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958: CMAAO GUIDELINES
- Evidence of fever, hyper immune inflammatory response (High ESR, CRP or ferritin): Tab HCQS (hydroxychloroquine) 400mg 1 tab twice on first day, then 400mg 1 tab once a day, based on acute phase reactants response.
- Tab Doxycycline (DOXT) 200 mg first day and 100 mg from day 2 to 7 Or Azithromycin 500 mg daily for five days. (Antibiotic with anti-viral response)
- Anti-parasitic tab Ivermectin 12 mg 1 tablet once only (by all family).
If severe hypoxia or pneumonia with very high D-Dimer and Ferritin: give IL-6 pathway inhibitors (Actemra 400 mg 50K) IV: 8 mg/kg as a single dose (NIH 2020b; NIH 2020e).
5. In high risk cases in first three days of onset: Favipiravir or Fabiflu 1600 mg twice daily on day 1, followed by 600 mg twice daily for a total duration of 7 to 14 days (Cai 2020; NIH 2020a).
- Inj Clexane 0.6 Ml OD or BID in all above age 58, heart patients, hypertension, diabetes, heart failure, asthma, COPD, post cancer, on oxygen, sudden drop of oxygen on rest or exertion.
- Prednisolone 1 mg per kg stat if sudden development of hypoxia on exertion or rest (3-7 days).
- Inj Remdesivir 200 mg day 1 and 100 mg day 2-5 at the development of oxygen requirement
- Sleep prone on your abdomen.
- Prone oxygen by oxygen concentrator, minimum rate to get 92-96% oxygen levels.
- Vitamin D: Cap D-Rise 2000 IU once a day for three months.
- Elemental Zinc 75 mg daily.
- Vitamin C 500 mg twice daily for three days and then 500 mg daily.
- Tab Ranitidine 150 mg twice daily till the duration of illness.
- Tab Meftal 200 mg or Naprosyn 500 mg or Indomethacin 25 mg or Nice 100.
- SpO2 and Pulse monitoring regularly, especially day 4-7, three times daily.
- Inform your local authorities, if COVID positive.
- Inform if Temp >1030F or lasts >14 days or Breathlessness, SpO2 falls by >4 after six minutes walking, persistent chest pain.
- Sudden loss of smell and taste is not a serious sign, may persist for some time, may come and go, may come before fever.
- Conjunctivitis may occur in one eye and is not a serious sign.
- Rash may occur on any part of body (more in women) and is not a serious sign.
- Pus cells may be present in urine, indicate cystitis and not secondary infection (TLC will remain low).
- Monocytes presence indicates high viral response.
- High CRP > 100 means very high inflammatory response.
- Loose motions (70% women) means super spreader and often a mild sign. May come and go. Take ORS.
- Whole family may get COVID or COVID like illness, all may have different symptoms, at least one will get loose motions.
- All should do betadine (povidone iodine) gargles twice daily and povidone iodine nasal wash.
- Get CBC with ESR, CRP, LDH on day 1 and day 5 onwards every third day.
- If lymphocyte count is low (< 1000): LOPIMUNE twice a day for two weeks (Ritinovir and Lopinovir).
- Review with reports at email@example.com
- 9th day onwards, you have non replicative virus and cannot pass on the infection to others.
- RT-PCR test may remain positive for up to 48 days.
- Those who are 65 plus or have underlying diabetes or heart disease should wear three layered fabric mass.
- Join daily zoom session at 8am (ID drkkaggarwal).
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA