Given the rapid spread of the coronavirus scare, which has led to people with even mild flu or upper respiratory infections wondering if they will fall in the net of positive cases for COVID-19, here is what Dr Samrat Shah, MD, internal medicine at Mumbai's Bhatia Hospital, believes are necessary protocols to be followed for both patients and doctors.
Which basic protocols must be followed by both doctors and by the patients visiting them, who need not be positive for COVID-19?
1) Patients with no travel history abroad, no co-morbid condition and no shortness of breath: If they have just fever, cold and cough, they should be advised to stay at home for a couple of days. If the symptoms worsen then they should see their doctor.
2) Patient with high fever and co-morbid condition but no shortness of breath and no travel history to affected countries: These patients need to do an important test to screen out other viral and bacterial infections by doing a simple throat swab by polymerase chain reaction (rapid BioFire) which is done in all good private hospitals. If the patient turns out to be positive for flu, then it rules out coronavirus, if negative then it could be coronavirus and they have to go in for COVID-19 test.
Many people across the country are also experiencing some form of mild flu, sore throat, respiratory infections, fever, headaches, at the moment since the past few weeks... What could be the reason for this?
This could be due to other infections such as as influenzas (common cold), parainfluenza, rhinovirus, gram-positive bacterial infections and atypical bacteria.
Should they be wearing a mask before going to their family physicians?
If the patient is having a co-morbid condition and if the patient is suffering from cold, cough and fever then they should wear it. Otherwise, it is not required for normal people.
How does one differentiate between patients suffering from upper respiratory infections, mild flu and COVID-19?
Protocol needs to be laid for those suffering from upper respiratory infections, which depends on this quadruple symptoms-
1) Co-morbid condition: Type 2 DM, known heart disease, cancer patients, immunosuppressed patients, end-stage lung or liver or kidney disease
2) Travel history: Positive in endemic area, red flag for highly endemic, orange for moderate endemic and green for safe countries
3) High-grade fever
4) Shortness of breath
Furthermore, these patients can be further categorised as:
1) Mild: If [there is] only history of fever, cold and cough without positive travel history and no shortness of breath and no co-morbid conditions
Approach: Advise them to stay at home for a couple of days if symptoms worsen to see their doctor
2) Severe: Positive for all above quadruple symptoms
Approach: Advise to go to emergency rooms of any government-authorised Hospital for proper management to prevent complications [like] pneumonia, ARDS, sepsis, multiorgan failure.
3) Moderate: Patients who have a high-grade fever, Co-morbid conditions, but no shortness of breath no positive history of travel in highly endemic areas
Approach: Subject those patients for a routine blood profile. If complete blood count shows leukopenia (30-45 per cent of China COVID 19 patients had it) with lymphocytopenia (85 per cent of COVID 19 China patients had it according to statistics) … the most important prognostic marker is NLR (neutrophils to lymphocytes ratio). 3.13 is the cut-off and if NLR is more than 3.13 with age more than 50, then straight admission to ICU and if NLR is less than 3.13 and age is less than 50, then they can be isolated at home.
Which are the other ways in which we can rule out COVID-19?
Presently, no specific drug is available for coronavirus, somewhat effective would be the nucleotide analogue—Remdesivir which was once used for viral haemorrhagic fevers like Ebola and shows some potential against SARS.
