[PaddleShifter]

Originally Posted by Gannu_1

on a daily basis to boost immunity?

It should be kept in mind that multivitamins and zinc are immunity boosters but they can not prevent COVID-19.

Excessive zinc intake can cause zinc toxicity and can also reduce immunity, alter iron levels besides causing trouble in the gut.

To compensate for the deficiency of these nutrients in one’s daily diet, it is advisable to have a brief course once in a while. e.g.
1 tablet of Vitamin C once a day for 15 days and 1 tab of zinc (50mg) once a day for 10 days.

Disclaimer: I am MD (Microbiology) doctor and not a clinician.

[ninjatalli]

A question to the doctors (and the better informed)

We did a short inter-state travel last week and flew back over the weekend. By Monday the wife had a runny nose, mild cough and fever (~99.5deg) while I had recurring headaches and mild body pain that would come and go. A cousin whom we went around (in the traveled city) also had similar symptoms.

With COVID like symptoms, we both got tested yesterday and isolated ourselves in the house (maid etc told not to come). Over the last 24 hours, my wife's situation had gone back to normal (similar for the cousin) while I still have the headaches today. The PCR tests came negative for both of us.

Do I assume this to be a viral fever due to the recent travel (we were put up in an AC hotel room in the other city)? Or do we continue with the isolation and do a wait and watch for next 2-3 days. Our local doctor seems to be a bit caught up hence a second opinion.

[drrajasaravanan]

Originally Posted by lapis_lazuli

How do you arrive at such a decision? There is a committee that sits on a proposal, there is a debate that follows, or, you refer to publications, peer discussions? Like how is the decision to "use or not use" a drug in a hospital, arrived at? I hope my query is clear? Like, in NCR, some doctors will prescribe "ivermectin" while some "don't believe in it". How exactly, (except personal discretion) are these (in some cases, probably life changing) decisions arrived at?

Hi,
The team I am with follow standard recommendations of care which is set but MOH&FW. The team drew up feasible guidelines based on recommendations not limited to MOH. And further plan is individualized on day to day basis. Routine care does not include Hydroxychloroquine, Ivermectin or remdesvir. Actually with respect to Remdesvir Nov20 WHO recommended against usage due to lack of benefit. We conserve our resources and use them appropriately. The consistent benefit has been proven with steroids, anticoagulants and antibiotics in certain subset and this is what majority are treated with. COVID necessitated changes to the usual approach in assessment and care. The whole media nonsense about remdesvir being life saving and shortage is ridiculous. Now I am seeing patients who don't even need oxygen with less than 10% lung involvement asking for antivirals. Roughly if I should take a guess less than 1% of positive patients need ICU level of care and in that 30% will have recovery without impact on quality of life, 30% will recover with severe restrictions and 30% will die ( This is personal and I don't have data). The problem happens in India is due to inappropriate usage of resources and greed to make more money. If you need further answers or clarification do ping me.

[drrajasaravanan]

Originally Posted by Gannu_1

To the resident docs on the forum - is it advisable to have vitamin C and Zinc tablets on a daily basis to boost immunity?

Hi
Tab Vit C 500mg to 1gm every day will cause no issue as its a water soluble drug and supports many cellular functions. Tab Zinc 10 to 20mg per day is also fine unless you have pre-existing kidney function.
Having said this the recent analysis have showed not much benefit of taking these supplements. My suggestion no need for regular supplements if u r having nutritionally dense food. If you are feeling sick please start supplements appropriately.

Originally Posted by ninjatalli

A question to the doctors (and the better informed)
Do I assume this to be a viral fever due to the recent travel (we were put up in an AC hotel room in the other city)? Or do we continue with the isolation and do a wait and watch for next 2-3 days. Our local doctor seems to be a bit caught up hence a second opinion.

Hi,
Even if the RT PCR is negative which happens for multitude of reasons continue isolation and COVID appropriate behaviour for the next week.
Reason is the way the sample is taken and stored makes a impact on the result. In current scenario all fever should be suspected as due to COVID and treated as such. In all probability you should be fine in less than a week but wait it out.

[INJAXN]

Originally Posted by INJAXN

I did get the RTPCR done again. Sample was given on 19th day since the first symptoms appeared, this time also it was positive , cycle threshold >30. First +ve report had cycle threshold between 20-25.

Finally I am tested -ve on 28th day after the first symptoms appeared. Its a big relief as now I can go and bring my wife and daughters back to home. My wife is at her parents home in a different city.

For people getting +ve report even after 14 days, do not worry much, look for the CT value in the report , if it is > 30, viral load inside your body is very less and you have recovered fully or you will get recover in couple of days.

[Zen2001]

Originally Posted by bkc

As you all know, the wave 2.0 of covid is very harsh on people. Most of the hospitals are full and the chances of getting a bed with ventilator/oxygen support is next to Nil, here in Bengaluru.
Most of them, though tested positive, can still manage without hospitalisation, as their symptoms are manageable.
However, in fewer cases, where the symptoms are very bad, the fear of losing a loved one, makes me weak.
The per day positive cases are also increasing rapidly, and is now nearing 22k per day in Bengaluru.
Request, members to post their contacts to get remdesivir for covid patients.

Testing is liberally available now (as compared to that in the beginning of the first wave), infectivity with possible mutant variants may be higher, but definitely the mortality isn't! Hence the new positives will always be greater in comparison. What you're not being told (by your sources) is the number of recoveries, which are also much higher. Most manage even without hospitalisation, as you have seen. So, instead we should thank our luck that this wave isn't so harsh as compared to before. Don't go by absolute positive numbers, check data that gives you positives per million population and the positivity rates for the correct prospective. As yes, forget Remdesivir, if difficult to procure - it doesn't improve mortality, just reduces duration of hospitalisation.

Originally Posted by motorworks

I looked up a lot of articles on the internet and most people seem to suggest that there is immunity for the first 6 months at least. So should I be worried? Or could it be just a seasonal flu or fever due to the stomach bug?

Each person's immune response is unique hence can't be generalized. Wait and watch, follow isolation and seek help if progressive symptoms. Even after a full recovery, it is possible to get a positive PCR for upto 6 weeks after recovery (even if you're not re infected).

Originally Posted by drrajasaravanan

Hi,
As far as I know Remdesvir is not life saving or essential to treat COVID. Yes there is one large scale study proving its effective but many small scale study doesn't replicate the same findings. Please don't go by what's shown in the media.
This time the infective rates are high and rapidity with which its spreading in my city is also alarming but I don't think the mortality rate is higher than last time and definitely not to the extent of what I saw abroad.
Just to add I am part of a team handling COVID cases and most of us in the team do not support using remdesvir for all covid patients and definitely not as a routine.

Exactly true. Even the supposedly higher infectivity much just be attributable to increased testing. What is more important to watch is the positivity rates (but these might be skewed by selectively testing more asymptomatic than symptomatic) in the local area and positives per capita or per million rather than absolute numbers. Without a denominator, such figures are basically trash.

Originally Posted by msdivy

Surprising that the doctors don't have an alternative treatment. Recommending Ramdesvir seems to be a last throw of dice by doctors.
The point is total +ve case number is a piece of useless standalone information.

Most viral infections actually have no specific treatment, rather they don't NEED specific treatment. Same case here. That's why over 80% recover at home without doing anything specific. What is being treated actively are just complications - and there are specific treatments for specific complications. And as is the usual scenario, any complication (of any infection) with a comorbid disease generally tends to have worse outcomes than the same complication in a person without comorbidites.
.

Originally Posted by Gannu_1

To the resident docs on the forum - is it advisable to have vitamin C and Zinc tablets on a daily basis to boost immunity?

Not really. Unless you have a pre existing documented deficiency. If not just eat healthy.
Otherwise soon we'll have a shortage of these as well!

Originally Posted by drrajasaravanan

Routine care does not include Hydroxychloroquine, Ivermectin or remdesvir. Actually with respect to Remdesvir Nov20 WHO recommended against usage. The consistent benefit has been proven with steroids, anticoagulants and antibiotics in certain subset and this is what majority are treated with. The whole media nonsense about remdesvir being life saving and shortage is ridiculous. Now I am seeing patients who don't even need oxygen with less than 10% lung involvement asking for antivirals. Roughly if I should take a guess less than 1% of positive patients need ICU level of care and in that 30% will have recovery without impact on quality of life, 30% will recover with severe restrictions and 30% will die ( This is personal and I don't have data). The problem happens in India is due to inappropriate usage of resources and greed to make more money. If you need further answers or clarification do ping me.

Absolutely correct. People only read what they want to - why don't they read the SOLIDARITY trial. Or even read about the flaws in Gilead's primary trial! The same about HCQ, Azithromycin, Ivermectin and Doxycycline. The last 3 are being currently prescribed like sweets to the public - can it get more ridiculous? What the ICMR/MOHFW needed to do (long ago) was to come out with evidence based national guidelines, updating the same regularly, circulating them widely across all healthcare systems (incl AYUSH), and instituting a mechanism to oversee compliance with the same. Failing to issue clear guidelines causes more confusion (half knowledge is worse than ignorance), which leads to chaos and later panic. Now only in damage control mode have they issued the disclaimers on (non) effectivity of Remdesivir. And by asking manufacturers to increase production sends a contradictory message.
The same is now seen with something as otherwise mundane as oxygen. There are some guidelines, nobody follows them, people flocking private hospitals only because they can demand oxygen/certain therapies, and hospitals in turn want to be seen "doing something" to justify the treatment costs. I'm referring to the mild and borderline moderate cases, without co morbid diseases admitted in hospitals just for "precautionary reasons" who ended up misusing these resources.

Originally Posted by INJAXN

For people getting +ve report even after 14 days, do not worry much, look for the CT value in the report , if it is > 30, viral load inside your body is very less and you have recovered fully or you will get recover in couple of days.

Don't bother with repeated tests - can be positive for weeks even after a full recovery. Clinical recovery is the yardstick rather than a laboratory recovery. Don't go by CT values either - that is affected by quality of sampling, storage, number of days post infection - and does not correlate with clinical severity anyway.

[drrajasaravanan]

Hi
I urge people irrespective of their medical knowledge to please look at the guidelines posted in the website of MOH&FW. It precisely states level of care and gives broadstrokes on what to except for varying situation. Alternatively CDC India also has varying guidelines for different scenarios.
This.media induced mania has gripped everyone and quite a lot of people who don't even need hospitalization are occupying beds and patients who need hospitalization are at home without appropriate care.

[poloman]

Most of us are badly affected by the news and images of oxygen shortage in the country. Any first hand experiences or assurances from doctors on the forum. What percentage of Covid inpatients need oxygen therapy? How bad the situation can turn?

This guy is a relatively young politician and was active even one week before.
https://www.newindianexpress.com/cit...i-2293395.html

[drrajasaravanan]

Originally Posted by poloman

Most of us are badly affected by the news and images of oxygen shortage in the country. Any first hand experiences or assurances from doctors on the forum. What percentage of Covid inpatients need oxygen therapy? How bad the situation can turn?

This guy is a relatively young politician and was active even one week before.
https://www.newindianexpress.com/cit...i-2293395.html

Hi,
Roughly 95% don't need hospitalization. 3% will need oxygen supplementation. 2% will need ICU. The oxygen requirement is quite significant in the 2%. Having said that my centre doesn't have any lack of oxygen as we are not dependent of external supply and have installed a concentrator. We do order external supply to fulfil failsafe policy and concentrator trouble shooting scenarios. Majority of large tertiary centres should have the same system. The problem will be in small scale and govt centers who may not have such system.
We had time after the first wave but the hospital managements at several places were ill prepared to handle and took it for granted. Even otherwise the panic is unwarranted as we have the potential to solve it. I hope govt clears the air before the frenzy for stockpiling oxygen starts.

[AltoLXI]

Posted by Dr. Krutika Kuppalli here

[motorworks]

Originally Posted by Zen2001

Each person's immune response is unique hence can't be generalized. Wait and watch, follow isolation and seek help if progressive symptoms. Even after a full recovery, it is possible to get a positive PCR for upto 6 weeks after recovery (even if you're not re infected).

.

Originally Posted by bblost

Wishing you a speedy recovery.



Since normal body temperature is supposed to be 98.6, why are you calling 98-99 as a fever?

Originally Posted by drrajasaravanan

Hi,

From what I know the immunity after getting infected once can last up to 6 months which is not a hard rule. Having said that getting infected within a span of 50 days is extremely unlikely. It can be another bug and not COVID in all probability. But treat this with due diligence and appropriate level of care. And kindly get in touch with a doctor who can examine you in case it worsens and stop using Prof.Google for self diagnosis.

Thanks for all your responses. I visited a doctor in person this morning and he suggested that I take some basic blood test and also the anti body test. He also prescribed a mild anti biotic, to treat it like a normal flu. He has advised me to wait for 1-2 days before taking the RT PCR test.

However, I received my anti body test report and it seems that I do not actually have sufficient antibodies of COVID. So possibility is that I may have had a very mild infection and hence not developed anti bodies for the same.

But the issue is that I seem to be feeling a lot worse than 45 days ago when I first tested positive. Im having fever on and off, a lot of tiredness and head ache. Plus chills on my feet and hands. So im just going to wait for a day and then probably take the test on Saturday.

What Im really concerned for is the post result scenario, if it ends up positive. For one, the recent media highlights on younger patients just dying due to lack of oxygen has scared the shit out of me. And second, how my family would deal with this whole scenario. Even the last time around 14 days quarantine was very difficult on my wife and 8 year old son, and another such episode would be quite difficult. And also the risk of me passing it on to them, since my viral load may be higher than the first time around.
A lot of thoughts on my mind, have to just wait and watch.

[drrajasaravanan]

Originally Posted by motorworks

What Im really concerned for is the post result scenario, if it ends up positive. For one, the recent media highlights on younger patients just dying due to lack of oxygen has scared the shit out of me. And second, how my family would deal with this whole scenario. Even the last time around 14 days quarantine was very difficult on my wife and 8 year old son, and another such episode would be quite difficult. And also the risk of me passing it on to them, since my viral load may be higher than the first time around.
A lot of thoughts on my mind, have to just wait and watch.

Hi,
Please do not get bogged down by what you see in media. Media has managed to create a state of fear. There are 3 scenarios for low antibody titres and whole lot of questions left unanswered. Probably its not COVID but treat as such. I know it's not easy but play it safe. I see you are from Bangalore and the tertiary care facilities there are great. You in all likelihood will not need any of it. Stay calm and if you have any query or doubts pm me.

[motorworks]

Originally Posted by drrajasaravanan

Hi,

Please do not get bogged down by what you see in media. Media has managed to create a state of fear. There are 3 scenarios for low antibody titres and whole lot of questions left unanswered. Probably its not COVID but treat as such. I know it's not easy but play it safe. I see you are from Bangalore and the tertiary care facilities there are great. You in all likelihood will not need any of it. Stay calm and if you have any query or doubts pm me.

Thanks for offering support, Im actually feeling much better this morning, probably will wait and watch before getting the test.

[drrajasaravanan]

Hi,
There were discussion earlier about oxygen running short in hospitals. I discussed with the personnel handling oxygen supply in my hospital.
50 to 60 percent of oxygen need is fulfilled by the concentrator as the requirement has increased so much in the last month. They have two tanks of liquid oxygen each of which can hold the needs for one week. Plus they have oxygen cylinders which will sustain the needs for 48H. Oxygen concentrator and liquid oxygen in storage is used routinely while cylinders rarely. This is as per recommendations of the committee managing disaster preparedness for my organization.
I asked him about the current problem and I agree its mainly due to hospital relying only on the huge cylinders which has to be switched every couple of days and need a certain turn around time to be effective. Now the need has increased they turn around time is shorter and ill prepared hospitals are facing problems. I feel these hospitals will figure out a way to optimize resources and shorten the turn around time. Please note this is a private opinion of my colleague who is associated with this industry. Most tertiary hospital in South India have at least two of the three resources for oxygen and significant number of them have all the three. I hope this puts to rest the hungamma surrounding people dying without oxygen. There are people making money out of this misery and so is the media. Please stay calm and decide rationally.

[McLaren Rulez]

And now this: https://www.bbc.com/news/world-asia-56855387