The second and the more dangerous wave of COVID-9 has raised many queries. From the use of common drugs like Favipiravir and Remidesivir, to lung CT scans and to getting vaccinated, people have a plethora of questions. Doctors answer these FAQs

COMMON QUERIES.

What is this new strain?

Viruses and other pathogens are known to mutate and differentiate by nature. According to the WHO, a virus replicates or makes copies of itself, which is usual. These changes, by definition, are called “mutations”. A virus with one or more new mutations is referred to as a variant of the original virus.

Mutations in viruses — including the coronavirus causing the COVID-19 pandemic — are neither new nor unexpected. All RNA viruses mutate over time, some more than others. For example, flu viruses change often, which is why doctors recommend that you get a new flu vaccine every year."

The three infamous COVID variants which are said to carry the most risks- ones which have emerged from Kent, UK ( B.1.1.7 variant), South Africa (B.1.351 variant) and Brazil (B.1.1.28.1 or P.1 variant) are all variations of the original virus strain.

A double mutation, however, emerges when two mutations of a virus strain come together to form a third, super infectious strain.

Should blood thinners be taken? For whom?

Doctors decide on the use of blood thinners on patient to patient basis. Blanket use of blood thinners on every COVID patients can be harmful.

Should lung CT be done? Who qualifies?

COVID-19 pneumonitis is seen in a particular pattern on HRCT and is a quickest way to direct treatment. However RT PCR is the gold standard test to establish diagnosis.

The test is recommended only to those who need it. Inexplicable exposure can lead to cancer risk. The timing and the patient selection is paramount.

What is the purpose of lung CT as opposed to a cbc blood test which will show infection in any case?

CT Scan helps doctors decide about the severity of disease. Also in some cases where RT PCR is negative we treat patients on the lines of COVID if HRCT suggests do. The timing and the patient selection is very important when it comes to CT Scanning.

Dr Arunesh Kumar, Senior Consultant & Head Respiratory Medicine/Pulmonology, Paras Hospital

ALL ABOUT STEROIDS

Are steroids helpful?

Corticosteroids, or a more commonly used term steroids, are a type of anti-inflammatory drugs. This drug is used to treat many conditions in which the body’s defense system doesn’t work properly and causes tissue damage.

Steroids have proven to help patients in the COVID-19 fight. But if the patient does not have serious systemic inflammation, a steroid might backfire. It may hamper the immune system’s ability to fight the virus.

When does one start them?

CRP tests (Blood levels of a substance called C-reactive protein (CRP), a marker of inflammation) are standard. If patients’ CRP is high, treatment with steroids, on doctor’s advice, can cut the risk of death or ventilation by 77 per cent.

However, the AIIMS Director has warned against taking steroids in the early stages of the infection, which can lead to severe viral pneumonia.

What are the steps/precautions to be taken by people with comorbidities?

By definition, Comorbidities is when a person has more than one underlying health-related conditions at once. If patients with milder symptoms but comorbidities consume steroids with medical consultation can lead to increased risk for medication-related adverse effects such as delirium. In such cases the viral infection may less likely to benefit from corticosteroids.

Under what conditions are they to be taken?

It has been seen that patients with severe COVID-19 can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. In such cases, corticosteroids of certain potency can help in preventing or mitigating the deleterious effects.

What is potency?

Only a certified medical practitioner can suggest the potency of a particular steroid. A patient’s blood reports and appropriate CT scan can help the doctor to decide the right dose of the steroid.

What do Diabetics do?

It has been reported that steroids can increase blood glucose levels. These levels need to be controlled to avoid secondary bacterial and fungal infections. Therefore, experts have suggested rational use of steroids in diabetic patients.

Why are steroids being recommended now and how are they to be tapered?

After closely observing its effects, the Union Health Ministry has mentioned the use steroids for the treatment of COVID-19 patients in moderate to severe stages of illness among other therapeutic measures. Time and duration of the medication can only be monitored by a treating doctor.

Can they be taken without prescription?

No. If these drugs are not taken under the doctors’ guidance, it may hamper affect natural course of Covid treatment & lead to patients reporting additional side-effects.

Dr Deepak Verma, Internal Medicine, Columbia Asia Hospital, Ghaziabad (Unit of Manipal Hospital)

Know this too

Are Fabiflu and Remdesivir really helpful?

Fabiflu and remdesivir are weak antivirals. Remdesivir, as we all know, is being sold in black all over as is fabiflu, which is very sad. Remdesivir was made 10 years ago as a medicine for hepatitis C. Unfortunately, it didn’t work out well. And then it was tried for Ebola as well. About 500 patient trials showed that there was no benefit of Remdesivir and now it has been given emergency approval for COVID as well. But the biggest trial that WHO did, solidarity trial which had more than 12,000 patients showed no benefit of Remdesivir in any patient on mortality or outcomes. So WHO actually removed the placebo from its list of authorised medicines not just for COVID but for any disease, but still FDA has given it approval so it is the only FDA approved drug without any effective trials in place. And that is why it is being prescribed everywhere for COVID ICU patients. And that is the reason the demand has shot up so much. Similar is the case with favipiravir which is available as Fabiflu, there is no actual trial to show that it is beneficial. But still, doctors are prescribing and people are buying it.

Should everybody wear a mask at home, at all times?

Wearing a mask every time at home maybe too much if there is no infection and if people are not going out, but if somebody is going outside and there is a chance that he may bring the infection home, then wearing a mask is advisable. Also, if somebody is ill at home then wearing a mask should definitely be the norm rather than the exception.

Should children below 10 also wear masks, if a family member tests positive?

Yes, everyone should be wearing masks if there is a patient in the house even children, because this particular strain is causing the disease in children as well. We have seen children as young as 10 months old being affected.

If you tested positive when to take vaccine?

If you have tested positive, it is better to wait for some time before you take the vaccine. So the recommendation is that you should wait for 45 days after you’ve tested positive and even longer if you have serious disease.  So if you’ve been in ICU you can wait for as long as 90 days.

Can a Covid positive person, after 14 days step out for a test? Is he vulnerable to infection again?

There is no need to get a test done after you have got infected. You can actually continue your routine work after 17 days, and there is no need to get retested. But if you do step out, of course, you can get infected again, there is a very little chance less than 1 per cent. Also, there is a chance that when you step out, you can touch surfaces which have been touched by an infected person and the virus can be on your hands. It may not infect you, but your hands and your clothes can still carry the virus. This way you can definitely bring the virus home. Hence, you have to be very careful once you come in. Change your clothes, have a bath, discard your mask, wash your self thoroughly and put your clothes in hot water.

Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals