By Dr Edward Nazareth

May 4: As expected, the second wave of COVID19 has proved to be much dangerous and contagious than the first one. This virus is following the similar pattern which Spanish flue had more than a century ago. The Spanish flue pandemic affected and spread in two waves in 1918 1nd 1919. Like Spanish flue, the second wave of COVID19 is affecting the younger population, more than during the first wave. Inflammation of the lungs (pneumonia) and respiratory failure manifest faster. In the second wave good numbers of children also are getting infected which was rare in the first wave.

The deadly Covid-19 second wave has devastated big cities like Delhi, Mumbai, Benagaluru, Pune etc. Hospitals and crematoriums are running out of space, and funerals are taking place in car parks. The pandemic has now firmly gripped many smaller cities, towns and villages where the devastation is largely under-reported. Most of the COVID beds in the hospitals in Mangaluru and Udupi are getting filled up. Shortly these cities also will experience shortage of ICU beds.

The second wave is not sparing anyone. The people who take care, who have taken vaccine also are showing the symptoms of infection and are tested positive. A good number of health workers also are infected by the second wave. Though vaccinated people seem to be having lesser complications, there are incidences where vaccinated also are admitted to ICU.

On this background here is a question-answer session for the people who may be tested positive for COVID19 infection.

Test or wait?

*Should I go for COVID 19 tests if I have body ache, sore throat and mild pain? As this can be due to common cold, can I wait for a day or two?

During this season of second wave of COVID19, which is highly contagious than the first, it may be wiser to go for the test as soon as you get the symptoms of upper respiratory tract infection. During the first wave the main symptoms were fever, chills, cough, body ache, and loss of smell and taste. But in the 2nd wave there are more symptoms like pink eyes, loose motions, and hearing impairment. These are totally the new signs detected in the second wave.

By going for the test, you can be sure about the infection and take precautions. If one has the symptoms and if the report is negative, it cannot be assumed that the person doesn’t have the infection. In the RTPCR test about 30% of the people may get a negative report even if they have the disease. It is better to be cautious when there are symptoms of the disease.

Most of the symptoms of common cold or flu subside within two to three days, although some colds can linger on for as long as 2 weeks, most clear up within a week. During the present pandemic all upper respiratory tract infections may have to be considered as COVID19 infections unless ruled otherwise.

*I remain inside the house except for morning walk and occasionally to the provision store, I do not go out. I take all precautions. I wear the mask regularly. I have taken two doses of vaccine. Can I still get infected by COVID 19? My symptoms must be due to common cold.

If you can get infected by the virus of common cold, you can surely get infected by COVID19 virus which spreads almost the same way as the virus of common cold. The common cold virus and virus COVID19 are of the same family. Moreover, it is known that the COVID19 virus that spreads in the second wave is more contagious. Even after vaccination the people can get infected. The available vaccines are known to give 60% to 70% protection during trial phases which may be less in the actual use.

If you have the symptoms of the infection, irrespective of the care you have taken it is better to go for the test.

Personal care and preventing spread

*What should I do if the test is positive for COVID19 infection?

As 95% to 98% people with COVID-19 have mild illness, you need not get panic once the report is positive. Most of the people do not need hospitalization and can recover at home without medical care. However, you have to be careful.

Personal Care

• Take care of yourself. Take normal diet, the one you have been taking. If you are a non-vegetarian, you can take fish or soft meat (like chicken) as per your liking. Drink lot of fluids. Fresh fruits, fruit juices are good.
• If you have fever or body ache, consult your family physician and take medicines as per his advice. Normally 500 milligrams of paracetamol tablets are advised to be taken after food twice or thrice per day depending on the symptoms. Most of the other tablets like vitamin or D or Zinc do not do miracles. They may be used as they are harmless.
• You have to buy a digital pulse oximeter and check your oxygen level thrice a day. The pulse oximeters are available in local medical shops. The pulse oximeter is a compact, portable gadget that measures the oxygen amounts in the system. It is clipped firmly on to the fingertip and painlessly analyses two important parameters- one determining the oxygen levels in the bloodstream and the other gauging the pulse rate i.e. how fast the heartbeats.
• It may be also advisable to have a digital thermometer to check the body temperature.

Preventing spread

• It is important that you should not spread the disease to others once you know that you are positive. Do not leave your home, except to get medical care.
• In your home, as much as possible, stay in a specific room and away from other people and pets. If possible, you should use a separate bathroom.
• If you need to be around other people or animals in or outside of the home, wear a mask.
• Wash your hands regularly with soap and water for at least 20 seconds. Use hand sanitizer if soap and water are not available. Use an alcohol-based hand sanitizer with at least 70% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.
• You should wear a mask over your nose and mouth if you must be around other people or animals, including pets (even at home). You can use good quality surgical masks. You may not need to wear the mask if you are alone.
• Try to stay at least 6 feet away from other people. This will help protect the people around you. If there are elderly and sick people, they are at extreme risk of problems if they get infected. If possible, try to stay away from them.
• All the people in the house need to wear the mask and they have to wash their hands regularly.
• Do not share plates, glasses and other eating utensils, towels, or bedding with other people in your home. Wash these items thoroughly after using them with soap and water. All your linen (intimate wear, bed sheets etc.) may be soaked in bleaching powder solution for at least half an hour before they are washed. Wash them separately, not with the linen of other people.
• It is better if you clean the high-touch surfaces (like table, chair, remote controls, doorknobs, bathroom fixtures etc.) in your room and bathroom. You have to wear disposable gloves.
• Let someone else clean and disinfect surfaces in other common areas in your house.
• If someone else has to clean your bedroom or bathroom, they should do so carefully. The person should wear a mask and disposable gloves prior to cleaning.

Inform your contacts

You have to inform all your close contacts that you are tested positive for COVID-19. An infected person can spread COVID-19 starting 48 hours (or 2 days) before the person has any symptoms or tests positive. By letting your close contacts know they may have been exposed to COVID-19, you are helping to protect everyone.

Parents of the positive

*I have elderly parents who are in their late 70s. Both have diabetes and hypertension, but under control. Now I am tested positive, what they should do? Should they undergo the tests? If they are positive can we stay together? If they are negative, do I have to stay somewhere else?

Ideally, once you are positive all your contacts have to undergo RTPCR tests 5 days after you had symptoms. If they do not undergo tests, they are to be considered positive unless proved otherwise. They need to watch for the symptoms of COVID19 infection and check their oxygen level using separate pulse oximeter.

Right from the day you are tested positive, it is better if you do not come into direct contact with your parents. If you have the facility, they may stay separately at least for two weeks from the day you developed symptoms or you were tested positive.

How many days?

*For how many days do I have to watch oxygen level and follow isolation? Is it for a month?

During the second wave of COVID19 infection, most of the complications are seen in the second week of onset of the symptoms. The symptoms of COVID-19 infection differ from person to person. The ones who have typical symptoms present with viral or flu-like illness in the first few days of the onset of this infection. The initial days of infection can be quite confusing; many people experience very mild symptoms or are even asymptomatic. However, it’s only through day 5-10 that the actual severity of the infection can be determined.

Most of the complications develop from day 5 to day 10 of the onset of illness. Therefore it is advisable to constantly monitor the oxygen saturation for two weeks since the day of onset of symptoms, or if asymptomatic from the day of positive report.

Warning signs of complications

*Are there any warning signs of impending complications or the complications develop all of a sudden?

The COVID-19 infection can cause different (or no) symptoms in different people, but one of the biggest complications it causes is for the respiratory system.

The emergency warning signs are:

• Trouble in breathing: Shortness of breath or dyspnea is a problem which usually happens when there is any kind of compromised lung function, which makes it difficult for oxygen to get into the lungs.
• Persistent pain or feeling of pressure in the chest
• Inability to wake up or stay awake
• Confusion
• Pale, gray or blue-coloured skin, lips, nails beds.

The blood oxygen level is an important indicator of impending problem. If the oxygen starts dropping and reaches to 90 in the pulse oximeter, immediate medical attention has to be sought.

As it can be difficult to get bed in case of emergency, it is better to keep in contact with the physician from the day you are tested positive. You physician can help you to get proper care in case your condition deteriorates.

How reliable are the tests?

*My cousin’s son had symptoms of COVID19 infection-throat pain, body ache, fever. He had come from Bengaluru and was in home isolation. His test report came negative and all were happy, that it was common cold. Within a week his grandmother became ill and was tested positive. Then all in the house, including he underwent the tests at a different centre and all were positive. The elderly lady passed away. How reliable these tests are?

At present two types of diagnostic tests are available for COVID19. RTPCR is the commonest and most reliable test. It tests the viral RNA. It may take few hours to days to get RTPCR test results. Antigen tests, detect specific proteins on the surface of the COVID 19. Antigen test results may be available as little as 15 to 45 minutes.

The rapid RTPCR test is now available at certain centers. Except that the results are available early, the accuracy of rapid RTPCR tests is comparable to normal RTPCR test.

The accuracy of any diagnostic test depends on many factors, including whether the sample was collected properly. For RT PCR tests, which are typically analyzed in a laboratory, test results may be affected by the conditions in which the sample was shipped to the laboratory also.

Results may also be affected by the timing of the test. For example, if one is tested on the day he/she was infected, the test result is almost guaranteed to be negative, because there are not yet enough viral particles in the nose or saliva to detect. The chance of getting a false negative test result decreases if tested at least 5 days after one is infected, or a few days after the development of symptoms.

In most of the centers RTPCR test may be false negative in 30% to 40% of the cases-that means even with the infection, the result may be negative.

Generally speaking, if a test result is positive, it is almost certain that the person is infected. The negative test result is less definite. During the pandemic a negative test result in any person with the symptoms of the disease has to be taken cautiously and the person should take all precautions as if he is COVID19 positive. He has to isolate himself for at least two weeks.

If a person has COVID-like symptoms and get a negative RTPCR test result, there is no reason to repeat the test unless the symptoms worsen. If the symptoms worsen CT scan of the chest may be the next test to diagnose the infection. Some of the physicians advise the patient with the symptoms of the infection and a negative report to go for CT scan chest to rule out infection. However routine CT scan of the chest in patients without worsening of the symptoms is not advisable.

Happy hypoxia

*I have heard that in some people oxygen can drop without any symptoms. How to know that?

During the present surge of infection due to the second wave, many youngsters including teenagers and those in their 20s, 30s are also acquiring COVID-19. One alarming observation in these youngsters is known as ‘happy hypoxia’. While blood oxygen levels below 90 per cent are considered low, adolescents and youngsters with readings as low as 80 per cent or less do not exhibit any common symptoms of COVID-19 such as cough, fever and even have no problems in breathing. However, this is a severe indication of malfunctioning of the lungs which requires immediate hospitalization and urgent medical care. These signs are displayed by not only young people but also the older population, who are either asymptomatic or have just mild symptoms of COVID 19 and still experiencing a state of happy hypoxia or decreased blood oxygen concentrations.

Even when there are only minor symptoms of COVID-19, such as cough, sore throat, fever, headaches, without any perceivable breathing difficulty, it is advised to continuously measure blood oxygen levels using a pulse oximeter. In some people with fair skin, change in the skin colour also can be a significant finding. The change of the colour of the lips from the natural shade to blue, while skin discoloration from the original tone to a red/purple appearance can be the indicator of drop in oxygen level in the blood. Keeping an eye out for these warning signs of happy hypoxia is important when the individual is at home.

Also read: 

• COVID 19 vaccine hesitancy: Misinformation & misconceptions - By Dr Edward Nazareth
• COVID19 vaccine: Side-effects, co-incidences, rumours, benefits - By Dr Edward Nazareth
• Approval of COVID19 vaccines, safety concerns - By Dr Edward Nazareth
• COVID19 mutation and its impacts - By Dr Edward Nazareth
• When will we get COVID 19 vaccine? - By Dr Edward Nazareth
• Second wave of COVID19: Are we prepared? - By Dr Edward Nazareth
• Home care: Living with COVID19 positive - By Dr Edward Nazareth
• Positive, negative & negative positive-reality of COVID-19 tests - By Dr Edward Nazareth
• COVID-19 vaccine-expectations and reality - By Dr Edward Nazareth
• Common cold, common flu or COVID-19 - What next? - By Dr Edward Nazareth
• Children, COVID-19 infection and school reopening - By Dr Edward Nazareth
• Immune system, COVID 19 infection, and building up immunity - By Dr Edward Nazareth
• Asymptomatic, pre-symptomatic, and living with coronavirus