Covid-19 came to the family in April.
It was traumatic for all of us at home. We had to think on our feet and move fast. Now that it is behind us, I have the time to sit back and think about all of what transpired. How did we manage? What did we do to cope?
Quite honestly, I feel reluctant to share this narrative for two reasons.
First, because when the disease hit home, it was a mentally taxing affair and emotionally trying time.
Second, because I am not a medical doctor. I fear my experiences may be interpreted as advice from a qualified practitioner. Because this is not medical advice and my experience cannot replace professional advice. All that I know is basis tending to one 75-year-old patient at home and this advice is neither authoritative nor prescriptive in a world where professionals are grappling over what protocols ought to be adhered to.
The good news I can share is that the 75-year-old patient in my family who contracted the disease is perfectly fine now and life at home is back to normal. But what we are still clueless about is, how did she contract it?
That is why as I look at the news and pore over the data, I am reasonably convinced the probability that many people whom I know will contract the virus is high. Worse still, what I can now see is a healthcare system under severe stress, especially in Mumbai, where I live. There is a shortage of well-equipped beds and trained healthcare workers. The authorities sound unsure as well with the goal posts around testing, isolation and hospital admission thresholds being moved around arbitrarily. With the Unlock underway, and cases yet to peak, things are about to get worse.
That is why I feel morally obliged now to share this narrative. My endeavour here is to help you understand this disease better, get diagnosed faster and seek professional advice earlier if you or anyone you know may need it.
My biggest takeaway in all of this: the earlier you detect it, the faster you can act to get rid of the disease, without complications. That message, however, isn’t going across.
Watch for symptoms
It was another routine day at home. She casually spoke of how the food tastes bland. It is only now, in hindsight, it occurs that this was an early symptom that indicated the Covid-19 virus had invaded her system.
Three days later, she complained of a light fever. She wasn’t coughing. We put it down to a passing flu. And as standard practice goes, offered her paracetamol. But the fever persisted. By the fifth day, the thermometer showed her temperature refused to come below 101 degrees. By now, she was extremely tired, and had started coughing. But she wasn’t breathless.
Get a Pulse Oximeter, now
Luckily we have a doctor in the family, and we checked her oxygen levels with a Pulse Oximeter right away. Available for as little as Rs 2,000, this device can be purchased from most chemists, it is idiot-proof, non-invasive, and focuses a light beam on your fingernail to measure oxygen levels in a person’s body. In the final reckoning, this was a life saver.
To understand why this is important, may I suggest you watch this one-minute-long video of a doctor speaking about silent hypoxia—a condition when an individual’s oxygen saturation levels drop to levels such that their lungs don’t get enough of it, but they don’t feel breathless.
Since that episode, we have ordered one for our apartment complex to share. People where I live have been asked to watch for symptoms that range from a mild cough to extreme tiredness or a fever. If anyone feels out of sorts, they are asked to get their oxygen levels checked right away. Avoiding silent hypoxia is crucial. (Read the notes at the bottom of this story.)
Stock up on Oxygen
Back to my narrative, when the Oximeter showed her oxygen levels were way below what she needed, we dropped all that we were at and directed our efforts to organize an oxygen cylinder and rent an oxygen concentrator—a machine that works on electricity to concentrate the available oxygen in the air and performs the same function as an oxygen cylinder.
We hooked her up to the cylinder and started her on a steady flow of oxygen. A doctor or a nurse should be able to tell you how to hook it up and the required flow based on the drop in oxygen level. The cylinder ran out in a few hours.
That was when we hooked up the concentrator to keep the oxygen going. It took a little while and we were on edge. But as the oxygen started to permeate through her cells, she started to feel better. We could see it was beginning to make a palpable difference.
Once again, with the benefit of hindsight and basis what I’ve witnessed, a few takeaways.
- When oxygen levels drop, contact a medical professional right away and start administering oxygen under their care. Like I articulated earlier, given how stretched our healthcare system is, I strongly recommend you rent cylinders, ensure they’re refilled, or purchase/rent an oxygen concentrator. You could pool in with neighbours to do that and get some for your apartment complex.
- Keep contacting a lab to test for Covid-19 and get the patient into the waiting list for being admitted into a hospital. It’ll take a while to get through.
- Isolate the infected person at home. Separate out everything you think they may touch or use. Start wearing masks at home. I know it’s tough to do. But try you must to protect others in the family.
- If the infected person is coughing, try getting a chest x-ray/CT done so you can show the doctor what condition the lungs are in. A chest X Ray/CT could also be one of the first indications for Covid-19.
Under medical supervision, we started administering her with Hydroxychloroquine (HCQ). This is one line of treatment for Covid-19. Because she has a history of arthritis and HCQ is a drug used to treat this as well, she had developed a tolerance to it.
Now, minus medical supervision we may not have known what may have been the right dosage to administer to her. The doctor asked that we increase her paracetamol dosage to keep the fever in check.
Like I said earlier, it took multiple calls to get a lab technician to come home to take her samples for a Covid-19 test. The test took place the next day and the results took another three days to come via the Municipal Corporation (BMC).
She was then mandatorily moved to the hospital. But these were the early days when the city wasn’t reeling under the onslaught and beds were still available at hospitals. If my memory is right, she was moved into hospital on either Day 8 or 9.
Even though we had supplemented the drop in oxygen immediately, the x-ray showed a small pneumonia patch in her lungs. The doctors took a call and wheeled her into ICU where they administered a cocktail of drugs which included HCQ, Azithromycin (for the pneumonia patch), Tamiflu for fever, and Zinc supplements.
To put it very mildly, the days that followed were nerve wracking. How would she fare? Would everyone else at home be okay? The place was quarantined and everyone was tested.
Meanwhile, the drugs started to work on her. She was moved out of the ICU back to a regular ward and was home in eight days.
The outcomes of the tests started to come through as well and everyone turned out negative. All of us at home, and around us, collectively sighed in relief. Until date though, we still don’t know how she contracted the infection.
As for those battling the disease, no one knows if the disease has any lasting effects or if it has run its course. All I can say is one month after the episode, we are resting easy.
The above suggestions are NOT substitutes for hospital care, but rather than freezing with inaction given all the confusion, they may allow you to start taking steps to avoid deterioration of the patient’s condition while waiting for care. Please be in touch with your family doctor.
Chances are that you will be able to prevent a serious episode. Remember, 80% of cases are likely to be mild and may be handled with home care itself.
Do watch this CNN interview with a Dr. Richard Levitan who early on said that testing should not be postponed till patients become breathless, because by then it could be too late. Simply put, blood starts carrying lower levels of oxygen to the entire body and that stresses both the lungs and heart to pump harder. In many cases, the Hypoxia is “silent"—i.e. the body adjusts to lower levels of oxygen without any outward symptoms. This creates hidden stresses on other organs and by the time the breathlessness shows up, the body is already overwhelmed by the infection.
Note for Smokers
If you smoke, unfortunately, the reading on your oximeter may be higher than your actual oxygen saturation. This is because smoking increases carbon monoxide levels in your blood, and the oximeter cannot tell the difference between the gas carbon monoxide from oxygen. If you smoke, talk to your health care provider about how to properly read your oximeter numbers. (More here.)