Tuesday, August 11, 2020


FAQs answered by Dr. N. Krishna Reddy, Senior Cardiologist and Country Director of ACCESS Health India.


Do I have Covid-19?


Mumbai Aug 11th  If you have fever, head and body aches, cough, breathlessness, sore throat etc. (flu like symptoms) and if you think you have been likely exposed to a Covid-19 positive case (caring for a known case, visit to public place where social distancing was not followed, visit to a hospital or dialysis setting etc.), there is a possibility that you may have Covid-19.


What should I do if I have flu like symptoms?


It is preferable to get a medical consultation through telephone, smartphone, or online. You can reach out to your own doctor or to any online consultation provider or any helpline. Based on your symptoms and vitals (heart rate, blood pressure, breath rate, oxygen levels that are easily measured through home devices or wearable devices), you may be asked to get a few tests done. These may include blood cell counts and chest X-ray. Based on clinical assessment, your doctor may advise you to get tested for the Covid-19 virus. Sometimes he/ she may order a CT scan of the chest. It is advisable to self-isolate if you have flu like symptoms, until you get the virus test results.


What Covid-19 test should I undergo?


You should undergo a virus-detection test. There are two types of virus detection tests available – one, based on RT-PCR and the other based on Antigen detection. While RT-PCR may take one to two days to get the report, antigen detection report can be made available on the spot or in few hours. Your doctor should interpret the test results and inform you. A negative test may not completely rule out Covid-19, especially if your clinical assessment is strongly diagnostic of Covid. Similarly, a positive test is not always confirmatory, especially in the setting of low clinical suspicion. If your antigen test is negative, you should undergo RT-PCR test to be sure. However, if your antigen test is positive, you are indeed Covid positive. If your RT-PCR is negative, but clinical suspicion is high, you should repeat the test after 4 days. If your RT-PCR is positive, it means that you do have Covid. In rare cases, contamination at the lab may give false positive results with RT-PCR test.  


What should I do if I test positive?


Your doctor shall decide if you can be managed at home or if you need hospitalization. If you have mild symptoms without any breathing difficulty and your oxygen levels are above 93%, you can be managed at home. If you have home monitoring and oxygen services, you can be managed at home with close monitoring. You should also have facilities for proper isolation at home. If not, it is better to get admitted in a notified isolation facility. About 5 to 10% of cases may require hospitalization for ICU care. If you are elderly, and have other chronic conditions like diabetes, high blood pressure, heart, kidney and lung disease, it is better to get hospitalized until you start recovering. 


What precautions should I take when I am in home isolation?


You should have a separate room along with a separate bathroom, if possible. People who care for you should have personal protection in the form of face mask and hand sanitization. It is advised not to share utensils and clothing that you use during isolation. If you have vulnerable people (elderly and people with various comorbidities) at home, they should take extra precautions. You should avail of the various helplines available. Public health personnel may take appropriate containment steps as per guidelines. You should fully cooperate with them in order to prevent local spread in the community.   


Where should I go if I need hospitalization?


You should have a list of notified hospitals (government and private) that are treating Covid cases. If you have some form of health insurance or are eligible for government schemes, you should get all the information on what Covid treatment is covered and by which hospitals, from your insurer. You should also gather information on the availability of good quality intensive care services and vacant beds. It is also good to gather information on approximate costs in each hospital so that you can shortlist hospitals as per quality and affordability.


Should I stock any drugs?


You should not stock up on any drugs or self-medicate. You should be strictly managed as per published or emerging guidelines. While approved drugs based on strong scientific evidence are limited, there are few other treatments that are given as part of an ongoing study. If you are advised costly drugs, you should seek information on the quantum and type of extra benefit by use of these drugs. Unnecessary stocking of drugs or oxygen supplies creates shortages to those who really need these.


When do I need a ventilator?


Around 5% of positive cases may need ventilator. The need is higher in vulnerable people (elderly and those with other chronic illnesses). When you are unable to maintain adequate oxygen levels despite oxygen administration from outside and developing severe breathlessness, we take a decision to assist injured lungs with ventilator support.


How should I protect myself from getting the virus?


Appropriate face mask, hand sanitization, and social distancing (maintaining 6 feet distance, avoiding crowded public places or functions) reduces the risk of getting the infection to less than 5%. If you are a healthcare worker or if you are caring directly for an affected family member, you should wear the disposable surgical mask. If you are involved in direct care of patient requiring aerosol generating procedures like nebulization, non-invasive ventilation, care of ventilated patient, it is advisable to wear N95 mask. In all other situations a reusable, appropriately designed cloth mask should suffice. You can re-sterilize N95 masks by keeping them in UV light chambers for 15 minutes or Hydrogen Peroxide vapors, if available.


How should I protect others if I am infected?


Self-isolation or facility-based isolation is the best method to prevent the spread. Providing information on people who might have come in contact with you a day or two before you developed the symptoms or after the onset of symptoms is vital to test and quarantine them.


How do I know if I am infected without developing illness?


Majority of people either remain asymptomatic or develop very mild symptoms that are ignored. If you think you might have been exposed to the virus, you can get an antibody-based serological test. Body develops antibodies in response to the virus infection as part of its defense mechanism. There are two types of antibodies – IgM and IgG. IgM antibodies appear within 1 week of infection, while IgG antibodies appear in two weeks. A positive serology test indicates that you have been already infected with Covid virus. While presence of IgM indicates a recent infection, presence of IgG indicates that you might have been infected prior to two weeks. While IgM antibodies disappear soon, IgG antibodies persist for long period of time. These antibodies are supposed to offer protection against reinfection. However, we still do not know as to which antibodies offer protection and for how long. A test that detects protective IgG (neutralizing) antibodies might suggest that you are protected against reinfection for at least 90 days. However, scientific evidence is yet to come to give such an assurance.  


What should I do if I need medical attention for other health problems?


It is very important to not neglect other medical problems during the Covid pandemic. Children should get their vaccines. Pregnant women should get recommended antenatal checks. Ongoing treatment for chronic diseases like tuberculosis, HIV, diabetes, hypertension, heart, lung, kidney diseases should be continued without fail. Wherever possible, it is better to get services direct to home in order to avoid visiting clinics, hospitals, pharmacies and diagnostic centers where the probability of contracting an infection inadvertently may be higher. However, symptoms suggestive of acute heart pain or brain stroke should not be neglected and you should not hesitate to go to emergencies. You should have a list of non-Covid hospitals to manage these. Some of the notified Covid hospitals also attend to other medical problems. 


When can one  interact with someone who has recovered from COVID -19 and their family members?


Two weeks after the onset of symptoms is considered safe to interact. However, personal protection and social distancing should be continued as the virus may still be detected in few cases up to 4 weeks.


Is it safe to visit people in their homes or offices while taking precautions?


As long as people follow appropriate precautions, both at family gatherings and in offices, the risk of transmission is very minimal. Aerosols may linger in the air for longer period in closed, airconditioned offices or homes. N95 masks may be preferred if someone has to stay for longer periods in such spaces.


Can we use lifts with other people, what are the precautions one should take in closed spaces?


If people have adequate masks and follow hand sanitization after exiting a lift, there is no increased risk to share lifts.


What number is a mass gathering and why should we avoid them?


More than the number of people, it is the behaviour of the people that determines the risk of transmission.


Any other thing that I should know?


There is flood of misinformation on Covid-19 that you have to be cautious about. You can seek information on authoritative sites like WHO, CDC (USA), NICE (UK), Johns Hopkins School of Public Health, Imperial College, London and ICMR. Secondly, it is natural to get emotionally affected in these times. It is always useful to talk out these problems so that they do not lead to other problems. There are helplines to assist with emotional problems. Refrain from using untested drugs and cures.         

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