Concluded Case

COVID-19 Pneumonia- Treatment at home possible?

A 32 years old - female - an employee in Mumbai , - living alone gives history of fever 1 week back , fatigue and SOB . Now - are afebrile since last 2 days - SOB has improved. .Earlier O2 saturation was 92 % - but since last 2 days,it is 95 % as she is monitoring it at home Consulted - telephonically COVID-19 testing has not been done . HRCT chest done yesterday was CORADS - SCORE - 4 and CT severity score 8/ 40 There are multiple irregular areas of air - apace opacifications,in both the lungs with a relative lower lobar and subpleural predominance Dependent densities in both the lungs,. She has decided to get Nasopharyngeal swab for RT - PCR done after 5- 7 days - considering there is no one to take her . She is in consultation with a near by doctor Management plan - 1.Whether she should continue treatment at home which she is taken Vitamin C , cough expectorant , Augmentin 625 B.D and Paracetamol S.O.S . The treatment has been prescribed to her telephonically by the concerned doctor 2.Now - she consulted me telephonically-regarding further course of treatment. At Jammu at far off a place - I can only give assurance and asked her to shift to near by hospital in case PO2 falls below 93 % persistently . 3.Any further - suggestions by Experts under these circumstances

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Already it has been 1 week . In my opinion if she remains stable like now for 2more days or so., There will be least risk for her to get complications. She is showing improvement clinically. Ct severity is mild. Moreover age is 32 which is a bit relief Add zinc 66mg od if she is not taking. Zinc is inhibitor rna dependant rna polymerase. Add vitamin D supplementation if she seems to have deficiency. There is no much need of augmentin. She can continue at home. If there is any trouble , she should approach a healthcare facility immediately

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Already it has been 1 week . In my opinion if she remains stable like now for 2more days or so., There will be least risk for her to get complications. She is showing improvement clinically. Ct severity is mild. Moreover age is 32 which is a bit relief Add zinc 66mg od if she is not taking. Zinc is inhibitor rna dependant rna polymerase. Add vitamin D supplementation if she seems to have deficiency. There is no much need of augmentin. She can continue at home. If there is any trouble , she should approach a healthcare facility immediately

Valuable opinion
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Now pt is asymptomatic covid19 and her spo2 level is 95 so it can be treated at home adv 1, spo2 levels should be checked 4 times a day by pulse oxymeter 2, cap doxycycline 100 mg 1 bd for 5 days 2, tab vit c 3times aday for 5days 3 tab zinc 50 mg once a day for five day 4, tab ivermectin 12 mg 1 od for three days 5 tab multivitamin once a day 6, tab ravipiravir 1800 mg bd for day 1 then 800mg bd for next 6 days followup after 6days and remain quarantine for next 14 days

Thank you doctor
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@Dr. Ajeet Singh - Sir in my opinion patient became symptomatic 1 week back and today is 8th day of symptoms and considering the median incubation period of 5- 7 days - it means - virus entered the body approximately 13 days back .Now the role of FAVIPIRAVIR is questionable as anti- virals are not effective after 10 days . Right now - FAVIPIRAVIR will do no harm than good Thanks

Patient current fall under the criteria of Asymptomatic one. HRCT severity is mild. Tab. Doxy ONE tab BD x 5 days Tax fabiflu 200mg (09tab BD * 01 day) f/b 04tab Bd x13 days. Tab zincovit one tab of x 10 days Tab vitamin C 500mg BDx 05 days Get one base line ECG done if the QT interval remains normal then can start Tab HCQ one tab od * 5 days. If some cough or any issues then nebulisation with xylocaine(2%) total 5 ml 1.5ml xylocaine +3.5 ml Ns BDx 05 days. Keep the Spo2 monitoring three times a day. Rest follow up everyday telephonically. If drop in spo2 or any other symptoms follows report to emergency medical care.

In my opinion, she is an ideal candidate to start Favipiravir drug, as she falls in category of moderate illness. I also have a concern that what all drugs especially Ivermectin, Doxycycline, Azithromycin are safe to start with Favipiravir ?? Are there any interactions of Favipiravir with these three drugs. For Favipiravir to start, kindly rule out Hyperuricemia and whether LFT, KFT are wnl or not. And also during therapy, you need to monitor uric acid, LFT and KFT. Dosage of Favipiravir - 1800mg twice daily on Day 1, 800mg twice daily from Day 2 to Day 14.

I agree with the opinion. Except the duration of favipiravir.is it necessary to continue upto 14 days?
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Hrct score needs critical care As she is in a stage of cytokine storm she should be shifted to covid hospital earliest So far treatment is concerned she may need inj Remdesivir otherwise she can well be managed on fluvir75mg 2bd or fepirivair 200mg Azithromycin 500mg oral or injectable Her 02 saturation is not alarming but monitoring of parameters will be important Otherwise normal covid infection can be managed at home isolation telephonically

Thanx dr Ashok Leel
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According to me, right now she is not having any complications and symptoms too, so it is better to wait for another 72 hrs and then take decision according to her condition, till then give Arsenicum Album 30C potency added to 30 number globules, 7 globules 3 times a day till the test comes negative or patient get asymptomatic.

Thanks @Dr. Priyanka Pawar
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You have done alot of work for relief I think T axithro 500mg. T vit d3 60000 I Zinc Also advise her to go for RT PCR IF POSSIBLES IF NO.ATTENDENT INGORM NEAR Y GOVT HEATH FACILITY FORVOVID TEST REST OF MANAGMENT IS O K

Thank you doctor
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In my opinion she will be admitted and keep under regular monitoring and constant evaluation to avoid any eventuality. We will not experiment with human life. Complete examination and through assessment is must.

Thank you doctor
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Corads score 4 is poor negative predictive value Admit antibiotics antiviral 5 minutes walk if spo2 drops by 5 then oxygen steriod lmwh if ddimer il6 high then cytolimizubab for cytomic strom

Antibiotics and antiviral to be started.steroids also beneficial.
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