COVID is different this time and we can NOT apply here what we have seen last time. Important new observations made are
1) Oral temperature of more than 100 on the 7th day or later is an indication of already moderate bilateral pneumonias on CT.
2) The CRP may not be very high at this stage, patient may not have any cough or breathlessness and saturation still is 96% or more at rest and patients will not desaturate despite CT score being 10 or more here
3) in next 2-3 days, CT score will jump to 16 or more, with again hardly any cough or breathlessness, fever being the only symptom with again saturation more than 95% at rest
4) However the same patient in next 24-48 hours will desaturate drastically to requiring not just oxygen but often NRBM, HFNC or NIV
5) So pls do an hrct chest in a patient who has fever on day 7 or thereafter, even if there is no cough breathlessness or desaturation. Waiting for these to be present before doing an hrct chest would be surely missing the bus and will adversely affect your patient outcome
6) I would definitely suggest starting steroids in these patients who have oral temperature more than 100 on day 7 or later, even if their saturation is 95% or more as waiting for even 2-3 days is making patients not only need hospitalization but actually icu care.
7) By starting steroids on time, all these patients are being managed wonderfully (even at home) along with being given anticoagulants, antibiotics, sugar monitoring, prone position
8) Not starting steroids in these patients with fever on 7th day or later is like creating a situation where the patients may end up in the icu and have a prolonged course often unfavorable
9) Surprisingly, patients without fever from 7th day onwards, even if they have cough or breathlessness are not doing badly.
Fever from 7th day onwards is the most important prognostic marker of this time’s COVID.
10) So let’s not insist on sticking to what we were doing last year as the virus is behaving differently this time.
Pls do not wait to start steroids till saturation at rest is below 94 or patient desaturates on exercise. Pls consider starting steroids for patients with moderate CT involvement and presence of fever of 100 from 7 day onwards, even if saturation is normal or there is no post exercise desaturation
Earlier evidence based science is not applicable this time and we need to act differently this time for better patients outcomes