DECIPHERING COVID-19 INVESTIGATIONS

Amidst the confusion and chaos following covid-19 pandemic, I have often seen patients and their relatives tensed over the reports and investigations ordered by doctors and their relevance. Also, owing to poverty and lack of insurance, many people are not able to afford the investigations which are necessary as a part of treatment. This blog is a compiled data of necessary Covid-19 investigations and their importance. Let’s start with introduction of the disease and their clinical manifestations:

 What are the signs and symptoms of the disease?

  • Fever, dry cough, sore throat
  • Tiredness, aches and pains
  • diarrhoea
  • conjunctivitis, loss of taste or smell
  • headache
  • difficulty breathing or shortness of breath
  • Chest pain or pressure.

 Investigations:

  • RAPID ANTIGEN TEST: It is quick bedside test that gives result within 20 minutes. Once rapid antigen test is positive, it implicates that person is suffering from covid infection. No need to do further RT-PCR test. If it is negative and the person is symptomatic then RT-PCR is advised. Once positive, no need to repeat rapid antigen test after 10 days since the virus stops replicating.
  • RT-PCR: It is the gold standard test but the results take minimum 8-12 hours to obtain the results. RT-PCR can detect any kind of strain except the newly discovered Indian variant (B.1.617). It is advisable to get more investigations done and quarantine yourself if you are symptomatic and tested negative.

What is CT value?

In simple words, it is the number of cycles that is required for detecting the virus. CT value above 35 indicates low viral load/infectivity and the value below 24 indicates high viral load and the need for hospitalization.    

  • COMPLETE BLOOD COUNT: There is decrease in total WBC count with absolute lymphopenia(N=1800-7700/mcl). CRP(N=<8.0 mg/dl) and LDH(N=110-210 units/L) levels are also raised. It is repeated 24-48 hourly.
  • RBS: Random blood sugar of covid-19 positive patients(especially those on steroids) is highly raised.
  • D-Dimer(<0.5 mcg/dl) and PT-INR(11-15 secs): Raised levels indicate an unusual amount of thrombosis and blood clot. Done after 48-72 hours.
  • Ferritin (13-150 ng/ml): Active ferritin production by macrophages and cytokines during inflammation leads to hyperferritinemia. High levels are associated with severe disease and high mortality. ALT(7-56 units/L), AST(N=5-40 units/L) and CPK(N=40-140 units/L) are raised indicating liver and muscle involvement.
  • Interleukin-6(<7 pg/ml): Several studies have indicated ‘cytokine storm’ associated with increased release of IL-6. It is generally done in deteriorating condition.
  • SARS COV2 Anti Spike protein antibody test: It gives you exact measurement of the antibody titres against SARS CoV-2 virus available in your body against Spike Protein after vaccination or infection.
  • CT CHEST: CT chest is done to know the severity of lung involvement in covid positive patients. A lung of covid-19 patient typically shows multifocal bilateral ground glass opacities.

What is CO-RADS scoring?

It is a classification used to determine levels of suspicion of Covid-19 infection.

What is CT severity score?

It is calculated from HRCT chest of a covid-19 positive patient to determine level of severity.

Each lobe of lung is given a score of 5(3 lobes on right and 2 on left). Based on the involvement of each lobe, numbering is done and cumulative score is derived out of 25. Another scoring

Score <8: mild infection

       9-15: moderate infection

         >15: severe infection.

When to do a CT scan?

CT scan is useful for diagnosing extent of lung involvement in Covid-19 patients. However, consult your doctor before undergoing CT scan. According to AIIMS protocol, HRCT is done in moderate and severe cases if there is worsening of condition. Chest X-ray has no role in diagnosis of mild Covid-19 cases.

If you find this blog useful, please share the knowledge with people around you.

COVID-19: TIPS TO COMBAT THE BATTLE

As the world grapples with covid-19 pandemic, there has been lot of panic and chaos amongst its residents. With many countries setting a new peak with each passing day, morale of the countries have been declining slowly. With the second wave infecting entire family, a huge spike in the cases is noted since the beginning of pandemic.  Here are few small steps that can soften the blow and aid in faster recovery.

  1. Refrain from straining: Heavy bouts of coughing or straining during constipation can decrease your oxygen saturation mainly in moderate cases of Covid-19 positive patients. Restrict your movements and refrain from applying too much pressure.
  2. Reverse Quarantine: If you have senior citizens or your family members with co-morbidities like diabetes, asthma, COPD or hypertension living with you then separate them from yourself as they are susceptible to get infected easily and are prone to develop severe infection.
  3. Superspreaders: Children are the superspreaders; it is beneficial to maintain social distancing between children and grandparents.
  4. While waiting in an ambulance owing to shortage of beds and medications, do not panic; it makes the situation worse. Breathe deeply and slowly. Lie down prone (sleep on your stomach). It increases your oxygen saturation.
  5. Breastfeeding: Covid-19 positive mothers can breastfeed her child with proper hand hygiene mask on. The antibodies production by mother has commenced which can give protection to her baby. After breastfeeding, baby should be separated from mother and proper social distancing has to be maintained. Mothers taking drug Favipravir cannot breastfeed upto 5 days.
  6. Healthy routine: Healthy routine contributes a lot to the personal development of an individual.  Keep up your personal hygiene. Wash your hands with soap and water for atleast 20 seconds under running water. Wear mask  every time you step out of your home.  While working from home, spare time for your hobbies. Maintain proper balance between personal and professional life. Maintain your sleep cycle.
  7. Food habits: Once infected, our body is in catabolic state. Consume more of whole grains like bajra and wheat, fruits, green vegetables and do hot water gargles. Consume fully cooked meal as the coronavirus get killed at normal cooking temperature. As the body undergoes lot of wear and tear, it needs a nutritious diet to replenish itself.
  8. Focus on your mental health: While the pandemic has contributed to almost 3.2 million deaths all over the world, the panic amongst the common man is inexplicably high. Along with medication, willpower is equally important. An optimistic nature plays a big role in boosting your mental health. Strengthen your mental health by practicing yoga or meditation. Spend a quality time with nature.
  9. Maintain social contact: Statistics have shown more than half of the people infected with covid suffer from anxiety. Talk to your parents, friends and all the people who give you positives vibes.
  10. Social media usage: While social media can be very helpful in today’s era, it can be equally distractive too. There have been many cases of fake medications and helpline numbers over social media. Please confirm it before reposting. Help the people surrounding you to get vaccinated. It is one of the most effective way to curb the disease.
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