Tackling the Covid-19 Second Wave in India

I am sharing this article to educate what lies ahead if someone is infected by the Corona-Virus, despite we are all aware of the precautionary steps involved.

This is from personal experience, based in India's financial capital - Mumbai. On 24th April 2021, I lost father to the dreaded virus. This happened despite him taking enormous precautions and understanding what lied ahead. Not only he did not venture out of the home, but also followed the sanitization procedure. We (myself and mother) followed his footsteps. Moreover, he had an ongoing ailment - backpain. How things transformed completely baffled everyone including my father. (Long story keeping it short)

The other thing simultaneously happened in our building, were numerous home quarantined cases.

It is no longer of not observing social distancing, and having symptoms like cold, itchy throat, fever, body pain, no smell, loss of taste. It hits the lungs directly and silently. The virus can be contracted despite being at home.

The Second Wave is too complex, and thus situation has become grim. We are all "Warriors" at this stage as of May 2021.

Kindly note there are more waves to come considering India's population, extremely poor - healthcare : population ratio, and of-course Covidiots.

Precautionary Check-list

✅Primarily, purchasing an oximeter

✅Oximeter reading at-least thrice throughout the day.

✅Stay at home 

✅Wear surgical mask at home as well

✅Ensure there is proper ventilation of air at home

✅For Outdoors, use double masking (N95 + surgical mask).

✅Do NOT use any fashionable mask

✅At-least one steam per day

✅Drink hot water and not lukewarm

✅Gurgling with salt-water

✅Walk within the home and maintain fitness

✅ Practise breathing by lying on your stomach (prone position)

Oximeter Reading 🔍

- Should always be 95 and above.

- Alarm begins the moment it drops below 95

However Oximeter reading should not be relied on and wait for it to drop below 95.

As per Dr. Mathew Varghese, one should consider "Timeline" an utmost factor, to combat the disease. Any symptom shown or felt should be noticed. Below is the video, detailing how the virus attacks the body, and what and how medication (coagulant, steroids) collectively/ separately should be given based on the timeline.

If symptoms shown:

RT-PCR and Antigen tests to be conducted at the earliest. Their reports are valid for 72hours since the test are conducted. Antigen test reports are out within a day but RT-PCR can take time

RT-PCR Score if Positive

•  17-24: High Viral Load
•  24-35: Moderate Viral Load
•  More than 35: Mild Viral Load

As known symptoms are shown, ensure oximeter reading is not less than 95. 

If a needy one is not getting oxygen, stay calm and breathe by lying on your stomach

Conduct the below mentioned tests even though you are advised with home quarantine when tested positive (HRCT not recommended unless advised by a doctor)

✅HRCT- scanning of lungs, conducted at MRI diagnostic centres

There is a huge queue to conduct this test as well. If one is on a waiting list, check out for other center. The earlier the better. Report is out within 3hrs but request for the earliest.

Reveals two scores: CT Severity and CO-RADS Score

➡️CT Severity

Our two lungs are divided into 5 parts. As right lung is bigger than left, it is divided into three and left is of two parts. Each part has a score of 5, and hence a total score is 25

•  Less Than 8: Mild
•  9 to 15: Moderate
•  Greater than 15: Severe

➡️CO-RADS Score (Level of Suspicion)

•  CO-RADS 1: No
•  CO-RADS 2: Low
•  CO-RADS 3: Intermediate
•  CO-RADS 4: High
•  CO-RADS 5: Very High
•  CO-RADS 6: Very High with PCR+

✅Other Tests (Blood Tests) with respective Severity Range, conducted at any pathology lab.

These results can come within couple of hours after conducting.

1️⃣ C Reactive Protein

•  0 – 6: Normal
•  7 – 25: Mild
•  26 – 100: Moderate
•  >100: Severe

2️⃣D-Dimer Test

•  < 0.5: Normal
•  < 1: Mild
•  > 1: Moderate – Severe 

3️⃣Ferritin Level (Normal Range)

• 13 – 150 ng/ml

4️⃣ESR (Normal Range)

• 0 – 22 mm/ hour

5️⃣ LDH (Normal Range)

• 0 – 250 U/L

6️⃣ Neutrophil to Lymphocyte Ration (NLR)

•  < 3.5: Mild
•  > 3.5: Moderate – Severe  

7️⃣ Renal Function Test

Type of Patients

➡️Covid Patient

• RT-PCR is positive

➡️Covid Suspect

• RT-PCR is negative
• CT severity (HRCT) is above 15

For the above any type of patient, conduct blood tests as mentioned at the earliest. This can help to be on an extreme safer side.

📄Documents to be kept handy

Have a soft-copies of all these and store it on Cloud (Google Drive)

☑️Aadhar Card of patient and kin

☑️All tests reports conducted

☑️Current medication if any

☑️Any recent history of hospitalization

☑️Medical / Covid Insurance documents.

☑️Supplier details for below mentioned additional medicines. Though any medical facility shall have stock of them, but if they run out of stock they shall inform the patient's kin to secure with required quantity.

1. Infliximab 100mg ( Remicade ) 
2. Adalimumab 
3. Sepsivac 
4. Becacizumab 400mg ( Avastin )  
5. Becacizumab 100mg ( Avastin ) 
6. Remdesivir and Tocilizumab. These are injected when the patient’s HRCT score goes above 20 (or can vary). These now might not be procured privately as state government has passed orders only the medical facility have the rights to procure them

🚑 Ambulance 🚑

Have contact details of Ambulances. They are not easily available, and turn around time (TAT) can extend to an hour as well

🏥 Hospitalization 🏥

After listening to a certain person, the person's three sentences were good enough to send me shiver down the spine, and tremors were felt. As healthcare system is under severe stress, admit patient to whichever hospital you may get.

Do NOT wait for any nearby hospital.

❗The battle is not over until a patient is out of hospital with complete recovery❗

Types of hospital

1️⃣Covid Center

2️⃣Covid Hospital (Private / Public)

3️⃣Non-covid Hospital (Private / Public)

For touch base with -

➡️Covid Center

☎️Booking a bed at Covid Centre (Mumbai)

Step 1: Dial hotline number of your ward in Mumbai if you know or dial 1916 (They shall provide hotline number)

Step 2: Share the patient’s details – Name, Latest Oxymeter Reading, Tests conducted (RT-PCR, Antegen)

Below 90 oximeter reading (or some other), Covid centres shall not accept patients, due to oxygen crunch. (Acceptance can change depending on the supply of oxygen)

Step 3: Update patient’s details as per latest report

Step 4: Until RT-PCR report is positive, the patient shall be treated as Covid – Suspect

Covid Center accepts patients who are Covid – Positive only and not Covid – Suspect. There is still a struggle at certain centers whether to accept Suspect patients or not. Please clarify on this with respective Centers. These centers are not meant for those patients who need caretakers.

Those hotline numbers are known as Covid War-rooms. A patient will get a Registration number.

➡️Covid & Non-covid Hospitals (Private/ Public)

Have a database of them.

Type of patients admitted to respective hospital

1️⃣Covid Center

• Only those who are Covid Positive
• Covid Suspect; confirm with respective covid center if they can admit
• Not applicable for patient who needs a care-taker (Admit to only those hospitals having caretaker)

2️⃣ Covid Hospital

• Covid positive
• Those having CT severity (HRCT) more than 15 and RT-PCR negative

Once CT severity is reduced and RT-PCR is negative, the patient needs to be shifted to non-covid area. If the hospital does not have non-covid area, the patient needs to be admitted to non-covid hospital on their own (Book Ambulance as well as non-covid hospital)

As of 8th May 2021, Government revised policy stating suspect cases can be admitted to Covid Centres , and Covid Hospitals

3️⃣Non-Covid Hospital

• Only those who are non-covid
• CT severity (HRCT) is less than 15 (score may vary as per hospital)

The entire healthcare system of India is under severe stress, and is in complete disarray. Complete mismatch of supply-demand. The respective tests can be delayed due to heavy demand. There is acute shortage of oxygen supplies, hospital beds and hence a black market has erupted for equipment like Oxygen Concentrator, hospital admission, and medication.

Stay calm under any situation

- It's time to help one another.

- If either of the government suggests for complete lockdown; embrace it.

- Be ready to absorb the economic shock

- May month is critical

I hope this comes to an end very soon......

Any suggestion or helping information, may add up in the comment section.