Second Wave: We have 2 options – one, rant & rail against the ‘system, second, do whatever we can to avoid getting infected

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The #COVID-19 numbers in India are not looking good, but here are my (not so) random thoughts on it


We have 2 options – one, rant & rail against the ‘system’ and lament how it has let us down; second, do whatever we can to avoid getting infected & if infected, minimize adverse consequences to ourselves & others. If you belong to the first, you can stop reading now 

How can we avoid getting infected? There’s no magic bullet, I’m afraid. This is primarily a “stick to the basics” approach. More difficult than it sounds. First, maintain all precautions that we know help. These include masks (whenever you are not at home and not alone), physical distancing to the extent possible, and washing hands frequently.

The 3 Ws – Wear a mask, Watch your distance, Wash your hands. Masks work, and are probably the most important precaution given our current understanding that aerosols are the predominant mechanism of spread. The best is a well-fitting N95 mask, which is now widely available & not too expensive – you could re-use them too. How can you optimally use an N95? Get 5 masks, and rotate their use – this is safe, burns less of a hole in your pocket, and is environment-friendly. The next best option is to use two masks – wear a surgical mask first, and a cloth mask over it for a snugger fit. 

How physically distant need you be? The simple answer is “the more the better”. 6 feet preferable, but a minimum of 3 feet. Better still, avoid crowds as much as you can. Meet others only if absolutely necessary – most meetings can be done virtually. Being outdoors is better than indoors, but while open gardens and parks are low-risk (where permitted by law), avoid large gatherings – whether they be weddings, parties, and yes, election rallies and religious (all religions) gatherings too.

Second, get your vaccine as early as you can. In India now, anyone over the age of 45 is eligible for the vaccine. Getting a vaccine gives you 70-80% chance of avoiding getting infected and 95% chance of serious illness. That’s as good as it can get. There’s been a lot of noise about which vaccine to take. Anyone who strongly recommends one over the other is talking nonsense. There are no studies so far(& unlikely in the immediate future) to directly compare two vaccines to show which is better. So, take the first one you get What about side effects of vaccines? We’ve heard of blood clots etc.
Yes, they do occur, but they are extremely rare events, and the benefits of taking a vaccine far outweigh the risks. 

What happens if you do get #COVID_19? Yes, you still can get it even in spite of taking all precautions, and yes, even after you’ve taken the vaccine. Remember, none of this is 100% effective – but 70 to 95% effective is a whole lot better than 0% Make preparations even before you get infected. Buy a thermometer and a pulse oximeter to keep at home. These are two important instruments you need in case you get infected. First, don’t panic on getting a #COVID_19  positive report – 98% get through without major issues. Isolate yourself from others. You can do this at home if possible. Chart your temperature using the thermometer, & your oxygen saturation with the pulse oximeter. Check both 2-3 times/day, the latter before & after a brisk 6-min walk. Make sure you drink enough fluids and keep yourself hydrated. Stay positive – you’ll get through this. 

When should you be concerned and seek medical help? If your baseline saturation falls under 94% or if your fall in saturation before and after the 6-minute walk is 4% or more. Contact a hospital, and start proning yourself (lie chest down, back up) What medicines should you take? If your oxygen saturation is fine & you have no symptoms other than fever, all you need is Paracetamol There is some data that inhaled Budesonide helps you recover faster, but no hard endpoints like reduced mortality

There is no evidence to suggest that anything helps – including Favipiravir/ Ivermectin. Don’t waste your time desperately trying to procure them What medicines help for #COVID_19? Unfortunately, very few. What definitely works is pronging and oxygen (when saturation is low), and steroids (Dexamethasone) for moderate to severe disease. But what about #Remdesivir#Tocilizumab and #ConvalescentPlasma#Remdesivir doesn’t help much, and certainly not in all patients; there is probably a small subgroup in which it helps – those requiring oxygen, but not sick enough that they require ventilation. And even here, it doesn’t reduce mortality, probably helps earlier recovery, #Tocilizumab also helps only in very specific subgroups – those sicker than described above, requiring rapidly increasing levels of oxygen or rapidly deteriorating respiratory parameters 

My plea here is to please allow your physician to decide when Remdesivir/ Tocilizumab is required – there are very limited situations when they are beneficial & please don’t pressurize them to prescribe it – much of the shortage today is because of unnecessary prescriptions There is even less evidence to support the use of #ConvalescentPlasma for COVID_19. almost all studies done so far have shown that it is of no benefit.

Please don’t waste your time looking for a donor. In short, these are difficult times, but each of us can do our bit to protect ourselves, our loved ones, and the world at large by some simple, but effective measures. Stay safe, folks, and we’ll see this through. 

Tweet thread by Pramesh CS
Thoracic surgeon Director @TataMemorial @CancerGridIndia

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