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This article makes a point that politicians(often elderly with mild symptoms or co-morbidities) should stay at home and isolate themselves till they feel sick . I thoroughly disagree with many assertions in this piece and I will explain here why. https://www.newslaundry.com/amp/story/2020%2F08%2F05%2Fministers-set-a-poor-example-by-taking-up-hospital-beds-as-soon-as-they-test-positive-for-covid?__twitter_impression=true
First let us look at COVID case fatality rate by age. It follows a power law. Elderly have 10-15 times risk of death than young .
if Patient is 55+/ hv co-morbidities+. Risk multiplies many fold. While other diseases like flu too do this -COVID is remarkable.
if Patient is 55+/ hv co-morbidities+. Risk multiplies many fold. While other diseases like flu too do this -COVID is remarkable.
Dr. Rao (who has written the article) advises Admission only when Patient become sick with Saturation less than 90% that is Grade 4 . These are not in consonance with our medical guidelines.
Our national guidelines differ from this advice. advise strict supervision/admission to COVID care units for Patients with mild symptoms but high risk factors. And Admission Moderate Symptom Onwards (RR>24, Saturation <94)
https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19.pdf
https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19.pdf
This is logical as well. Unlike other disease we don't have very effective oral medications (HCQ hasn't lived to its promise in RCTs, Favipiravir is weak Antiviral that has "worked" in small RCTs) for outpatient treatment of COVID.
While we do have partially effective IV Medicines like Remedesivir and Plasma for moderate severity (saturation 90-94% ). And IV Steroids
Further there is a window when Remedesivir and Plasma work,
Further there is a window when Remedesivir and Plasma work,
These work only when given at right time (Patient just starts needing oxygen ,increased breathlessness ) in early high viremia phase(stage 2). Once Patients land up in High Flow Oxygen stage(stage 3) ,these drugs are not very effective.
It is very difficult to "time" this at home. Most elderly people with less reserves are not able to do pulse oximetry and walk tests adequately. There is phenomenon called happy hypoxia as well where COVID Patients is unaware of lack of oxygen.
Further,there is time gap between awareness of Symptoms and Admission. Since these patients deteriorate fast by the time they come to Hospital. They are already in very severe phase.
I work in a COVID Dedicated Hospital. None of my patients admitted under me less than 50 years has died. Quite a few with higher age and co-morbidities have died. Many elderly are directly landing in ICU unlike younger patients.
Similar things happened in Italy as well and in Wuhan where stay at home advice was given in early part of pandemic (leading to massive house hold transmission) and high mortality rates as Patients presented late.
. As a response Wuhan started manadates central Quarantine for every Infected Patient and clamped down both its transmission and mortality. https://theprint.in/world/mass-quarantine-patients-with-mild-covid-19-symptoms-chinese-experts-warn-italy/391306/
The article uses a supportive evidence that Medical errors are leading cause of deaths. Yet we must remember that a lot of literature on errors is based on modelling and faulty. And derived from ironically taking improved medical care as a gold standard. https://www.kevinmd.com/blog/2016/05/hyperbole-seldom-helpful-especially-comes-medical-errors.html
Practice of medicine is simple but not simplistic.
If You are young and can safely isolate adequately protecting your family members -> stay at home.
Elderly or ,with co-morbidities Be under Strict Medical supervision either at home or in hospital (as our guidelines suggest).
If You are young and can safely isolate adequately protecting your family members -> stay at home.
Elderly or ,with co-morbidities Be under Strict Medical supervision either at home or in hospital (as our guidelines suggest).
