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All we need to know about COVID-19 10
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Lecture1.1
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Lecture1.3
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Lecture1.4
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Lecture1.5
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Lecture1.6
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Lecture1.7
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Lecture1.9
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Lecture1.10
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The COVID-19 infection has two phases, the first is the viraemic phase and the second one is the immunologic phase. These two have to be promptly identified and managed appropriately as mentioned above. The critical treatments are oxygen therapy when hypoxic and steroids during severe immunologic phase of the disease. Non Invasive Ventilation and other supportive care including appropriate anticoagulation when needed are crucial and may help to avoid ventilation as prognosis by then can be grim with almost 30-50% mortality.
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Do’s and Don’ts in Covid 19:
- FIRST DAY OF SYMPTOMS: Documenting the day of symptom onset very precisely is of the prime importance as it decides line of investigations, Modes of treatment and need to hospitalize and duration of isolation.
- RT PCR test: A positive Rapid Antigen Test is highly specific and does not require corroboration with RT PCR test. However, a negative RAT in a symptomatic patient needs to go for RT PCR test.
- ISOLATION: Immediate isolation is of paramount importance and needs to be stressed emphatically to patient. Ignoring the disease, delaying the RT PCR test (or Rapid Antigen Test) is not justified.
- DOCTOR SUPPORT: the patient has to have 2 weeks of isolation. It is extremely important to address his anxiety and also to see that he has a direct communicating link to an experienced health care worker.
- COMORBIDITIES: Assessment of comorbid conditions at the time of diagnosis and measures to control those comorbidities which can be corrected (Hypertension, Diabetes) should be always be kept in mind at the time of initiating treatment
- COVID TESTS: Battery of investigations for Covid may not be needed for all the patients at the time of diagnosis and best reserved for patients who are at high risk due to multiple comorbidities. Basic investigations must include vital data, CBC with N/L ratio, CRP and sugar levels.
- CT CHEST: HRCT of thorax may not be advocated early in the course of disease in mild disease. It may be ordered on day 5 unless patient has definite signs and symptoms of lung involvement with comorbidities. A normal 6-minute walk test may alleviate the need for HRCT scan.
- Favipiravir & Remdesivir: Role of Favipiravir in mild disease should be restricted to those having multiple comorbidities and having age above 45 or 50 especially when presenting very early in the course of disease. Remdesivir may be reserved for moderate disease having comorbidity and coming early in the course of disease. (5 to 7 days)
- Vitamin D: Many trials have now signified the role of Vitamin D in management of Covid.
- Steroids prescribed on day 1 or early in the course of disease (unless documented hypoxia) may cause harm or may not be beneficial.
- Anticoagulation: Injectable LMWH and/or newer oral anticoagulants should be used in patients having rapidly rising D Dimer values or history of thrombo embolic risk.
- ECOSPRIN: Role of aspirin has been established in multiple trials and may be used as 75 mg single dose medication for those above 40 years of age..
- VITALS: Monitoring the patients is the most important factor in management of disease. Regular measurement of temperature by properly calibrated thermometer, measurement of sPO2 by a properly used pulse oximeter and measurement of blood pressure and glucose levels at home in addition to a regular eye on inflammatory markers will screen the moderate and severe disease from mild disease.