New norms: Treat all those with symptoms, mask up at home

Underlining that the virus strain in the second surge is highly infectious, the head of India’s Covid-19 task force Monday recommended that the time has come to wear masks in “home settings” to break the chain of transmission.

Significantly, another member of the Covid-19 task force and Director of AIIMS Randeep Guleria said that given the unprecedented surge, it is imperative to start Covid-19 treatment of those who show “classic Covid-19 symptoms” despite negative RT-PCR tests or of those whose results are awaited.

These two key recommendations came as India reported a record 3,52,991 new cases Monday and 2,812 deaths in the last 24 hours; the country’s active caseload has reached 28,13,658.

“In my view, looking at the pandemic and the number of cases, we have to do clinico-radiological diagnosis, for those whose RT-PCR tests are getting delayed but the patient is showing classical Covid-19 symptoms, or CT scan shows classical Covid-19 symptoms. We should accept this is Covid-19 and these people should get treatment as per Covid-19 protocol…the RT-PCR tests also could come negative because its sensitivity is not 100 per cent,” Guleria said.

Flagging the surge, V K Paul, who heads the Covid-19 task force said, that there are benefits to wear a mask at home given its rapid spread.

“We should stay at home and get treatment (for mild symptoms). We have to adopt the right things… promote home care. We also have to remember that if there is one positive case in the house — it is very important that the person wears the mask; because he spreads the virus. I want to say that time has come that we should start wearing masks at home even in normal circumstances. Earlier we spoke about (wearing a mask) outdoors. The spread of the infection is faster and by chance someone can get it. There are benefits if you wear a mask even when you are sitting with someone at home,” Paul said.

“In this situation, it is very important that we wear a mask. We should not unnecessarily venture out. Stay with the family. However, even with the family, please wear mask. Please don’t invite people into your home. At home, if someone has an infection, extra care should be taken because the virus is highly transmissible. The angle of transmissibility is becoming clear. It is very important we don’t go out or invite people as we protect our families,” Paul said.

On Monday, Guleria emphasized that people with mild symptoms should not panic — and that this can result in overwhelming of health infrastructure.

“In this critical phase of the pandemic, we have to ensure that our hospital facilities are optimally utilised. There is an unnecessary panic that is causing more harm than good. There is panic among patients who are tested positive, and have normal oxygen saturation; they also start searching for hospital beds because of which we are experiencing a huge rush outside the hospitals. Genuine patients will suffer because of this panic because they will not receive proper treatment,” Guleria said.

Guleria said some people, in panic, have begun hoarding medicines. “This is also causing an unnecessary shortage of certain drugs in the market. There is also misuse of drugs because people assume that if they consume the medicines from the first day itself (after testing positive), they can protect themselves. This causes side effects,” Guleria said.

Guleria, specifically, raised the issue of “rational” use of oxygen at home. “In this disease 85 per cent will have mild disease, who will recover slowly. All of them will recover with supportive treatment. They only need home isolation and close monitoring. We have to watch the warning signs: high temperature; low oxygen saturation; severe vomiting; and fatigue. If everyone wants a hospital bed due to panic, then no health infrastructure can handle this load,” Guleria said.

“Some people also think that if they store oxygen and start oxygen therapy from the first day, they would not need oxygen later. These are wrong notions. Oxygen is an important aspect of Covid-19 treatment; but its misuse is an equally important aspect. Even those who have 94-95 oxygen saturation level, the oxygen is reaching the key organs. There is no requirement to make it 98-99 through oxygen therapy. This is misuse because the same oxygen can be used for those whose levels are below 90. When it is falling (below 94), contact your doctor,” Guleria said.

Paul further added that those in home isolation should not hoard Remdesivir but instead use drugs recommended for mild disease as per clinical management protocol.

“For those in home isolation, patients can use Ivermectin and Hydroxycholoroquine. If the cough persists for more than five days, you can take inhalation budesonide,” Paul said.