A BMC health worker conducts thermal screening at Lokmanya Tilak Terminus on Monday. Pic/Sayyed Sameer Abedi
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, multiple—and often conflicting—updates about the protocols for Covid-19 care have left people confused and in doubt. In this, the first of a two-part series, Dr. Sameep Sehgal, a pulmonologist at Temple University Hospital talks to Mid-Day.com about some questions that are frequently asked about testing positive, standard care and prescriptions, and hospitalisation. Here are the excerpts:
Dr Sameep Sehgal
In some reports, it has been said the RT-PCR test is not always detecting the B.1.617 variant. What should those with symptoms do then?
No tests are a 100 per cent accurate for any viruses or variants. The PCR test for Covid can also have “false negatives”, 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 B.1.617 variant is not detected by current tests.
Since 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 1-2 days can be done. The best way to avoid infecting others is by self-isolating.
Should Covid-19 patients get a CT scan too? What is the difference between Ct value on the RT-PCR test, and a CT scan report?
Chest 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 Covid-related breathing problems and your PCR is negative to help establish the diagnosis of Covid pneumonia.
Cycle 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 don’t use it to make treatment decisions.
At what point should a patient seek hospitalisation?
Patients with mild Covid do not need to be hospitalised and can recover at home. Main reasons to seek hospitalisation — shortness of breath, chest pain, drop in oxygen saturation (less than 92 per cent), inability to take care of self at home.
Days after an assessment published in The Lancet said there is consistent strong evidence that SARS-CoV-2 virus behind the Covid-19 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 necessary?
Covid 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 don’t live with- whether you meet them inside your house or outside your house. I don’t 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 “double masking” with two surgical or a combination of surgical and cloth masks. A good fit for the mask is important.
What is the SOP for Covid-19 patients who are managing symptoms at home?
• It varies based on each person’s individual situation. High risk patients (over 60 years, other medical problems, obesity, or on immune suppression medications) will need to be monitored more closely.
• Self-isolate patient and all the people living in the same house. ALL in close contact should be considered COVID positive and self-isolate to help prevent spread to other people.
• Watch for symptoms of worsening disease — 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 hospital.
• Monitor temperature, heart rate and oxygen saturation at home- usually once or twice a day depending on their individual situation.
• MOST patients do not need to see a doctor and can be managed at home with as needed paracetamol, hydration and rest.
• Routine use of steroids, antibiotics, antiviral, high dose vitamins etc is NOT needed in mild disease and over medication can lead to harm.
There is a lot of conflicting information on steroid prescriptions for the Covid positive. Do they help or harm?
In patients with Covid-19, 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 avoided.
There has also been an increased demand for medicines such as Remdesivir or Favipiravir and for plasma therapy in treatment of Covid-19 in India. What does the evidence say about the use of these treatments?
Remdesivir — only useful early in the course of the disease (within first 10 days) in patients who are in the hospital and have low oxygen levels.
Favipiravir — 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 don’t use this medicine to treat patients.
Plasma therapy — several studies have shown NO improvement in patients with Covid. We don’t use it to treat patients anymore. I recommend against using resources to donate and administer plasma in Covid patients.
How long after testing positive for Covid-19 can one get vaccinated?
I suggest getting vaccinated usually 4-6 weeks after recovery from Covid. If received monoclonal antibodies (not currently available in India) it is recommended to wait for 90 days.
Is it advisable to opt for elective surgery during a pandemic? What are things to remember when doing so?
It depends on how “elective” 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 proceed.