Deeksha Singh*

OBGYN Therapist, MP Medical Science University, India

*Corresponding Author: Deeksha Singh, OBGYN Therapist, MP Medical Science University, India.

Received: April 22, 2021; Published: April 30, 2021

Abstract

  Covid is spreading so rapidly and this time pandemic is killing so many people! In India we lack medical facilities, especially we lacks hospital and specialised staff! So, government asked people for home isolation in case of viral infections! I have made this covid treatment plan with the help of many data from my patients and study! Hi I'm Dr Deeksha and today am going to give you summarize treatment to help you recover with covid! Thanks to Dr Ramakrishna Chaitanya, anaesthesiologist, Medical College, Hyderabad for helping me with this!

Covid summarized treatment plan include:

• Medicine
• Role of meditation
• Role of social media
• Diet
• Physiotherapy role!

So in the whole study I have explained in detail about role of all these in rehab of Pre and Post covid treatment ! I have also included the lab tests needed to know about covid!

Keywords: ACBT (Active Cycle of Breathing Technique); RAT (Rapid Antigen Test); HRCT (High Resolution CT); RTPCR (Reverse Transcription Polymerase Chain Reaction); PD (Postural Drainage); ABC (Airway Breathing Circulation); WBC (White Blood Cells)

Abbreviations

Physiotherapy: Branch of medical science deal with exercise!; Meditation: Meditation is a practice which includes a technique - mindfulness, or concentrating the mind on a particular object, thought, or activity - to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state; Mannual Hyperinflation: Use of rebreathing bag manually inflate the lung aid to removal of secretions!; RAT: Rapid diagnostic test to detect the presence or absence of antigen!; RT PCR: Reverse transcription polymerase chain reaction is a laboratory technique combining reverse transcription of RNA into DNA and amplification of specific DNA targets using polymerase chain reaction

Having symptoms, fever high grade, cold, sore throat, cough, malaise at this time of Pandemic should be taken as suspected covid.

Day 2 to day 5 of symptoms to get the Real Time PCR and more likely to come positive. (at present so called gold standard)

HRCT chest and x-ray chest advisable on day 4 - 5, acts as a supportive evidence or to pick up early ground glassing.

If test comes negative then though welcome news, watchful for next 7 to 10 days and repeat the test if symptoms worsens.

If test comes positive then self-quarantine, ideally:

• Separate room
• Separate toilet
• Self-care
• Self hygiene.

If separate toilet not possible to flush the toilet thoroughly by disinfectant may be household phenyl after its use by infected person:

• Monitor SPO₂ twice a day daily. Should be more than 95%.
• To do six minute test twice a day
• Rest SPO₂ - > 95%
• Walk for 6 minutes in a room itself
• SPO₂ after walk if equal or less than 93% - likely to have hypoxia.

To get hospitalized for further management

• Medicines symptomatic
• Paracetamol 1gm qds
• No need of NSAIDs
• Vit C

One can take antiviral as

• Favipiravir
• Lopinavir

Of late Favipiravir recommended.

But then to do basal LFT, ECG.

No role of prophylactic antibiotics in home quarantined positive patients.

Investigations during quarantine:

• CBC
• CRP
• Xray chest.

Investigations during hospitalization in first 5 days:

• Besides
• CBC
• CRP
• Xray chest
• D-dimer
• LDH
• Ferritin
• Creatinine
• LFT
• To watch for N:L ratio
• More than 3.5
• Warrants antibiotics.

During hospitalization medicines given:

• Favipiravir/lopinavir/remdesivir
• Doxy
• Ivermectin
• (Doxy and Ivermectin no proven role but can be used on OPD basis treatment)
• Vit C high dose 1.5 gm
• Zinc 50 mg minimum.

Day 7, day 8:

• IL6 test
• To detect cytokines storm

From day 6:

• In covid patient with hypoxia
• Antiviral
• Remdesivir added
• D6 to D10
• Five days
• 200 mg IV First day
• 100 mg IV for next four days
• Availability is issue but available at major hospitals
• Cipla and Hetero are manufacturing and hopefully availability will not be issue in next 2 weeks
• Remdesivir only five days
• Creatinine clearance should be checked for
• The thumb rule in use of antiviral is
• Early to start is always better
• Informed consent required for use of remdesivir as well favipiravir.

 Another important drug is use of steroids:

• Methyl prednisolone is the drug of choice
• 1 mg/kg/BW BD for 5 days IV.

• Rise in inflammatory markers.
• CRP high
• Ferritin high
• But to give under the cover of broad spectrum antibiotics
• To check for that Procalcitonin levels are done if high suggests underlying sepsis the Antibiotic cover is important higher ones of course IV.

Use of dexamethasone instead of MP if issue with cost and availability of MP

• Use of dexamethasone has its value at hospital
• Strictly not to be used on OPD basis for first five days of symptoms
• Don't Start Dexa or any steroids just because one has diagnosed with Covid. It may have detrimental effect if started before time.
• Of course as general practitioners we should not use it.

Low molecular weight heparin is another drug added on day 5 of symptoms in view of hypoxia/who requires oxygen:

• Inj Clexan 40 mg/60 mg once a day continued till discharge and continued at home or replaced by oral anticoagulant for a week and repeated test of D dimer is important. If normal then it is stopped.
• Sometimes if D dimer is relatively too high then higher therapeutic dose is used of Inj Clexan
• Reason of using it - as micro vascular thrombi - pulmonary embolism - is one of the complication
• LMWH in all patients irrespective of D dimer
• Prophylaxis or Therapeutic doses depend on D dimer levels.

Treatment of hypoxia

• HFNC
• High flow nasal canula delivery of oxygen as high as 40 to 60 lits with closed mouth
• In prone position
• All the time nursing in prone position and CARP protocol has good outcome
• Importance of prone position
• Heart, anterior mediastinal organs falls forwards
• Better aeration of lungs
• Posterior lobe involvement becomes lesser
• NIV/CPAP not recommended
• NIV has got its limitations including
• P SILI (Self Induced Lung Injury) and difficulty in prone nursing.

If on HFNC

• PCO₂
• ABG not achieved as desired.
• PaO₂/FiO₂ ratio < 150 on HFNC
• To shift to ventilator.

Cosmetic ventilators are just automated AMBUs and don't have any role.

If clinically

• Hypoxemic
• Fever with chills increases
• Tachycardia
• indirect evidence of cytokine storm
• Recognize cytokine early. Monitor labs frequently
• Confirmed by
• CRP increase
• IL6 increase
• Ferritin increase
• LDH increase
• WBC rise
• Tocilizumab (anti IL6)/Eculizumab (anti CD6) injection to be used
• Timing is very important
• Not early not late
• D8 to D12
• 3 digit CRP
• 10 to 12 times rise in IL6
• IL6 reports sometime takes two days
• But as CRP too high better not to wait for IL6 report otherwise it will be too late
• Rule out infection before giving it, send procalcitonin
• Of late cytokine storm is seen in 3^rd week too
• D16/D17
• Only one dose of tocilizumab
• No role for second dose.

Sudden death in covid causes

• Acute coronary syndrome
• Pulmonary embolism

Antibody test for surveillance

• For plasma donation
• High tires 1:1024
• Quantitative

Late complication

• Early to say
• But may be fibrosis of lung.

IVIG only if suspecting infection induced HLH

• LDH/Ferritin in 1000s.

Plasma donation must be encouraged. Committee like ZTCC should be formed for monitoring it's use.

All frontline health care provider should take HCQ prophylaxis weekly till the end of pandemic. There is no other proven prophylaxis available besides HCQ.

We are nowhere near herd immunity.

Don’t let your guards down especially in common areas, canteen, chambers when with someone.

Good basic supportive care and tender loving care is the key for favorable outcome.

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Before using or prescribing please ask your respected physicians and physiotherapy staff to know your current symptoms!

• Breakfast- Banana, Soaked raisins, Poha, egg, fresh fruits and bread!
• Lunch- Dal, Phulka, Sabji, Salad and Chutney!
• Evening- Veg Soup, Jaggery, Dry Snacks, Tea, Rusk, Biscuits and Salad !
• Dinner- Khichdi, mix soup, sabji, phulka and salad!

You can do exercises on your bed or edge of bed or chair! Covid recovery strength exercise routine outline include bed or chair for different stages of recovery and level of fitness!

• Positioning: This include side lying with good lung down and bad lung uppermost. Upper Thorax elevated position or bed elevated position is good too!
• Postural drainage: Position according to use gravity assist drainage of secretions!
• Manual chest clearance techniques: These done after patient in postural drainage position to aid clearance of secretions includes percussion, vibrations and shaking.
• Active cycle of breathing techniques: It include breathing control, thoracic expansion exercise and forced expiration! Ask patient to take three deep breath in, usually combined with hold then forced expiration, help in clearing bronchial clearance!
• Airway suction: Removal of bronchial secretions through suctions catheter via nose or endotracheal tube!
• Manual hyperinflation: Use of rebreathing bag manually inflate the lung aid to removal of secretions!
• Intermittent positive pressure breathing (IPPB): Assisted Breathing using airway pressure and expiration is passive!

• Breathing exercises
• Neck and shoulder stretches
• Seated marching
• Shoulder roll
• Marching on spot
• Lumbar rotation
• Bridging
• Knee to chin
• Sit to stand
• Pursed lip breathing
• Diaphragmatic breathing
• ACBT
• Walking
• Resting elevated bed position using pillow
• Calf Stretching.

  You can use your wrist watch for seeing the second hand for 60 count and increase the account accordingly! You can also use visual imagery guided technique method with relaxation position for meditation! [1-10].

• Connects you with your inner world.
• Balance your body, mind and soul.
• Inoculate good values in your baby.
• Prepare yourself for birth ND beyond.
• Help to increase energy inside you.
• Deeply bonds you with your baby.
• Positive attitude towards your body changes.

Conclusion

  I want to conclude my whole article on covid rehab plan! The pandemic is a prolonged emergency, where the situation is unlikely to resolve quickly. It is therefore of extra importance that your own wellbeing and that of those around you is looked after. You can take steps to reduce the amount of strain you experience.

• Taking regular breaks.
• Eating and drinking enough (avoid alcohol).
• Regular physical activity.
• Talking about your feelings, if you want to. This is a personal preference so you should not force others to talk (or listen) if they do not want to.
• Looking out for colleagues who may be struggling to cope.

Acknowledgements

  I would love to express my gratitude to my mom Mrs Kamlesh Singh, my father or can say my idol Mr. Sughar Singh, my sisters Nisha Singh, Neha Singh, my brother Mr Veer Vikram Singh, and my brother-in-law Mr Laxmi Kant Siddharth without their unbelievable support, love, encouragement and sacrifice, I would never have come so far. Their trust gave me new strength to lead such a beautiful life. I would like to express my gratitude to all my patients, without whom there would not be a protocol at all. I would like to express my sincere gratitude to Mr Anuj Kanojia for his constant encouragement throughout. I wish to express my thanks to Dr Rebecca Maidansky and Kim especially for their prompt assistance and cooperative attitude. I would like to thanks my clinic staff and my team! I hope this protocol help many needy patient!

References

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4. Rapp D E and Kobashi K C. “Mid-urethral slings: Techniques and outcomes”. Urology Times-Clinical Edition (2008).
5. Brigham and Women’s Hospital. “Urinary Incontinence” (2011).
6. Subak LL., et al. “Weight loss to treat urinary incontinence in overweight and obese women”. The New England Journal of Medicine 5 (2009): 481-490.
7. Muller N. “What Americans understand” (2005).
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9. Subak LL., et al. “Urinary incontinence in women: Direct costs of routine care”. American Journal of Obstetrics and Gynecology 197 (2000): 1-9.
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Citation

Citation: Deeksha Singh. “Current Covid Summarized Treatment Plan”. Acta Scientific Women's Health 3.5 (2021): 78-83.

Copyright

Copyright: © 2021 Deeksha Singh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.