All Your COVID-19 Queries Answered!

India’s second wave saw a lethal strain of the COVID-19 virus and an unparalleled number of cases. Dr Renuka David helps us understand the illness, its progression and impact, and what the treatment entails.

Is the COVID-19 virus airborne?

The CDC (Centre for Disease Control and Prevention) has recently updated Coronavirus guidelines stating that COVID-19 can spread through airborne particles. So yes, COVID-19 is airborne, and with this particular mutation, there is a fear that it may create added resistance to treatment. Airborne transmission means that you expel a piece of the virus when you exhale, talk or cough. Those micro-droplets or aerosols can be so small that they are able to float in the air and potentially travel. Sometimes these droplets can travel an entire room. People can inhale these particles and get infected. These micro-droplets can travel up to 6 feet or so. The Coronavirus can survive in colder and less humid air and can stay in the air for upto 3 hours. Toilets can be a major source of transmission especially if used by multiple people and poorly ventilated. Toilet flushes spread aerosols. It becomes imperative to put the toilet seat cover down before flushing. Prevention here, is definitely better than cure. Be overcautious. While going out, double mask yourself. Always pair a surgical (inside along your face) and cloth mask (over the first mask) for double masking. Also wear a face shield when you step outside. There is also the strong recommendation to mask yourself even at home for added protection, especially if you’re living in a closed community.

What age group has been impacted during India’s second wave?

People between the ages of 20 – 45 are more affected. Statistics show that 21.4 percent of people between the ages of 21-30 years and 21.47 percent of those between 31 – 45 years are being impacted. After the first wave, the vaccine was introduced and administered to those over 60, and for those with co-morbidities, over 45. Also, this group was badly affected during the first wave, so there is some immunity now among them. Younger people on the other hand have stepped out to work and for social interactions, so this is another cause that the virus is spreading in this population. In fact, the progress of infection is so rapid, that deaths are occurring even after the third and fourth day of infection. COVID-19 is not yet considered a major threat to children.

How is COVID-19 linked to lung infection?

COVID-19 can affect the lungs causing what we call Covid Pneumonia. The damage is not done by the virus per se. Inflammation of the lung tissue occurs due to the antibodies and chemicals produced by the body in response to the virus, attack your own lung tissue. When that exacerbates, it produces something that medical doctors call the Cytokine Storm, (an immune response where the body starts to attack its own cells and tissues) noted between Day 7 and Day 14 of the infection. To sum it up, it is not the virus, but the body’s own antibodies that cause Covid Pneumonia. The use of steroids play a major role in combating this. So how do you know if you could potentially have COVID pneumonia?

  • If your temperature does not come down and rapidly keeps rising even after a few days.
  • If the oxygen saturation reading on the pulse oximeter falls below 94.
  • Shortness of breath.
  • Respiration rate more then 24.
  • Do the six-minute walk test as well, where you take the saturation reading after walking briskly for six minutes.
  • Another new symptom that is a cause for concern is excessive diarrhoea.

These signs should raise the red flag.

What is the difference between an oxygen cylinder and oxygen concentrator?

The oxygen concentrator is equipment which pulls in atmospheric air, takes out oxygen and feeds it to the patient. The oxygen cylinder directly administers pure oxygen to a patient through tubes and a mask. Oxygen concentrators run on electricity, which is therefore needed 24 x 7. Also, though concentrators claim to produce 5 litres per minute, the more accurate estimate is 4-4.5 litres per minute. Patients who need more than that need an oxygen cylinder. These equipment should be used when the pulse oximeter reading falls below 94 percent.

What is proning?

One can increase their body’s oxygen levels naturally by ‘proning’, which concentrates air and oxygen into the chest cavity by assuming an optimum position for breathing. It can increase your saturation by 6 – 7 percent. Lie face down, with one pillow below your chest and two below your hips so that there is enough space between your tummy and the bed. Do this for 1-2 hours followed by lying on your right lateral for 1-2 hours, left lateral 1-2 hours and back for 1-2 hours. Note, proning should not be attempted by pregnant women, those with heart disease or spinal problems, and should be avoided after a meal.

How should I treat COVID-19 at home?

The first week from Day 0 – Day 7 is viral replication with mild symptoms like a cough, running nose, congestion, loss of smell and taste, headache, general body pain or even a mild diarrhoea. Irrespective of whether one has got COVID-19 or not, paracetamol, multivitamins and zinc are the essential medication. If one develops fever, take paracetamol every 6 hours even if the fever subsides. Get a pulse oximeter and check your oxygen saturation twice a day. For cases where the symptoms worsen after the first week like fever not subsiding in-spite of taking paracetamol, or oxygen saturation falling below 94 at rest or after the 6 minute walk test, from Day 7 – 14, the inhalation of steroids have shown to produce very good results through a steroid inhaler. Consult your doctor for a treatment plan based on your needs especially if or when one requires oxygen. Remember that antibiotics do not combat viral infection. So it is advisable not to bombard your body with unnecessary antibiotics unless you develop secondary bacterial or fungal infection and your doctor strongly approves it. Good old home remedies like regular steam inhalation, warm saline gargling, kashayam, warm turmeric milk at night, adding a lot of garlic, pepper and turmeric in your food, building up your immunity by vitamins and regular exercise plays an important role in combating the infection.

Do I necessarily need a CT scan of the chest?

A CT chest is not required for everyone, as it puts unnecessary pressure on an already overloaded healthcare system. Dr Randeep Guleria director of the All India Institute of Medical Sciences advices not to overdo the CT scan as it increases exposure to X-Rays a hundred-fold. Consider getting it done only under certain conditions. Firstly, it should be done after the seventh day, and not before that. Even if the results of your RTPCR test is positive, do not do a CT scan before Day 7. Also, do it only if your oxygen saturation level dips below 94, if you have persistent fever, and if certain inflammatory markers are raised in your blood test (your doctor will know and guide you). Take your overall CT severity score into consideration. A mild score is 8/25, a moderate is 9-15/25 and severe is 16 and above. Therapy depends on the scan recommendations. Always remember, it is not recommended for everyone just because they have tested RTPCR positive.

What is plasma therapy and when do I need it?

Plasma is a component of the human blood that carries antibodies. Hence it is believed that plasma therapy can be effective in COVID-19 treatment if it is checked for neutralising monoclonal antibodies, which work in the first week of infection. After that phase, WHO doesn’t recommend it as there is no concrete evidence available to say it will work. So, the first five days of the infection is the only time one should ideally use it.

Can I use blood thinners to deal with COVID-19?

Blood thinners should be used only by those hospitalised and not those at home. They should be administered under medical supervision, as you may bleed if not supervised properly.

Sometimes, a patient appears to recover and suddenly takes a turn for the worse. Why does that happen?

We are seeing this during the second wave of the pandemic. The symptoms presented by the patient during the first five to seven days are of a regular upper respiratory viral infection like common cold, body pain and gastritis. 85 percent of the patients recover within the first week of the infection. However in some cases, the immune bodies attack their own body cells – in this case, the lung tissue – causing the cytokine storm, resulting in inflammatory changes in the lungs. This is when the oxygen level in the blood can start dipping requiring the patients to be put on oxygen. Hence it appears that a patient who appears to be recovering takes a turn for the worse, and is seen more in the population between 30 and 50.

What is the duration of the illness?

We have only a general ballpark duration. Infections that are mild to moderate tend to test negative after the 14th day. A severe case takes about 20 days. Those under home quarantine should generally recover after Day 14.

What is the immunity coverage of the vaccine?

As of now, research is still ongoing, but the general consensus is that for 10-11 months after the second dose, there is immunity coverage. Beyond that, booster doses will most likely have to be looked at once a year. We will have more clarity about this in the coming months.

If you’re COVID–19 infected, after what duration should you get vaccinated?

It is recommended that you get vaccinated 90 days after recovery, since the virus gives you immunity for that period.

Do anxiety and panic exacerbate the symptoms?

Yes. I’d like to give you an example. Recently, the Pastor of our Church who is co-morbid with chronic renal failure on regular dialysis was admitted with COVID-19 to the hospital. He was under severe mental stress, worrying about the church activities and his family. His oxygen saturation was not rising above 85 putting him in the “critically ill” category. It was only after his wife met him, and alleviated his fears, did he find mental peace of mind. There was a remarkable improvement with his oxygen levels going up. He was soon discharged.

Can pregnant women take the vaccine?

Ideally, pregnant women should not take the vaccination as there are not enough studies to say how safe or beneficial it is. However, one has to assess the risk and benefit ratio. If the woman is at high risk of contracting COVID-19, her doctor can help her take a decision.

Can a person who is asymptomatic take the vaccine?

Absolutely. He should always double mask and keep sanitising his hands to prevent transmission of his viral load to others.

What can I do to recover from the side effects of COVID-19?

Continue to consume vitamin C and zinc supplements even after you test negative for COVID-19, which builds your strength and immunity. Include protein-rich foods in your diet to help maintain muscle mass, and get in plenty of complex carbs like sweet potato and oatmeal to boost energy levels. Stay hydrated with plenty of water, coconut water and fresh vegetable juices. Avoid tea and coffee in excess and completely steer clear of alcohol and fizzy drinks. Sleep for at least eight hours every night, and try and take a walk for half an hour daily to slowly start building up on physical activity and fitness levels.

Can you debunk some popular COVID-19 vaccination myths?

  • Vaccination prevents disease – not infection of COVID-19. Once you’re vaccinated, the severity of the infection is generally mild-moderate. Only 4 -5 percent of those vaccinated suffer from severe infections. Even after you receive the vaccine, continue masking, handwashing and following physical distancing norms.
  • Just because the vaccines were developed quickly, it doesn’t make them unsafe. They have gone through rigorous testing for safety standards, and the clinical trials and reviews have shown them to be both safe and effective.
  • If you’ve already had the virus, it doesn’t guarantee immunity against future occurrences. Vaccination will help build immunity against this.
  • Considering yourself low-risk is not good enough reason to avoid being vaccinated. Not only is this a myth (young, healthy people are also susceptible), but you need to be vaccinated to protect your family and community in the long run.
  • Vaccines can be administered safely during a woman’s menstruation cycle.

What are the ideal reference values I should be looking for?

Blood Pressure
120/80: Normal
130/85: Normal (needs to be controlled)
140/90: High
150/95: Very high

Oximeter Readings
95 – 100: Good Oxygen Levels
94: Normal
90 – 94: Low Oxygen Levels
Below 90: Very Low Oxygen Levels (needs oxygen support)

Pulse Rate
60 – 80 per minute: Normal
72 per minute: Standard
90 – 120 per minute: High / Increased

92.0 – 98.6 F (Normal)
99.0 (Normal Fever)
100.0 F – 102.0 F (High Fever)

Consult Dr. Renuka