COVID-19 Notes
By Dr. Satish K Gupta
Management of Covid-19 in suspected Omicron during early days of 3rd wave in India
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- Basic management of Omicron will remain symptomatic by way of:
- Antipyretics/NSAID
- Decongestants
- Antihistaminics
- ViTC and Zinc (off label)
- Hot water/Tulsi kadha
- Bed rest
- Hydration
- Despite no proof of benefit drugs like Ivermectin and Azithromycin Doxycycline, they are likely to be used by most physicians.
- Molnupiravir will become available in India shortly: 4 tabs of 200 mg twice a day for 5 days to high risk patients e.g. Covid with CKD, COPD, DM, Heart Disease, Obesity or other co-morbidities and elderly patients can be given. Drug is known to prevent hospitalization in about 30% patients. Watch for Nausea, Headache, Diarrhea.
- Paxlovid may take another one and half months to hit stands.
- Trial of Remdesivir for 3 days in OPD based patients didn’t show any reduction of viral load. Patients on home isolation will have logistic issues percipitated by IV administration requirements of the drug.
- Fevipiravir will be used by most physicians under principle of *Better Safe than Sorry* Dose 1800mg BD on day 1 and 800mg twice a day for 5 to 7 days.
- Monoclonal Ab.
- Tertiary care centres will continue use Regeneron to Rich and affording high risk patients (preferably for those who don’t have detectable antibodies against SarsCoV-2), pending Proof of Omecron infection (which takes about 4 to 5 days after RT PCR report).
- Sotrivumab is unlikely to be available soon.
- Pulse Oximetry in Winters
- Being chilly winters in North India, it will very difficult to monitor Spo2 from finger based Pulse Oximeter.
- Equipment may not record Saturation or record fallaciously undue low reading due to peripheral vasoconstriction which might to lead to unnecessary panic.
- Ask patients to rub hands for 5 to 7 minutes or warm hands and fingers with room warmer/heater before using Pulse oximeter.
- Omicron is stated to have faster spread of transmission. So it may affect whole family.
- Past Vaccination may not be able to protect from infection but hope that it will continue to protect from hospitalization and severe disease.
- Don’t know if Omicron will show faster progression of symptoms in vulnerable people . Thank God Omiicron is said to have low risk of severe disease.
- Indicators of Cytokine Shock Syndrome:
- Second peak of fever on 7 to 10 day, chills, extreme weakness, remain signs of Impending Cytokine Syndrome in which case one may use
- Steroids or
- JAK inhibitors e.g.
- Bericitanib 4mg OD for 7 to 10 days
- Tofacitanib 5 to 10 mg BD for 7 to 10 days (With or without Antivirals)
- Toclizumab best left to specialist
- Please monitor Blood Sugar at all stages of disease
- Anticoagulants used only in Bed ridden patients in prophylactic doses Enoxaparin 4 to 6 mgm once a day or in therapeutic doses if there is evidence of thrombosis
- Fall in Oxygenation to less than 94% should prompt
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- Prone ventilation
- Oxygen support.
- Budesonide Nabulization
- IV Corticosteroids
- Dexamethasone 8mg (Dexona injection) once a day
- Oxygen Mask
- Non rebreathing mask.
- HNFO.
- NIV ( CPAP Bipep etc)
- Ventilation
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- Second peak of fever on 7 to 10 day, chills, extreme weakness, remain signs of Impending Cytokine Syndrome in which case one may use
- Basic management of Omicron will remain symptomatic by way of:
Also read: Treating COVID-19: What does Molnupiravir do?
*Dr. Satish K Gupta is an MD in Medicines, a Visiting Senior Consultant Physician and Internist at Max Super Speciality Hospital, and a Clinical Assistant Professor at GS Medical College, Chaudhary Charan Singh University, Meerut. He is the author of Journey of COVID in India: A Doctor’s Perspective
