COVID-19

What is corona virus?

Corona viruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19.

What is COVID-19?

COVID-19 is the infectious disease caused by the most recently discovered corona virus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.

How is COVID-19 spread?

The virus that causes COVID-19 mainly spreads from person to person. This usually happens when an infected person coughs, sneezes, or talks near other people. The virus can be passed easily between people who live together. But it can also spread at gatherings where people are talking close together, shaking hands, hugging, sharing food, or even singing together.
Doctors also think it is possible to get sick if you touch a surface that has the virus on it and then touch your mouth, nose, or eyes. A person can be infected, and spread the virus to others, even without having any symptoms. This is why keeping people apart is one of the best ways to slow the spread. It is also possible for the virus to spread from an infected person to an animal, like a pet. But this seems to be uncommon. There is no evidence that a person could get the virus from a pet.
There is also no evidence that it can be spread through the water in a pool or hot tub.
But because the virus can spread when people are close together, things like swimming in a crowded pool are still risky.
Experts do not think the virus is spread through food like some other viruses.

What are the symptoms of COVID-19? Can COVID-19 be prevented?

Symptoms usually start 4 or 5 days after a person is infected with the virus. But in some people, it can take up to 2 weeks for symptoms to appear. Some people never show symptoms at all.
Most people (about 80%) recover from the disease without needing special treatment.
People with fever, cough and difficulty breathing should seek medical attention. When symptoms do happen, they can include:

Fever
Cough
Trouble Breathing
Feeling Tired
Shaking Chills
Muscle Aches
Headache
Sore throat
Problems with sense of smell or taste

Some people have digestive problems like nausea or diarrhoea. There have also been some reports of rashes or other skin symptoms.
For example, some people with COVID-19 get reddish-purple spots on their fingers or toes.
For most people, symptoms will get better within a few weeks. But some people continue to have some symptoms for weeks or months. Doctors are still learning about the long-term effects of COVID-19.

Am I at risk for getting seriously ill?

Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing.
Older people, and those with underlying medical problems like serious heart disease, chronic kidney disease, type 2 diabetes, chronic obstructive pulmonary disease (COPD), sickle cell disease, or obesity. People who have a weak immune system for other reasons (for example, HIV infection or certain medicines), asthma, cystic fibrosis, type 1 diabetes, or high blood pressure might also be at higher risk for serious problems.

What should I do if I have symptoms?

If you have a fever, cough, trouble breathing, or other symptoms of COVID-19, call your doctor. If your symptoms are not severe, it is best to call before you go in. Many people with only mild symptoms should stay home and avoid other people until they get better.
If you do need to go to the clinic or hospital, wear a mask to cover your nose and mouth. This helps protect other people.
The staff might also have you wait someplace away from other people. (Social distancing) If you are severely ill and need to go to the clinic or hospital right away, you should still call ahead if possible. This way the staff can care for you while taking steps to protect others. If you think you are having a medical emergency, call for an ambulance (in INDIA, dial 108).

Is there a test for the virus that causes COVID-19?

Yes. If your doctor suspects you have COVID-19, they might take a swab from inside your nose and/or throat for testing. If you are coughing up mucus, they might also test a sample of the mucus. These tests can help your doctor figure out if you have COVID-19 or another illness.
There is also a blood test that can show if a person has had COVID-19 in the past. This is called an "antibody" test. Antibody tests are generally not used to diagnose COVID-19 or make decisions about care. But experts can use them to learn how many people in a certain area were infected without knowing it. They can also use antibody tests to study whether a person who has had COVID-19 could get it again.

Testing strategy for COVID-19: (Click Here)

How is COVID-19 treated?

Many people will be able to stay home while they get better. But people with serious symptoms or other health problems might need to go to the hospital. Doctors are studying several possible treatments for COVID-19. In certain cases, doctors might recommend medicines that seem to help some people who are severely ill. They also might recommend being part of a clinical trial. A clinical trial is a scientific study that tests new medicines to see how well they work.

Updated clinical management protocol COVID-19 (Dated: 03 July 2020) (Click Here)
Do not try any new medicines or treatments without talking to a doctor. Guidelines for home isolation: (Click Here)

What can I do to cope with stress and anxiety?

It's normal to feel anxious or worried about COVID-19. It's also normal to feel stressed or lonely when you can't do your normal activities or see friends and relatives. Keep in mind that most people do not get severely ill from COVID-19. It helps to be prepared, and it's important to do what you can to lower your risk and help slow the spread of the virus. But try not to panic.

Which are different investigational Therapies?

At present, use of these therapies is based on a limited available evidence. As the situation evolves, and when more data become available, the evidence will be accordingly incorporated, and recommendation upgraded. Further, use of these drugs is subjected to limited availability in the country as of now. Currently, these drugs should only be used in a defined subgroup of patients:

i Remdesivir : (under Emergency Use Authorization) may be considered in patients with moderate disease (those on oxygen) with none of the following contraindications:

AST/ALT > 5 times Upper limit of normal (ULN)
Severe renal impairment (i.e., eGFR < 30ml/min/m2 or need for hemodialysis)
Pregnancy or lactating females
Children (< 12 years of age)

Dose: 200 mg IV on day 1 followed by 100 mg IV daily for 4 days (total 5 days)

ii Convalescent plasma (Off Label) may be considered in patients with moderate disease who are not improving (oxygen requirement is progressively increasing) despite use of steroids. Special prerequisites while considering convalescent plasma include:

ABO compatibility and cross matching of the donor plasma
Neutralizing titre of donor plasma should be above the specific threshold (if the latter is not available, plasma IgG titer (against S-protein RBD) above 1:640 should be used)
Recipient should be closely monitored for several hours post transfusion for any transfusion related adverse events
Use should be avoided in patients with IgA deficiency or immunoglobulin allergy

Dose: Dose is variable ranging from 4 to 13 ml/kg (usually 200 ml single dose given slowly over not less than 2 hours 4This document will be updated as more data emerge.
The document contains some potential off label/investigational use of medications and is based on a consensus of experts along with the available evidence. An informed and shared decision making is essential before prescribing any of these therapies. (Click Here)

iii Tocilizumab: (Off Label) may be considered in patients with moderate disease with progressively increasing oxygen requirements and in mechanically ventilated patients not improving despite use of steroids. Long term safety data in COVID 19 remains largely unknown.
Special considerations before its use include:

Presence of raised inflammatory markers (e.g., CRP, Ferritin, IL-6)
Patients should be carefully monitored post Tocilizumab for secondary infections and neutropenia
The drug is contraindicated in PLHIV, those with active infections (systemic bacterial/fungal), Tuberculosis, active hepatitis, ANC < 2000/mm3 and Platelet count < 1,00,000/mm3

Dose: 8mg/kg (maximum 800 mg at one time) given slowly in 100 ml NS over 1 hour; dose can be repeated once after 12 to 24 hours if needed