A Presentation on

My Experiences with COVID-19

Sanjay Singh
Indian Railways Service Of Electrical Engineers
General Manager, Rail Vikas Nigam Limited, New Delhi
 Disclaimer
This is just sharing of experience and not any
medical advice. Treat me like your friend/colleague/
family member, who is guiding you based on his
knowledge and experience. Any treatment, of
course, has to go as per your doctor’s advice.
 Acknowledgement
Whatever knowledge related to COVID-19 I have, I owe it to:

1. Dr KK Agrawal, Padma Shri, Heart Care Foundation of India

2. Dr Neeraj Jain, Pulmonologist, Sir Ganga Ram Hospital, New Delhi

3. Dr Navneet Kalra’s videos available on YouTube

4. Dr Ashok Jainer, Consultant, UK National Health Service Trust

5. Dr Surya Kant Tripathi, Pulmonologist, Lucknow

6. My consulting doctors, Dr Ashish Srivastava, Emergency Medical Officer,

U P Govt, Kanpur, Dr Gayatri, Lifeline Hospital & Research Centre,

Azamgarh and Dr Sudhir Kumar Gupta, Kailash Hospital, Noida

7. Lot of other doctors, educators, physiotherapists, paramedical experts

through their videos on YouTube

8. Different standard documents, research papers, treatment protocols etc.

 My COVID JOURNEY
Date Day Detail Mistake
I get exposed to COVID suspect colleague in my chamber,
09-04-2021 -1 Removing mask and taken tea together
take vaccine on same day.
10-04-2021 0 Everything normal -
Consider it after effect of vaccine while
11-04-2021 1 Feverish
Covaxin has no fever
12-04-2021 2 Fever of 100 degrees, by chance, take RTPCR test -Do-
Fever of 100 degrees and body ache by evening, RTPCR
13-04-2021 3 Did not suspect COVID even on 3rd day
test report at 8:30 PM, medicines start
Added Fabiflue and Doxycycline to already started
Azithramycin, Ivermectin, Zinc, Vit C, Vit D as per adv of
14-04-2021 4 -
doctor, Also advised Pan-D, Montair LC, Deflazacort, steam
inhalation, kadha
Taking oxygen level without letting
15-04-2021 5 Medicines continue, Fever 101, Oxygen 97-98
Oximeter stabilise
Medicines continue, Fever 101, Accidently put Oximeter for No idea when to get blood test and HRCT
16-04-2021 6
2 minutes and notice drop in oxygen level to 94 done.
Medicines continue, Fever 101, Oxygen 93-94,Contacted
17-04-2021 7 Delay in contacting the doctor
doctor, he advises for blood test, denied HRCT
Medicines continue, Fever 102, Oxygen 93-94, blood
Delay in blood test and HRCT, didn’t start
18-04-2021 8 sample collected, get HRCT done as per advice of friends,
steroid as not available in market
Steroid Methylprednisolon recommended by Dr Gayatri
 My COVID JOURNEY
Date Day Detail Mistake

Only Doxycycline, Fabiflue and Vitamins and Minerals continue,

Could not start steroid even on
19-04-2021 9 Fever 103, Oxygen 93-94, Blood test and HRCT report awaited,
Day 9
steroid not available in market
Blood & HRCT Report comes, CRP 17.7, D-dimer and Ferritin OK,
20-04-2021 10 Delay in start of steroids
HRCT score 10, started Methylprednisolon 32 mg in afternoon
Taking 32 mg steroid per day
Methylprednisolon 16 mg BD. Fever subsides to 99-100, oxygen
21-04-2021 11 against recommended 100mg
level 93-94
out of fear
Fever subsides to 99-100, oxygen level 93-94, took 16mg 3 times as
22-04-2021 12 48 mg taken against 100mg
fever continues.
Oxygen level drops to 81-82, rush to hospital, 40 mg Solu
23-04-2021 13 -
Medrol(steroid) injection started alondwith antibiotics
Fever subsides, 40 mg steroid injection morning and evening with
24-04-2021 14 antibiotics continued, oxygen again falls to 81-82, oxygen support -
not given as no breathlessness. Maintained 90+ by proning.
No Fever, 40 mg steroid injection morning and evening with
25-04-2021 15 -
antibiotics continued
No Fever, 40 mg steroid injection in morning with antibiotics. Taken
26-04-2021 16 -
on 16mg oral steroid in evening
Discharged from hospital with oral steroid 16mg, Augmentin 625mg
27-04-2021 17 thrice a day and Doxycycline 100mg twice a day for 5 days, vitamins -
and minerals to continue
What Mistakes We Do ?
• Delay in identifying the disease
• Delay in accepting that I have been infected
• Delay in start of medication
• Delay in testing
• Waiting for RTPCR report before starting medication
• Not taking complete medication
• Not isolating yourself immediately
• Not able to assess correctly the severity of the disease in different stages
• Not getting the HRCT and Blood Test done on Day 5 or Day 6 despite severity
• Delay in starting second stage medication based on steroids
• Inadequate dose of steroids
• Not taking anti-coagulants
• Overconfidence on your body’s stamina and missing the Hypoxia
• Not going for intravenous treatment even in case of severe disease
Source: FLCCC Alliance

CLINICAL GUIDANCE FOR MANAGEMENT OF COVID-19 (Version 2.1)
Mild disease
Upper respiratory tract symptoms
(&/or fever) WITHOUT shortness
of breath or hypoxia
Home Isolation
Contact & droplet precautions, strict hand
hygiene
Symptomatic management (hydration, anti-
pyretics, anti-tussive)
Stay in contact with treating physician
Seek immediate medical attention if:
Diffic l in b ea hing RR min S O
94%
High grade fever/severe cough particularly
beyond 5 days of symptoms onset
A low threshold to be kept for those with any
of the high-risk features*
Tab Ivermectin (200 mcg/kg once a day for 3
to 5 days) to be considered
(Avoid in pregnant/ lactating)
If fever is not controlled with a maximum
dose of Tab. Paracetamol 650 mg QID, may
consider use of NSAID like Tab. Naproxen 250
mg BD
Inhalational Budesonide (given via DPI/MDI
with Spacer at a dose of 800 mcg BD for 5 to
7 days) to be given if symptoms (fever and/or
cough) are persistent beyond 5 days of
disease onset
Systemic Steroids NOT indicated in mild
disease; HOWEVER, may be considered in
cases with high grade fever and worsening
cough beyond 7 days ONLY in consultation
with the treating physician for a duration of
3-5 days.
Tab Dexamethasone 0.1-0.2 mg/kg OD
OR
Tab Methylprednisolone 0.5-1 mg/kg in 2
divided doses
*High-risk for severe disease or mortality
Age > 60 years
Cardiovascular disease including
hypertension and CAD
Diabetes mellitus and other
immunocompromised states
Chronic lung/kidney/liver disease
Cerebrovascular disease
Obesity
AIIMS, New Delhi
3rd May 2021
COVID-19 patient
Moderate disease Severe disease
Any one of: Any one of:
1. Respiratory rate > 24 /min 1. Respiratory rate > 30 /min
2. SpO2 < 93% on room air 2. SpO2 < 90% on room air
Admit in Ward Admit in ICU
Respiratory support
Oxygen Support:
Consider use of NIV (Helmet or face mask interface depending
Target SpO2: 92-96% (88-92% in patients with COPD)
on availability)/HFNC in patients with increasing oxygen
Preferred devices for oxygenation: non-rebreathing face mask requirement, if work of breathing is LOW
Intubation should be prioritized in patients with high work of
Awake proning should be encouraged in all patients who are breathing /if NIV is not tolerated
requiring supplemental oxygen therapy (sequential position changes Use conventional ARDSnet protocol for ventilatory management
every 1-2 hours)
Anti-inflammatory or immunomodulatory therapy
Anti-inflammatory or immunomodulatory therapy Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an
Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an
equivalent dose of dexamethasone 0.2 to 0.4 mg/kg per day)
equivalent dose of dexamethasone 0.1 to 0.2 mg/kg per day)
usually for a duration 5 to 10 days
usually for a duration of 5 to 10 days
Patients may be initiated or switched to oral route if stable and/or
improving Anticoagulation
Weight based intermediate dose prophylactic UFH or LMWH
Anticoagulation (e.g., Enoxaparin 0.5mg/kg per dose SC BD)
Conventional dose prophylactic UFH or LMWH (weight based e.g.,
enoxaparin 0.5mg/kg per day SC OD) Supportive measures
Maintain euvolemia (if available, use dynamic measures for
Monitoring assessing fluid responsiveness)
Clinical Monitoring: Work of breathing, Hemodynamic instability If sepsis/septic shock: manage as per existing protocol and local
Change in oxygen requirement
antibiogram
Monitoring
Serial CXR; HRCT chest to be done ONLY If there is worsening
Serial CXR; HRCT chest to be done ONLY if deteriorating
Lab monitoring: CRP and D-dimer every 48 to 72 hrly; CBC KFT, LFT Lab monitoring: CRP and D-dimer 24-48 hourly; CBC, KFT, LFT
every 24 to 48 hrly; IL-6 levels to be done if deteriorating (Subject to daily; IL-6 to be done if deteriorating (subject to availability)
availability)
After clinical Improvement discharge as per revised
discharge criteria
EUA/Off label (use based on limited available evidence and only in specific circumstances):
Remdesivir (EUA) may be considered ONLY in patients with
o Moderate to severe disease (i.e., requiring SUPPLEMENTAL OXYGEN), AND
o Who are within 10 days of symptom onset, with
o No renal or hepatic dysfunction (eGFR <30 ml/min/m2; AST/ALT >5 times ULN (Not an absolute contradiction), AND
o Recommended dose is 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days
Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET
o Presence of severe disease (Preferably within 24 to 48 hours of onset of severe disease/ICU admission)
o Significantly raised inflammatory markers (CRP &/or IL-6)
o Not improving despite use of steroids
o No active bacterial/fungal/tubercular infection
o The recommended dose is 4 to 6 mg/kg (usually a dose of 400 mg in a typical 60kg adult) in 100 ml NS over 1 hour (single dose)
Convalescent plasma (Off label) may be considered when following criteria are met
o Early moderate disease (Preferably within 7 days of symptom onset)
o Availability of high titre donor plasma (Signal to cutoff ratio >3.5 or equivalent depending on the kit being used)
o Usual dose is 200 ml given over a period of 2 or more hours
Department of Medicine, AIIMS (ND)
What Else is Important to Know ?
• Ensure immediate isolation as you notice first symptoms
• Time is the essence hence start medication early.
• Take good diet rich in protein. Take lot of water and liquid
diet to keep yourself hydrated. Take steam inhalation.
• Keep monitoring oxygen level in moderate and severe
cases, it may fall any time.
• Fall in oxygen level below 90 requires admission as a
precautionary measure, not to panic
What Else is Important to Know ?
• Do 6 minute walk test. Walk 500 m in 6 minutes. If your oxygen level
falls by more than 4 points, your lungs are not able to take sufficient
oxygen indicating severe inflammation requiring hospital admission
• Better the body stamina, longer the oxygen level will sustain. Don’t
get misguided by ‘Happy Hypoxia”. Normally oxygen level falls
after Day 10 and, in most of the cases on Day 12 to Day 15
depending upon body stamina. So you have 5 to 8 days for
treatment of second stage, starting from Day 6. If not treated
properly with adequate dose of steroid, patient will go in stage 3
requiring oxygen support and ICU.
What Else is Important to Know ?
• Do not workout. Take complete rest.
• Maintain oxygen level at 90+ by Proning
• Day 6 is most important in your COVID journey. On Day
6 fever will subside in mild cases and you start recovery.
• If fever persists above 100 degrees on Day 6, immediate
HRCT, Blood Test and start of second stage medication
with steroids and anticoagulants is required.
What Else is Important to Know ?
• Steroid and Anti-coagulant are the only medicines of
stage-2
• Dose of steroid is important. Under dose doesn’t work.
• Take second stage medication in hospital if possible. If
not, go for physical consultation not tele-consultation.
• HRCT may be repeated after 5 days if required.
• CRP is the most important parameter which indicates
inflammation and needs to be repeated every 2-4 days
to monitor the progress
What Else is Important to Know ?
• D-Dimer indicates clotting in blood. Higher values need
immediate attention and administration of anticoagulants
• Timely admission to hospital and intravenous treatment is
important in severe cases. Any delay may endanger your
life.
• If whole family is infected, focus on elderly people.
Children will recover on their own.
• Post COVID care and regular followup with your doctor is
important
Thank You