How to manage home quarantine in COVID-19 positive cases, particularly in Tripura, in this crisis our of pandemic: A guideline

Dr Basab Ghosh

September 9, 2020, 09:11:31   

(Intention of this post is neither to gain any personal benefit or to hurt any individual, institution, office, department, state, etc; rather if anyhow some support could be extended to the sufferings!) 

1) Home management: Once positive totally quarantine in the house, preferably in a separate room with separate toilet. Number  of persons positive and in the same house how many are negative, this is immaterial. I suggest treat everyone in the house as positive.

Corona virus is discharged in the stool and possibly those virus might infect others if sharing the toilet, so always use mask in the toilet. If western toilet, then always keep the lid covered before flush. 

Keep the room as well as house clean. It will be very tuff, but try to clean the floor and other surfaces clean with soap water; if you allow to dry the floor, soap will dried up and will not cause accident. 

Keep the bed clean. Remember Corona is destroyed in soap water, so clean anything with normal soap water and it's enough. 

2) Diet: Healthy diet with normal fruits, vegetables including green leafy vegetables, egg, fish, meat, milk, curds, etc. Healthy diet will increase power (immunity) of the body to fight COVID-19 out of your life!

3) Hygiene: Maintain dignity in garbage disposal as per your availability, don't throw in the roadside. Always arrange disposal to the Municipality garbage container or in multiple packets keep inside your house, it's a matter of just 14 days! 

Maintain spitting and cough hygiene inside room and in the house. Use facemask as much as possible when coming in two meter contacts of any positive or negative family members. This will minimize viral numbers (load) in all family members. 

Take daily bath preferably with warm water to avoid cold and cough, because that may disturb in clinical assessment. 

4) Awareness : Remember at home further assessment is totally symptom wise; your explaining of symptoms, Thermometer and Pulseoxymeter are the maximum helping tools for tele consultations!

Neither neglect nor overreact, late reporting to symptoms might cause dangerous consequences!

6) Prescription:
(Those medicines, as Sl. No A to I, as cocktail tried by several experts and according to them it should be helpful.)

A) Tablet Ivermectin 12mg, 1 tad daily for 3 consecutive days. For all family members above 2 yr age.

(As per Govt of UP circular, this schedule of Ivermectin is mentioned here.)

B) Cap Doxycycline 100mg, 1 cap 12 hourly after meal for 5 days, for person having fever, cough or both. 

C) Cap or sachet of Vit D 60000 IU in 3 consecutive days as loading dose to boost immediate immunity as most of the Indian population is having Vit D deficiency, thereafter 1 cap or sachet weekly once continue for 8 weeks for all family members. 

D) Tablet Vit C 500mg 2 to 3 times daily for 10 days, thereafter 1 tab daily continue for 2 months, for all family members. 

E) Tab with 50mg elemental Zn preparation is ideal. (As per ICMR, for positive cases 50mg and for prevention 25mg elemental zinc is required.)

Most of brands contains substandard dose. By knowing following conversion one can calculate elemental zinc content:-
Zinc sulfate contains 23% elemental zinc,
Zinc gluconate 14.3%
Zinc oxide 80%
Zinc acetate 30%

F) Otrivin / Nasivion / or, any same preparation Nasal drops, 2 drops 3 times, (if nose is blocked as can be checked by pressing the other nose and try to breathe with the another one).

G) Steroid Nasal Spray Fluticone FT or any such preparations, 1 spray in each side, 2 times in a day. (Steroid Nasal spray is very helpful to reduce local inflammation and prevents entry of Corona virus to the system according to many experts.)

H) Tablet Montelukast 10mg containing preparation, 1 tablet daily once. (According to experts it suppresses the entry of Corona virus in the system.)

I) Steroid Nebulization with Beclamethasone or Budesonide. Some experts addressed it very useful both for prevention and treatment of positive cases. Now, in any Covid treatment centre it is started immediately for complain of cough,  sore throat, respiratory troubles, etc. 

The nebulizer machine in BPL costs around Rs 2500 and different companies are also available in the medical instrument shops. 

Dose: each ample of solution 2 times daily. It's very very soothing in my personal experience. 

Cleaning: clean after use in a bucket with soap and water, but don't clean the connection pipe. With one unit and one mask several person can use after proper cleaning after every use.

J) Tab Paracetamol 650mg, 3 to 4 tablets daily at 6 to 8 hr interval after some food to keep the fever under control. It also reduces body pain and helps to feel good. 

K) Tab Rosuvastatin 10mg, I tablet daily at bed time can be taken irrespective of blood cholesterol levels for good pleotrophic benefits by anyone above 30 year age for next 2 months.

L) Dexamethasone 6mg injection IV or IM daily once or tablets orally 3mg 2 times daily (if tablet is 0.5mg then 6 tab 2 times daily) for 10 days. If Fever is uncontrolled, cough is increasing, sore throat is disturbing even after regular gargling, some sort of breathing difficulty is felt, you feel that hospitalization is next step, please start this medicine. 

Without any further blood reports as prophylaxis / prevention, Apollo treatment protocol mentioned that in their 26th August treatment update.

M) Injection Low Molecular Weight Heparin (LMWH), for example Enoxaparin can be taken by anyone very easily at home as sub cutaneous infection. Procedure is same like insulin and insulin is always taken by the patients own self. 

Dose: Initially 40mg for below 80kg person and 60mg for above 80kg person.

If Fever is uncontrolled, cough is increasing, sore throat is disturbing even after regular gargling, some sort of breathing difficulty is felt, you feel that hospitalization is next step, please start this medicine. 

Without any further blood reports as prophylaxis / prevention, Apollo treatment protocol mentioned that in their 26th August treatment update.

N) Oxygen supply: 
If Oxygen is required from outside, this part is critical. It may last for several days and expert monitoring is must, so please get hospital admission. 

Oxygen supply from oxygen filled cylinders or containers requires constant supply from outside, which may not be very easy for a quarantine family. Any drop in required oxygen supply is injurious. Best way of Oxygen supply is by Oxygen Concentrator machines. They are costly, around 45000 to 55000 in present Agartala market, though availability is on demand and inconsistent. But very easy to use. It will concentrate Oxygen from room air, so headache of supply from outside is not their, but in any case it will not work without electricity, so backup cylinders at home is advisable. 

I came to know many patients are under oxygen support at home, so this 'para N' I included, otherwise personally I request immediate hospitalization. 

O) Pulseoxymeter: 
It is a simple instrument to measure blood oxygen concentration, costing Rs 1500 to 5000, available in the local Agartala market in Ratna Surgical (near ML Plaza) etc. In case  of Oxygen Concentrators, Pulseoxymeter is attached to that.

Normal physiological oxygen levels are 96% or above for below 70 year age. For Chronic Asymptomatic and certain other medical conditions and age above 70 year, normal physiological  oxygen levels are 94% or above. 

Six minute walking test: very good indicator for home quarantine patients to assess the lung function, because xRay chest or CT scan of chest is impossible for all. Check oxygen saturation after 3 minute and 6 min normal walking even inside room, if saturation falls by 4% at 6 min walking, very soon oxygen supply is needed. If saturation falls by 4% at 3 min walking, condition might require oxygen supply any point of time.

If patient is on Dexona and LMWH, then dose should be increased from 6mg to 8mg daily for Dexona and 40mg OD to 60mg OD or 60mg OD to 40mg BD for LMWH,  as per increase demand of oxygen supply from normal to outside supply or from low pressure supply to higher pressure supply. 

PLEASE REMEMBER "early" and "timely" treatment and hospitalization are very very crucial decisions for home quarantine COVID-19 positive cases!! 

Take care. Be safe. During my home quarantine, I could feel the helplessness of my fellow covid positive cases and wanted to share my gathered experience and knowledge to help anyone, if you trust me!
( This website media post is only as services to humanity, not for any medico legal purpose !)

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