Covid-19 home isolation guide

Home isolation : when and how?

Situation at Pune

In Pune we are almost on the peak of the severe wave of pandemic covid-19. We are just waiting for it to get over but we do not know how long it will take. There are new cases being reported everyday and Pune has unfortunately reached number one slot  in India.

Post Lockdown

Lockdown has been relaxed but we need to keep restraint on our own behaviour. We should not go out like everything is normal. Social distancing, wearing proper masks, getting out only and only if it is required, protecting our elderly people are still the norms and we must follow these in letter and in spirit. The health care system, hospitals, health care workers are under tremendous pressure.  There have been unfortunate events of loss of life due to lack of bed, lack of ventilator or lack of oxygen. To avoid such situations, it is a primary responsibility of every citizen in and around Pune and in Maharashtra to follow the rules and protect ourselves and our family members.  Very very strictly we should abide by the rules.

What are we supposed to do if the test is to be taken ?

It may so happen  that one of us would develop mild symptoms like a day of fever, sore throat, irritation or severe pain in the body with feeling of weakness, which can be a premonition of developing Covid-19 disease. These symptoms should not be neglected. Do report and ask for medical assistance, if you have any of these symptoms. There are flu OPDs being run in the hospitals.

If you give the throat swab sample , please quarantine yourself immediately . Report will come to you on mail. Fortunately with telemedicine now a reality, there are multiple ways by which your doctor can help you . Please do not hide the symptoms. Number of people are coming forward voluntarily to undergo the test when there is an index case in the vicinity.  The close contacts are asked to quarantine themselves and test if they have any minimal symptoms or if it is a significant contact, to test themselves then and there.

Covid-19 test and protocol for home isolation

If you do a swab test, what will happen ? Either you will be negative or you will be positive...   if you are negative well and good, but remember that 30% can be false negative..  Hence based on your own judgement and the symptoms, do not get into a denial, but quarantaine yourself which is most important to prevent the spread of the disease in the community. If at all you are positive, Pune Municipal Corporation (PMC) has given a mandate to allow home isolation for asymptomatic or mild cases . This reduces the pressure on the hospital system as beds are in short supply. You can be at home under the supervision of medical team. If you are getting into home isolation, you must stay in a single room with attached bathroom and should not get into contact with anybody else in the family for 17 days which is the mandatory period. During this period, you should eat well, look after yourself, take good rest, take medicines that have been prescribed and drink a lot of liquids to keep yourself well hydrated.  You can even do small exercises within the room. In fact the self-monitoring you must do includes your oxygen levels. The pulse oximeter reading should be above 95% as far as possible. If it starts going below 93%, you should alert the medical team. You can do a 6 minutes walking test.  If oxygen saturation after exercise is falling, it gives a warning signal that you need to be investigated.  If cough is persistent or if there is a feeling of breathlessness, the doctor may ask you to do certain blood tests or CT scan of the thorax. These two things are important for stratification of your disease state. We should not miss the boat if at all required you may be asked to get hospitalised. If hospitalization is required, you may be needed to be given injectable antiviral and steroid which has proven itself  for supportive medication. The use of medications is totally at the discretion of the medical person who is attending to you during this period.

Dealing with children

There is a problem with young children, if the mother comes positive and the child is negative. In such a situation, other members in the family should take charge of the child.  If the child is positive and the mother is negative, then the mother should wear a  mask herself while taking care of the child. If there are multiple people at home who are positive, they can stay together or mingle together or work together at home . But positive and negative people should not mix while at home . 

17 days is not too long a period from the point of view of smooth recovery and prevention of spread of infection in the society. Accept this and take full care of yourself and family.

 

During this period there could be mental stress that bothers you , you  may feel claustrophobic,  you may  get negative thoughts or you may get overburdened by your work from home status. In such situations, please maintain cool and calm down. Please try to maintain a certain routine. If you are working from home, please make it a habit that you get ready like you are going to office and start working. This way, adhering to your routine will help you to maintain sanity. 

You may feel too stressed out some time. In such a situation, do not hesitate to communicate with your friends and supporters to share positive thoughts and positive energy. If it goes beyond that, you  may need any further support. Please feel free to talk to a psychologist and psychiatrist.

Cheer up and follow the rules, this is going to get over sooner than later as the vaccine is just around the corner. However, till that  time, do not get scared but take utmost precautions. It is  heartening to learn  that in India our survival rate is quite high. The mortality rate is below 2 %. The rate of patients getting better has reached approximately 70% in India.

We look forward to the day when this pandemic gets over. Till then, follow the rules. 

Make sure that you DO NOT get infected.

Basic clinical needs for ventilation of COVID-19 patients

Clinical needs for a ventilator for COVID-19 patient

This video titled "Basic clinical needs for a ventilator to ventilate a COVID 19 patient" is an introductory video , intended to help biomedical entrepreneurs to understand the the basic requirements to create a ventilatory machine to handle ARDS / difficult lung /in COVID19. For doctors who want to learn how to ventilate, there are other modules.

Need is the mother of Invention, when it comes to ventilators

Pandemics are testing times. Great to see Indian Govt taking charge of the situation so proactively at various levels of this disaster management. In response to the facts like shortcomings of health infra , scarcity of the life saving ventilators, big business houses, innovators , biomedical engineers, medicos are all trying to stand up to the situation. Hopefully it should see some significant developments in Indian scenario of critical care medicine for availability ,cost effectiveness and capacity building.

While it is absolutely true that the ventilators evolved from iron lungs to synchronised lung protective machines, it happened only with better and better understanding of the pathophysiology of diseased lungs prompting mechanical changes in the ventilators over the years. Many intensivists are facing the queries regarding new prototypes of ventilators coming up, how much ever the efforts are lauded , haste in making crude prototypes should not cause harm than help to tide over the crisis.

Video to encourage Make in India

Here is a video created in line with the specifications given by Govt of India for ventilators as an effort to explain the details to courageous groups coming forward to “Make in India” ! This video was created with encouragement from Dr L S Shashidhara, Professor and Dean (Research), Ashoka University, Sonipat, 131029 India and Professor, Indian Institute of Science Education and Research (IISER) Pune (Currently, on Lien at Ashoka University) The video was shot at the ICU at Ruby Hall Clinic and features the following intensivists - Dr. Prachee Sathe (Director, ICU), Dr. Tanima Baronia (Senior Consultant, In charge, ICU) and Dr. Arunkumar (Consultant)

Cost effectiveness is a great determinant of acceptance of treatment modality in our country and obviously of the outcomes. But when it comes to lifesaving treatments like artificial ventilators, imported from other countries, it becomes disproportionately high expenditure in the bill of a critically ill patient ,who so ever bears it. It can be very painful for a sensitive intensivist to explain the “COST” of life to patient family.

Life after COVID-19

The life is not going to be the same after COVID-19 and Critical Care Medicine and ICUs also are hopefully going to change for the better for the common man! Let us welcome the new developments, with concern for quality at the same time !

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