6. Features of Pneumonia-

Temp>101
CRP
Rapid rise of CRP
Cough on day 3
5% fall in SPO2 after 6 min. walk.

COVID SECOND WAVE

1. RT-PCR may be negative-(read ORF and N gene also as S gene may not be detectable).

2. Diagnosis- (If RT-PCR negative) —— Clinical symptoms, Serum Markers
CT Chest.

3. Anti inflammatory medicines should be given between 7-10 days to
prevent Covid Cytokine storm.

4. CORONA is not a lung Disease. ( It is Systemic Thrombo-
hyperinflammatory Vascular Disease)

5. Virus stops replicating after 9 days.

 

. 7-  Loss of smell is equal to RT-PCR

. 8-  15 minutes of exposure is required to get the infection.

COVID CLASSIFICATION

SPO2
RR XRAY-CHEST

CT CHEST SYMPTOMS

MILD

>94 <24 WNL

WNL or <25% Fever +/-

MODERATE

90-94 24-30

1 or 2 zones <50%

SEVERE

<90 >30

2 or more zones >50%

Fever with respiratory distress.

EARLY INVESTIGATIONS

1. CBC with NLR ( Neutrophil/Lymphocyte Ratio) 2. CRP,ESR,PROCALCITONIN
3. IL-6
4. D-DIMER ( Very important- Repeat after 3 days) 5. FERRITIN

6. LDH ( A sign of cell death)

Fever with breathing difficulty

IMPORTANT LAB READINGS

 

MILD MODERATE SEVERE

 

NLR <3/2 >3/2 >5/2

 

CRP <20 20-50 >50

 

FERRITIN <500 >500 >800

 

D-DIMER <.5 .5-1.0 >1.0

 

LDH <300 300-400 >400

 

IL-6 <5 5-50 >50

 

LFT WNL Slight change Moderate change

 

Notes—-

1. CRP a good marker to start Steroid

2. IL-6 is very unreliable.(Timely collection and rapid transportation
required. Choose the same LAB)

3. D-Dimer——Monitor every 2-3 days

4. LDH – Useful follow-up parameter

5. NLR a good prognostic factor.

IMPORTANT FACTORS

1. Antivirals should be given in replication phase.

2. Anti inflammatory ( steroids ) should be started in early
Pulmonary phase i.e. after 9 days (replication phase)

3. LMWH (ENOXAPERIN) 40mg or 1mg/Kg S/C OD dose should be given in all admitted patients.

4. Increasing Lymphopenia indicates severity.

CRITICAL SIGNS

1. Temp > 103 without PCM or 101 after PCM 2. Persistent cough
3. Sudden onset of shortness of Breath(SOB) 4. Rapid increase in CRP

5. CT Chest score >13/25

GENERAL TREATMENT

1. BP, PR, Temp, SPO2 monitoring 2. Plenty of fluids
3. Paracetamol
4. Good diet

5. Vit-C, Vit-D, Zinc
6. Ivermectin/ Favipiravir may help (weak antivirals)

SPECIFIC TREATMENT

1. STEROIDS—To all moderate to severe patients with SPO2 <94 any day of Disease.( Better to avoid in replication phase, in asymptomatic cases, in mild symptoms but less than 7 days, in cases

with CT score <8 with Disease <7 days, in Viremia phase with normal CRP and CT Chest.)
-Should be started in Pulmonary Phase.
-Methyl Prednisolone 40mg/day I/V is the Steroid of choice and next is Dexa.

2. ENOXAPERIN 40mg or 1mg/Kg or FONDAPARINUX 2.5mg S/C OD doses.

a. To all moderate to severe symptomatic patients

b. If PR >110

c. RR is >24

d. SPO2 <94

e. If Pneumonia suspected clinically, by Xray or CT Chest start LMWH on day 5 or high risk group day 1.

3. REMDESIVIR- In hospitalized patients ( should be started in less than 10 days of onset).

CYTOKINE STORM

1. Unremitting fever

2. Cytopenia

3. Hyperferritinemia

4. Pulmonary involvement

5. Shortness of Breath in second week.

6. Rising CRP >50

7. Worsening CT Chest

8. Fever onset in second week

Experimental drugs– COLCHICINE: can be considered in high-risk patients >65 within 24 h of a positive test. The dose
is 0.5 mg BD for 3 days, then OD till clinical illness resolves.