To be worried if you have COVID symptoms and have tested positive is entirely understandable. But please do not panic. And, for your own sake, do not self-diagnose and/or self-medicate. Consult your physician on the way forward.
If the symptoms are mild, there is no need to rush to hospitals seeking admission and it is pointless worrying about arranging oxygen and drugs like Remdesivir.
For, most people infected with novel coronavirus get cured on their own with minimal medical intervention. Only a small percentage of patients need medical oxygen support and round-the-clock attention in a hospital. Ditto with Remdesivir. It’s not for everyone.
The New Indian Express spoke to doctors across India and they say they have come across panicky patients and their attendants insisting on ICU or oxygen beds, irrespective of the condition of the patient.
Their angst may have been triggered by scary reports of deaths due to oxygen shortage and scarcity of certain life-saving drugs. But this further burdens the country's already creaky health infrastructure.
Let’s bear in mind that 85 per cent of COVID patients do not require hospitalisation. However, the scare around the ongoing second wave of the disease is such that many people start scouting for hospital beds as soon as they test positive.
Doctors in Karnataka say there have been instances of families of COVID-19 patients with mild to moderate symptoms pulling strings to get ICU beds. What they actually end up doing is to block admission of serious patients who really need critical care to survive.
"It has become another job for the already overburdened doctors to educate attendants about the patient's condition," said Dr C Arunkumar, medical superintendent, KIMS hospital, Hubballi, Karnataka.
'Getting admitted to ICU comes with added risks'
According to Dr Tinku Joseph, chief of interventional pulmonology at Amrita Institute of Medical Sciences, Kochi, home isolation and care would suffice in case of COVID with mild fever. "What people do not realise is that going to ICU and ventilator comes with its own set of risks in the form of infections like ventilator-associated pneumonia, which can affect chances of survival after intubation," added Dr Prashanth, Asst Professor at Mysore Medical College and Research Institute.
So, when actually should a COVID-19 patient seek hospitalisation and when one be provided with an oxygen or ICU bed? "A patient should be hospitalised only if SpO2 is below 93 per cent (88-92 per cent in patients with chronic lung disease) and respiratory rate is more than 24 per minute" said Dr Binod Kumar Patro, dean (research) at AIIMS-Bhubaneswar.
"ICU admission would be needed if the respiratory rate is over 30 per minute and SpO2 is less than 90%. If the condition deteriorates, the patient can be put on a ventilator," he added. Oxygen saturation, known as the SpO2 level, refers to the level of oxygenated haemoglobin in the blood, which is transported from the lungs to various organs and helps sustain vital functioning.
Dr Justin A Gopaldas, consultant, critical care medicine, Manipal Hospitals in Karnataka, said a patient who needs hospitalisation and is likely to need oxygen in the future, will be admitted to the general ward.
"Their need for oxygen is determined by a number of factors. If they have cough, cold or fever, but have oxygen levels of 99 per cent in the beginning, which later decreases to 94-96%, it indicates a downward trajectory," he explained.
According to Dr KP Aravindan, member, Kerala expert panel on COVID-19, IC U beds should be reserved for the neediest who require constant monitoring. "Most of the severe patients can be treated with the help of an oxygen bed. However, there is a rush to get admitted to an ICU bed. It is the doctors who should take the decision, based on the necessity of the patient and it should not be left to the discretion of patients," he said.
Hospitals typically decide on admission by giving preference to patients with co-morbid conditions and low oxygen saturation levels.
In Bhubaneswar, for example, the city's rapid response teams, led by doctors, first check the condition of patients and then allot beds as per need. "We decide on critical care if the condition of any patient deteriorates during treatment," said Dr Rajesh Lenka, nodal officer, AIIMS-Bhubaneswar.
Sri Venkateswara Institute of Medical Sciences at Tirupati has a triage centre for screening patients. "Based on their condition, patients are given non-oxygen beds or oxygen beds with ICU. Those whose condition is below the prescribed saturation levels will be allocated an Oxygen bed. Those with mild symptoms are sent for home isolation. If patients with mild symptoms are hospitalised, they are allocated normal beds," said Dr B Vengamma, director, Sri Venkateswara Institute of Medical Sciences, Tirupati.
The State COVID Hospital in Vijayawada, too, admits patients after their condition is examined at the triage centre. "Doctors collect blood samples and conduct various tests to check whether the patient has co-morbidities. If the patient is suffering from comorbidities and oxygen saturation levels are below 95 per cent, he or she will be given an ICU bed with oxygen support," said Dr N Gopichand, Nodal Officer, State COVID Hospital, Vijayawada.
"If the SPo2 levels are above 95 per cent, they will be given bed in the ICU without oxygen support based on their condition. Those with mild symptoms are advised to stay under home isolation for 14 days with medication," he added.
A doctor at the Government Chengalpattu Medical College Hospital in Tamil Nadu said if the saturation level of a patient on oxygen support stays above 92 per cent, there is nothing to worry. However, concerned bystanders -- misinformed by fake WhatsApp forwards and misleading news reports -- increase the oxygen flow till the saturation reaches 98-99 per cent because they think anything below that is unsafe.
"Doctors keep reducing the flow of the oxygen as the patient’s saturation improves to bring the person out of oxygen support. However, the attendants may think we reduced the flow because there is a shortage of oxygen. Therefore, after we leave, they immediately adjust the knob and increase the flow," the doctor added.
However, if COVID patients with normal oxygen saturation have serious medical problems like acute coronary artery disease, stroke or kidney disease requiring dialysis, then they need to be admitted in designated COVID hospitals, noted Dr Anjan Trikha of AIIMS Delhi.
"Likewise, patients with safe oxygen saturation but having persistent cough and fever for more than five days may need close medical observation," said Dr Kiran Madhala, HOD (Critical Care), Nizamabad Medical College.
"If cough persists beyond five days and does not resolve, it is recommended to get in touch with a doctor and under their guidance one can start on either tablet or inhalable steroids to reduce inflammation in lungs," he said.
If the saturation goes below 85 per cent, the patient will need ventilator support, he added. However, most people don’t understand the medical requirements of COVIDid patients for speedy recovery and try to push their own will on doctors and hospital staff.
Some are obsessed with Remdesivir, say Dr P Vasanthamani, dean, Government Kilpauk Medical College Hospital in Chennai. "If we don't give Remdesivir, the attendants insist it be given irrespective of the patient’s condition. They also manipulate the oxygen flow without understanding the medical needs of the patient," she said, adding that such interferences could delay the patient’s recovery.
(With inputs from Bengaluru, Bhubaneswar, Chennai, Hyderabad, Kochi, New Delhi and Vijayawada)