1. Related to Use of Oxygen during current COVID-19 Pandemic
Q. What is the normal respiratory rate of a healthy adult person?
A. Standard respiratory rates for a healthy adult range from 12 to 20 breaths per minute.
Q. Are 8 breaths per minute normal?
A. No. A patient needs to be evaluated medically.
Q. How many litres of oxygen per minute do we breathe?
A. The average tidal volume, i.e., the average amount of air inhaled and exhaled per breathing cycle, is 0.5 litre (500 ml). Minute ventilation (VE) is the total volume of air entering the lungs in a minute is 6 litres per minute.
Q. What should be the normal oxygen saturation as recorded by a Pulse Oximeter?
A. The normal oxygen saturation level in the blood (SpO2) should be 95% or higher. Some people with chronic lung disease, such as Chronic Obstructive Pulmonary Disease (COPD) or sleep apnea, may have normal levels of around 90%. The “SpO2” reading on a pulse oximeter shows the percentage of oxygen in the blood. If your home SpO2 reading is lower than 94%, call your healthcare provider.
Q. How do I check my oxygen level at home without a Pulse Oximeter?
A. If you do not have a portable finger pulse oximeter in your home, you can also learn how to assess signs and symptoms of low oxygen levels. Two classic signs of a low oxygen level are a rapid heart rate and a fast breathing rate. An average heart rate is 60–100 beats per minute and an average breathing rate is 12–20 breaths per minute. However, under low oxygen conditions, body responses include an increase in heart rate and breathing rate. Another sign of a low blood oxygen level is cyanosis or a bluish color change on your lips, nose, or fingertips. As your body loses oxygen, the blood cells in your body change colour in your bloodstream to a dark blue, which can be seen from the outside of your skin if it is severe. Cyanosis is typically a late sign of low oxygen levels and is considered a medical emergency. If you notice this bluish discolouration, you should immediately visit the nearest hospital.
Q. Do we see many cases of silent hypoxia in this wave? How can this be addressed?
A. Silent hypoxia or happy hypoxia is referred to as the early stage of COVID-19. As the oxygen level drops, one may start feeling shortness of breath, confusion, and other symptoms. Keep watching for these signs and do not ignore them. This is true for young people as well. If you monitor low oxygen level, change in lip colour from natural to blue or persistent sweating, consult the covid helpline or doctor. They could be the early sign of silent hypoxia.
Q. In brief, how can proning help enhance blood oxygen levels?
A. Proning is a medically accepted process to improve the distribution and exchange of oxygen in the lungs. A patient is safely placed from their back onto their abdomen (stomach), i.e., having face down to improve breathing and oxygenation. It has been shown beneficial for COVID-19 patients with compromised breathing comfort, especially during home isolation.
Q. Is pure oxygen used in hospitals?
A. Medical oxygen contains high purity oxygen used for medical treatments and is developed for use in human body. Cylinders contain a compressed oxygen gas and no gases are allowed in the cylinder to prevent contamination.
Q. What is the use of Medical Oxygen?
A. Oxygen is used for treatment in hospitals. Hence, it is considered a drug or a pharmaceutical product.
Q. What is the need for Medical Oxygen?
A. The human body requires oxygen to survive, and typically, we breathe in from air. However, if you have lung disease or other medical conditions such as COVID-19, you may not get enough oxygen due to compromised lungs. That can leave you short of breath and cause problems with your heart, brain, and other parts of your body.
Q. Can breathing 100 per cent oxygen harm your body?
A. Yes. Breathing 100% oxygen also eventually leads to collapse of the alveoli (atelectasis).
Q. Can you get excess (more than required) oxygen from an Oxygen Concentrator?
A. It is possible to get excess (more than required) oxygen from an oxygen concentrator. However, this is quite rare when oxygen concentrators are used as directed and prescribed. All supplemental oxygen requires a prescription from a doctor, who carefully chooses your oxygen requirement.
Q. What is the role of oxygen during COVID-19 Disease?
A. The demand for medical oxygen is increased in COVID-19 as the disease primarily affects the lungs and, in severe cases, causes death due to Acute Respiratory Distress Syndrome (ARDS) and pneumonia.
Q. When does a patient require medical oxygen in a COVID-19 positive case?
A. As per AIIMS/ICMR-Covid-19/National Task Force/Joint Monitoring Group (Dte.GHS), MoHFW, Government of India, Clinical Guidelines for Management of Adult COVID-19 Patientissued on 22 Apr 2021, moderate and severe cases of COVID-19 where the infection induces shortage of oxygen in the body due to its impact on lungs require medical oxygen and immediate oxygen therapy. Oxygen acts as a life-saver for COVID patients.
Q. What is Moderate COVID-19 cases?
A. In moderate COVID-19 cases a patient has upper respiratory tract symptoms (and/or fever) with shortness of breath. They have a respiration rate more than or equal to 24/minute and SpO2 90% to 93% with ambient air.
Q. What is severe COVID-19 cases?
A In severe Covid-19 case, a patient has upper respiratory tract symptoms (and/or fever) with shortness of breath. They have a respiration rate more than 30/minute and SpO2 less than 90% in room air.
Q. When does a patient require Mechanical Ventilator Support?
A. A patient may be put on a mechanical ventilator if it becomes very difficult to breathe or get enough oxygen into their blood. This condition is called respiratory failure. Mechanical ventilators are machines that act as bellows to move air in and out of the patient's lungs. The respiratory therapist and doctor set the ventilator to control how often it pushes air into the lungs and how much air the patient gets. The patient may be fitted with a mask to get air from the ventilator into there lungs. Or they may need a breathing tube if their breathing problem is more serious.
Q. Can Mechanical Ventilation be given at home?
A. Mechanical ventilators are mainly used in hospitals and transport systems such as ambulances and medical evacuation by air transport etc. In some cases, they can be used at home if the illness is long-term and the caregivers at home receive training and have adequate nursing and other resources at home. Being on a ventilator may make a patient more susceptible to pneumonia, damage to the vocal cords, or other problems.
Q. What is the 6-minute walk test for COPD?
A. The 6-min walk test (6MWT) is an exercise test that measures functional status in chronic obstructive pulmonary disease (COPD) patients and provides information on oxygen desaturation. This test is also being used for COVID-19. In case of COVID-19 symptoms, SpO2 level must be checked before taking a walk. Now, walk for 6 minutes without a break on an even surface and measure the SpO2 level. It may fall 1-2%, but consult a medical professional if it falls below 93%. (Source: https://ndma.gov.in/sites/default/files/2021-03/FAQs-on-Use-of-oxygen-.pdf)
2. Related to drugs and medications fighting the disease
Q. Is Remdesivir effective in the treatment of COVID-19?
A. No study has conclusively been able to prove that Remdesivir is beneficial in the treatment of COVID-19. However, India has approved Remdesivir under the National Clinical Management Protocol for COVID-19, which was developed after many interactions VIGYAN PRASAR 95 by a committee of experts. The protocol acts as the guiding document for the treatment of COVID-19 patients in India. Remdesivir is listed as an investigational therapy in the protocol, i.e., where informed and shared decision-making is essential, besides noting contraindications mentioned in the detailed guidelines.
Q. What Is Remdesivir? How Does Remdesivir Work?
A. Remdesivir is an investigational drug used to treat viral infections. It is classified as a broadspectrum antiviral with potential antiviral activity against a variety of RNA viruses. The drug works against the novel coronavirus by inhibiting replication of the virus in the body. Remdesivir functions as a prodrug that is modified in the body before it becomes an active drug. It is classified as a nucleoside analog, one of the oldest classes of antiviral medications, and resembles the RNA base adenosine. In general, nucleoside and nucleotide analogues simulate the structure of a true nucleoside or nucleotide. The simulated structure may then be incorporated into the virus. Remdesivir works when the enzyme replicating the genetic material for the novel coronavirus—RNA polymerase—incorporates the adenosine analogue in place of the natural molecule into the growing RNA strand. By introducing the modified agent, Remdesivir, replication of the novel coronavirus is interrupted, and the virus ceases to multiply and cannot infect more cells in the body.
Q. When should a patient of COVID-19 take Remdesivir?
A. The timing of the drug, when it is administered, is most important. Taking it too early or too late could do more harm than good. Remdesivir is applicable only in hospitalised patients who showed very low oxygen saturation and infiltrated their chest X-ray or CT scan. The optimal timing for Remdesivir is usually after five to seven days of having the virus. Early to mild or asymptomatic patients should not take Remdesivir. Also, it is of no use if it’s given very late because it would create a cytokine storm. A cytokine storm is when the immune system goes into overdrive. The body starts to attack its cells and tissues instead of just the virus.
Q. Is Remdesivir can be taken at home?
A. Remdesivir comes in a vial and has to be injected only after prescription and in the presence of a health practitioner. It is for patients who are hospitalised and severe. Therefore, it should not be given at home. It is for patients who need to be admitted and need hospital care.
Q. Are steroids effective in the treatment of COVID-19?
A. There is no evidence to support the use of steroids in the treatment of COVID-19. World Health Organization (WHO) recovery trial showed that steroids do have a beneficial effect. But again, the timing is critical. The recovery trial clearly showed that if we give steroids too early, it showed a harmful effect before oxygen saturation. Steroids are most effective during the later part of the disease when there is more inflammation and oxygen saturation is falling. Steroids are only helpful for moderate or severe cases.
Q. Is plasma a good way to fight off COVID-19?
A. Convalescent plasma has been a therapy devised to passively transfer antibodies from a recovered person to a new patient. While the therapy has been received with different opinions by the medical community, the important aspect is timing. It’s better if plasma therapy is used early before clinical worsening. Also, plasma with high titer neutralising antibodies would havebetter results. Hence, to achieve good results, correct patient selection, timing and a good quality plasma donor are needed for success in this form of treatment.
Q. Should a person with COVID-19 take Tocilizumab?
A. Tocilizumab is a drug of last resort. It should only be used when a COVID-19 infection in a patient is worsening despite steroids, Remdesivir and other treatments like anticoagulants. Tocilizumab is required in less than 2% of COVID-19 patients. Very few patients need this drug because it’s only for treating a cytokine storm and has a limited role.
Q. Is Favipiravir effective in treating COVID-19?
A. Favipiravir is another antiviral that is being promoted for the treatment of COVID-19. It was initially doled out as a treatment of influenza after the H1N1 pandemic. There is not enough evidence in robust studies to show that it is a good drug. Since it’s not a proven treatment, India’s national guidelines also don’t recommend its use.
Q. Is it possible to treat COVID-19 without any of the drugs mentioned above?
A. People with mild COVID-19 or those who are asymptomatic will improve with just symptomatic treatment. Mild COVID-19 infection can be treated with paracetamol, good hydration and multivitamins —without any treatment. Giving treatment when it is not required may be doing more harm than good.
3. Related to Black Fungus and COVID-19 Disease
Q. What is Black Fungus?
A. Black fungus, also known as MUCORMYCOSIS, is a rare fungal infection. It is called “black” because of the colour of the fungal growth. It is caused by exposure to mucor mould found in soil, manure, and rotten/decaying fruits and vegetables. It is ubiquitous and even present in the nose/mucosa of healthy individuals. This disease usually affects the sinuses, eye orbit, and brain. That is why it is also called “rhino-orbital-cerebral” mucormycosis. It may be lifethreatening in immunocompromised individuals (cancer patients, HIV/AIDS) and people with uncontrolled diabetes.
Q. What are the risk factors for acquiring Black Fungus infection?
A. Risk Factors are: • Uncontrolled Diabetes Mellitus • Treated for COVID-19 with corticosteroids • Treated for COVID-19 with immunomodulators • Treated for COVID-19 with mechanical ventilation • Prolonged oxygen therapy • Prolonged ICU stay • Immunocompromised state
Q. Why the sudden increase in Black Fungus cases?
A. It may be triggered by extensive use of steroids, which is a life-saving treatment for moderate to severe COVID-19 infection. Steroids lower the immunity and cause a sudden up-shooting of blood sugar levels in diabetes and non-diabetic patients. For patients on humidified oxygen, care should be taken to make sure there is no water leak to prevent the growth of the fungus.
Q. How serious is Black Fungus?
A. Black fungus infection causes a vision-threatening and life-threatening condition.
Q. Do all COVID-19 patients need to be worried about Black Fungus infection?
A. No. As discussed, high-risk patients need to be alert. Also, during COVID-19 recovery, everyone should watch out for early signs and symptoms.
Q. What are the precautions one can take to avoid this disease?
A. Following precautions one can take: • Boost immune system with diet, hydration and exercise. • Rational use of steroids by follow guidelines. • Strict Blood sugar monitoring and control in all patients who are on steroids.
Q. What are the early signs of Black Fungus?
A. some of the early signs are: • Facial pain • Facial swelling/puffiness/discolouration • Sinus headache • Stuffy nose • The blurring of vision/decreased vision • Double vision • Drooping of eyelid • Blood-stained nasal discharge • Dental pain
Q. Is Black Fungus treatable?
A. Yes. Early diagnosis and a prompt multi-speciality team of medical professionals can manage it.
Q. Which specialist should I visit for Black Fungus?
A. ENT and eye specialists are central to this disease. The team includes care coordination with neurosurgeon endocrinologist and microbiologist. (Source: https://www.eyeqindia.com/frequently-asked-questions-on-covid-and-blackf...)
4. Related to Indoor Air and COVID-19 Disease
Q. Will running an evaporative cooler help protect my family and me from COVID-19?
A. Evaporative coolers (or “swamp coolers”) can help protect people indoors from the airborne transmission of COVID-19 because they increase ventilation with outside air to cool indoor spaces. Evaporative coolers are used in dry climates. They use water to provide cooling and improve relative humidity in indoor microenvironments. When operating as intended (with open windows), these devices produce substantial increases in ventilation with outdoor air. Some evaporative coolers can be performed without using water when temperatures are milder to increase ventilation indoors. Avoid using evaporative coolers if air pollution outside is high and the system does not have a high-efficiency filter.
Q. Is ventilation important for indoor air quality when cleaning and/or sanitising for COVID-19 indoors?
A. When cleaning and disinfecting for COVID-19, ventilation is essential—in general, increasing ventilation during and after cleaning help to reduce exposure to cleaning and disinfection products and by-products. Increasing ventilation, for example, by opening windows or doors, can also reduce risks from particles resuspended during cleaning, including those potentially carrying SARS-CoV-2 (or other contaminants). Avoid ventilation with outdoor air when outdoor air pollution is high or when it makes your home too cold, hot, or humid.
Q. Will an air cleaner or air purifier help protect my family and me from COVID-19 in my home?
A. When appropriately used, air purifiers can help reduce airborne contaminants, including viruses, in a home or confined space.
Q. How can I increase ventilation at home to help protect my family from COVID-19?
A. Ensuring proper ventilation with outside air is a standard best practice for improving indoor air quality. To increase ventilation in your home, one can: • Open the windows or screened doors, if possible; • Operate an air conditioner that has an outdoor air intake or vent; and • Operate a bathroom fan when the bathroom is in use and continuously, if possible. However, the practices mentioned here are not enough to protect people from COVID-19. When used along with other best practices recommended by the Ministry of Health and Family Welfare, Govt. of India, the above methods can be part of a plan to protect yourself and your family. (Source: https://www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19)