected people develop mild to moderate illness and recover without hospitalization.
• The median time from onset to clinical recovery for mild cases is approximately 2 weeks and for severe or critical disease it is 3-6 weeks.
• Data suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation.
Can I get infected from Delivery Food, Packages, or Groceries?
• It’shighlyunlikelythatyou’llcatchCOVID-19frompackages,groceries,or food.
• Theimportantthingistolimityourcontactwithotherpeopleandwear mask.
• Ifyouuseadeliveryservice,havethemleavegroceries,food,orpackages outside your front door if you can.
• Wash your hands for at least 20 seconds before and after bringing things into your home.
• Ifyouwant,youcanwipedownplastic,metal,orglasspackagingwithsoap and water.
• Thencleananddisinfectcountertopsandanythingelseyouoryourbags have touched.
Can mobile phones transmit infection?
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Mobile phones are potent source of transmission
1. If same phone used by different people
2. BY fomite (surfaces)
Need to sanitize phones by spray of sanitizers after putting off phone and drying them before use.
Can I have infection if contacted +ve Patient?
Close contact defined as: Contact with CORONA +ve pt
✓lasting > 15 mts. ✓Distance is < 3 FT. ✓Not wearing mask
If contacted with a +ve patient, what to do?
• Covid testing
o RT-PCR (Throat swab test)
o Maximum sensitivity & specificity on 5th to 10th day
o If symptoms appear before 5th day, can get tested.
• Home Quarantine X 7 days.
• If a person has tested positive for Corona virus, and have mild symptoms, or had contact with someone who has COVID-19, needs to stay away from those who are well to check the spread.
• Govt now recognizes ‘Home Isolation’ with 24×7 Doctor’s consultation. (To reduce hospital burden)
• Isolation, now does not mean living alone, but all positive people in the family or neighborhood can live together while wearing a Mask. (Cohart Isolation)
• Isolation is for 9 days from start of symptoms, as virus becomes non replicative (non infective) after 9 days.
• After 9 days of Isolation, (Hospital/Home), pt. becomes non infective, but may still have symptoms due to the damage caused by the virus and needs care and rest.
• After Isolation, patient is sent for quarantine for 5 days, but with strict precautions of wearing mask, social distancing & hand washing.
• Multiple people who are suspects and not positive, can stay together, but always wearing a mask (Cohart Quarantine).
• Health care workers, Doctors, Paramedics and people travelling out of city are sent for 7 days’ of quarantine before resuming normal activities.
• After 9 days of Isolation, & 5 days of Quarantine, pt is deemed to be recovered, even if residual symptoms remain.
• At this stage, no need for a test to detect recovery.
• Sufficient number of antibodies (IgG) develop in the body.
• Between 14 and 28 days of recovery, Antibody titre in the blood is checked. If it is > 160, pt. is fit for Plasma donation.
• Plasma therapy is considered absolutely safe and is useful only when given in first 7-10 days of treatment, when pt’s IgG antibody concentration is poor.
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How to check Corona infection at home?
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6 minutes walk test
Walk for 6 mts at normal pace & check spo2 level. If it falls by 6 to 8 percent, your lungs are involved & you need medical attention.
NORMAL SPO2 95 – 97%.
SPO2 < 95%
IS AN ALARM – MAY NEED HOSPITALIZATIO N.
HAPPY/ SILENT HYPOXIA
When O2 falls down, but there is no breathlessness
– IMMEDIATE O2 REQUIRED.
Usually occurs when fever subsides.
NEED TO CHECK SPO2 – 3 DAYS AFTER FEVER SUBSIDES.
Timeline in Corona Infection
• When the first symptom appears
• Virus establishes itself in the body & pt experiences variable symptoms
• Most crucial days & extra care is required
• 4th day – O2 saturation test & 6 mts walk test should be done
• Post viral period – symptoms may remain, as repair of the massive damage done by the virus
• Viral replication does not occur (Non infective) but inflammation remains. • Pt can be transferred to non covid hospital/doctor.
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1st -3rd day
4th – 6th day
7th – 9th day
After 9th day
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Treatment for Corona virus disease
• There is no specific treatment for disease caused by COVID 19.
• However, many of the symptoms can be treated and treatment is based on the patient’s clinical condition.
• Generally, ‘Recovery is the rule & not an exception, and Mortality is an exception, and not a rule’. Mortality is < 3%.
• Plasma therapy is not required by most people.
• Many countries are trying to develop a vaccine against corona virus, but till date there is no break-through.
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Treatment protocol for Corona Infection Treatment depends on the nature of infection.
Mild infection – Home Isolation is prescribed (New Govt guidelines) in order to prevent burden on health care facility.
• Home Isolation – Isolation in one well ventilated room of the house with attached wash room, where pt can take care on his own. If family has more corona positive pts, they can stay together and can get online medical advise from the doctor.
• Monitor temperature, Pulse & spo2 twice a day.
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Treatment protocol for Corona Infection
Routine symptomatic treatment
• O2 therapy not required.
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Treatment protocol for Corona Infection
Moderate & Severe infection
In addition to all above,
• O2 support/ Ventilator
• Anticoagulant (Blood thinner)
• Steroids – Dexamethasone
• Anti inflammatory drugs – Tocilizumab
• Anti viral – Inj. Remdesvir
• Plasma therapy
• Interferon Beta 8 Million IU on Alternate Days x 3 Doses
• Pt made to lie in prone position.( On stomach/ lateral position.
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Does patient need to be tested on discharge?
• If disease was mild to moderate – no test is required at the time of discharge
• If onset of symptoms since 10 days,& no fever – no test required
• Quarantine over and normal activity can be resumed.
• Earlier 2 consecutive tests were done and if both negative, then only discharge was given.
• New guideline because even after 14 days of no symptoms, some people test positive as the dead virus is still there , though pt is non infective.
What are chances of Reinfection?
• Recent research shows that even after 8 wks pts. may test positive, but this is because of the dead virus and not reinfection.
• Sufficient number of antibodies develop in the pt., & less chance of reinfection are there.
• Repeat test is not advisable in such cases.
• Only if antibodies are insufficient, pt may be reinfected. In that case,
antibody test should be performed.
• RT-PCR cannot decide reinfection.
Home preparation for Corona treatment
Every house should be equipped with following :
1. Pulse oximeter – for measuring O2 saturation (spo2) & Pulse. – (Silent Hypoxia)
2. Good thermometer to measure temperature.
3. O2 Concentrator with the capacity of 5lt/mt O2 supply.
4. Blood Pressure instrument
5. Glucometer to measure blood sugar.
In emergency, you may not get bed in any hospital, and you can start treatment at home without delay with Doctor’s video consultation.
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Mean time for symptoms to appear
Mean time for Breathlessness to appear
Mean time for Ventilator requirement
Mean time for Death to occur
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Silent /Happy hypoxia
– occurs typically after
– immediatelycheck spo2
– give O2 support immediately.
Physical preparation for Corona infection
Lung exercises to increase lung capacity
1. Anulome – Vilome
2. Take a glass filled 3⁄4 with water. With a straw blow air in water continuously to completely empty the lungs. Then take a deep breath & fill the lungs. Repeat several times.
Learn to sleep on stomach
1. Lungs expand maximum when we sleep on stomach.
2. Corona affects the posterior and lateral part of lung.
3. By sleeping on stomach no pressure of heart & sternum on lungs, can expand fully.
4. Start doing it today!
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What is Herd Immunity?
Immunity in body develops due to – 1. Vaccination
2. Natural due to Infection
Herd immunity develops when 60- 70% of the population is either immunised, or carries sub clinical infection. This happens due to development of antibodies to the infection.
How to boost your Immunity?
1. Drink enough warm water
2. Practice Yoga and Meditation
3. Take 8 hrs. of sleep
4. Spices like turmeric, Zeera, Coriander & Garlic should be included in diet
1. Chyavanprash -1tbsp daily , Sugar free for Diabetics
2. Herbal Tea
3. Kadha – containing Tulsi, Cinnaman, Black Pepper, Dry Ginger, Cardamum, Laung, Raisin / Munnakka, Gud with fresh lemon juice for taste. Boil in water till water reduces to half.
How to boost your Immunity?
1. Pratimarsh Nasya- Apply coconut / Til oil in both nostrils once / twice a day.
2. Oil pulling Therapy – Take 1 tsp Coconut /Til oilin your mouth, squish it all around but don’t drink it for 1-3 mts. Spit it out & rinse your mouth with water. Do 1-2 times /day.
3. Steam inhalation with fresh mint leaves or Ajwain in water (For dry cough/Sore throat)
4. Take Clove (Laung) powder with Honey/Sugar 2-3times/day.
Drinks to enhance immunity
1. Milk with turmeric, black pepper, cinnaman, Ginger & coconut oil. Boil, cool add honey & drink.
2. Tea with ginger, cardamom,& Cinnaman
3. Badaam milk with turmeric, cardamom & Kesar.
4. Gargles – If virus present, it causes less multiplication. If virus is not present, it clears the throat
Ingredients for gargles
• Coconut oil
• Til oil
• Water soluble Aspirin (for throat pain)
• Povidine iodine gargles / nasal spray (kills the virus)
What to eat during infection?
• Highproteindietcontainingall essential Amino Acids – Dal – Chawal, Rajma – Chawal, Paneer, Soyabean, Milk
• BrownSugar(Khand)–White Sugar is very bad.
• Desi ghee – very good – does not lower good cholesterol, but some increase in bad cholesterol.
VACCINES IN DEVELOPMENT
• Strictly & honestly follow all precautions.
• Include immunity boosters in diet
• Stay in open, well ventilated spaces.
• Sleep for good 7-8 hours.
• Do Yoga & Meditation.
• Pray, have faith & Stay safe.