Covid-19 FAQs: Which test, when to hospitalise, which drugs are recommended

The second wave of coronavirus is still raging in many parts of India While there are reports of the situation improving in a few states the threat of a resurge remains Meanwhile multiplemdashand often conflictingmdashupdates about the protocols for Covid19 care have left people confused and in doubt In this the first of a twopart series Dr Sameep Sehgal a pulmonologist at Temple University Hospital talks to MidDaycom about some questions that are frequently asked about testing positive standard care and prescriptions and hospitalisation Here are the excerptsDr Sameep SehgalIn some reports it has been said the RTPCR test is not always detecting the B1617 variant What should those with symptoms do thenNo tests are a 100 per cent accurate for any viruses or variants The PCR test for Covid can also have ldquofalse negativesrdquo which means that the patient has Covid but the test returns negative When a test is properly done correct technique for sample collection storage and testing this is very rare usually around 5 per cent I am not aware of any credible data which shows that the B1617 variant is not detected by current testsSince there is high community spread in India at this time the risk of infection remains very high Anyone with compatible symptoms should consider themselves Covid positive and take appropriate precautions to avoid spreading it to others even if PCR is negative Sometimes a repeat test in 12 days can be done The best way to avoid infecting others is by selfisolatingShould Covid19 patients get a CT scan too What is the difference between Ct value on the RTPCR test and a CT scan reportChest CT scan is usually useful if a patient has breathing problems drop in oxygen saturation or suspicion for pneumonia It helps us diagnose pneumonia and the extent of lung disease Most patients who have Covid do NOT develop lung problems and hence do NOT require a Chest CT If your symptoms are mild and not affecting your breathing a Chest CT is not indicated Sometimes your doctor may ask for a Chest CT if there is high suspicion for Covidrelated breathing problems and your PCR is negative to help establish the diagnosis of Covid pneumoniaCycle threshold Ct is reported in some PCR reports It can indicate the viral RNA level in a specimen Lower Ct values are reflective of higher viral levels It has limited utility in treating patients and we donrsquot use it to make treatment decisionsAt what point should a patient seek hospitalisationPatients with mild Covid do not need to be hospitalised and can recover at home Main reasons to seek hospitalisation mdash shortness of breath chest pain drop in oxygen saturation less than 92 per cent inability to take care of self at homeDays after an assessment published in The Lancet said there is consistent strong evidence that SARSCoV2 virus behind the Covid19 pandemic is predominantly transmitted through the air Dr VK Paul of Niti Aayog suggested it is time to wear a mask even at home Is this necessaryCovid seems to be an airborne virus Evidence for this has been building up for many months I suggest using a mask with anyone who you donrsquot live with whether you meet them inside your house or outside your house I donrsquot think you need to wear a mask in your OWN home around people you live with A N95 and KN 95 mask offer highest level of protection followed by surgical masks and then cloth mask I suggest either using N95 if able or alternatively ldquodouble maskingrdquo with two surgical or a combination of surgical and cloth masks A good fit for the mask is importantWhat is the SOP for Covid19 patients who are managing symptoms at homebull It varies based on each personrsquos individual situation High risk patients over 60 years other medical problems obesity or on immune suppression medications will need to be monitored more closelybull Selfisolate patient and all the people living in the same house ALL in close contact should be considered COVID positive and selfisolate to help prevent spread to other peoplebull Watch for symptoms of worsening disease mdash shortness of breath chest pain very high fevers severe diarrhoea vomiting inability to eat dropping oxygen saturation If worsening contact your doctor or head to the hospitalbull Monitor temperature heart rate and oxygen saturation at home usually once or twice a day depending on their individual situationbull MOST patients do not need to see a doctor and can be managed at home with as needed paracetamol hydration and restbull Routine use of steroids antibiotics antiviral high dose vitamins etc is NOT needed in mild disease and over medication can lead to harmThere is a lot of conflicting information on steroid prescriptions for the Covid positive Do they help or harmIn patients with Covid19 steroids are only recommended in patients with low oxygen levels due to pneumonia In patients with mild disease steroids have NOT shown any benefit and potentially can cause harm They should thus be avoidedThere has also been an increased demand for medicines such as Remdesivir or Favipiravir and for plasma therapy in treatment of Covid19 in India What does the evidence say about the use of these treatmentsRemdesivir mdash only useful early in the course of the disease within first 10 days in patients who are in the hospital and have low oxygen levelsFavipiravir mdash There has been no well conducted study showing any benefit of this medication in COVID19 Further trials will be needed to determine if it is useful We donrsquot use this medicine to treat patientsPlasma therapy mdash several studies have shown NO improvement in patients with Covid We donrsquot use it to treat patients anymore I recommend against using resources to donate and administer plasma in Covid patientsHow long after testing positive for Covid19 can one get vaccinatedI suggest getting vaccinated usually 46 weeks after recovery from Covid If received monoclonal antibodies not currently available in India it is recommended to wait for 90 daysIs it advisable to opt for elective surgery during a pandemic What are things to remember when doing soIt depends on how ldquoelectiverdquo the surgery is and should be discussed with your doctor recommending the procedure The risk of Covid needs to be factored in and balanced with the benefit of the surgery For example a cosmetic procedure can probably be delayed but a gall bladder removal for infection or surgery for cancer may need to proceedAlso Read Explained Why Covid19 patients are vulnerable to mucormycosis or black fungus causes symptoms prevention