Excerpts from my Covid-19 diary…
Dr.
Sidhartha Satpathy (guest blogger)
The
fever started early in the morning on 21st July, and I remember
telling my wife to switch off the AC. After finishing my daily routine, I
decided to check my temperature and found it to be 100.4F. I was still a bit
sceptical and I almost ignored it until it went +up by a few notches within an
hour.
I
go for my Covid-19 tests
After
discussing with colleagues, I decided to get myself tested at the hospital
where I work. I must have visited this
facility several times during last couple of months, but it was a very
different feeling when I had to go in as a “suspected” Covid 19 patient.
Whatever I had heard about the ‘process’ of taking naso-pharyngeal and
oro-pharyngeal swabs was indeed true, but the process was quick. I also
volunteered for the Rapid Antigen Test (RAT), which I hoped would end my
suspense sooner.
I
was back in my office, waiting with fingers crossed, when I received a telephone
call from Dr. Arvind that my RAT had come positive. The doctor in me tried to
enquire about “false positive”, to which he replied that chances would be next
to zero, and suggested to wait for the reverse transcriptase polymerase chain
reaction (RT-PCR) test results. Informing my office staff, I trudged back home with
my mind full of images of white cover-all and PPE clad health care workers,
thanks to the overkill by TV channels. Simultaneously, I was trying to grasp
with two critical issues, viz. admission/home isolation and contact tracing of
family members/friends and staff.
I
break the news to my family and prepare them
On reaching
home, I broke the news to my daughters, who were both shocked and sad to hear
this, but bore it stoically. I decided to wear my N-95 mask all the time, and
told them to do the same, and maintain “social distancing” even at home. I confined myself to the drawing room, took a
paracetamol tablet, kept doors open for ventilation, and went about deciding
the future course of action. Within an hour, most issues had been sorted out.
It was decided that I would get admitted in the New Private Ward, and contact
tracing/testing of family members and friends would be done in the same afternoon.
I
get into the Covid ambulance
After
my family members had been tested, and told to selfquarantine in different
rooms at home, I decided to call the Covid ambulance (an ambulance service
dedicated specifically for transporting Covid suspects or patients) after
seeing the positive RT-PCR report. When the ambulance arrived with its lights
flashing, the security guards and bus drivers sitting nearby were stunned to
see me going inside the ambulance with my stuff. The security guard at the Special
Isolation facility seemed equally flustered but none-the-less offered what
looked like a hesitant salute.
I
settle down in the hospital room
I
was allotted Room no 2, adjacent to the donning room, which was to be my home
for some time. By the way, the donning room or the donning area is a dedicated
area in the Covid zone where one dons or puts on the PPE before entering the
patient’s room.
Once
in my room, I went about creating my ‘comfort zone’ within the cramped space. After
settling down on my bed, like most patients, I too wondered about the source of
my infection, and after much soul searching, identified three potential
episodes.
Those
included several meetings in my office at the cancer centre during the previous
week with a triple layer surgical mask, a visit to a dentist and a visit to the
salon on Saturday. I was unable to pinpoint on any one single episode as the
source of my infection.
Day
1
I started
making several calls to relatives and friends to inform them about these
unexpected developments. I felt it was my responsibility to keep people
informed I was Covid positive. I received support and advice in equal measure.
It
would be worthwhile to mention the advice from the professor in charge of the Trauma
Centre Covid facility, who had treated his 1000th patient on the
same day. He had advised me (i) adequate hydration to keep my urine colourless;
(ii) awake proning (lying flat with my face downwards) for 3-4 hours daily; and
(iii) breathing exercises to increase lung capacity, just in case things took a
turn for the worse.
My
first meeting with the white-coat Covid warriors was during evening rounds when
my history was sought, vitals measured, chest X-ray done, and preliminary
treatment started. The only catch was the requirement of an ECG before starting
hydroxychloroquine (HCQ) which was finally completed by 10 pm. HCQ is known to
cause cardiac complications. That is why a baseline ECG is done before
prescribing HCQ.
The
wonders of digital technology allowed me to send my ECG to my cardiologist, and
his clearance came within minutes, after which I could take HCQ. The emotional
turmoil, and stress of the day had increased my anxiety. As a result, I had difficulty
in sleeping, which was further aggravated as I woke up early on the next day.
Day
2
On
the second day, Dr. Arvind came for physical rounds and we discussed about my X-ray,
base line investigations (that had been sent for in the morning), and my fever(100-101F),
which was my only symptom.
The
broad treatment plan was decided keeping in mind my co-morbidities, after I had
cross-consulted them digitally. He assured that by evening the reports would be
available, and we could further fine-tune the treatment, if needed.
Good
news came in the afternoon, as all my family members and a close friend had
tested negative, and I heaved a sigh of relief. It was now evident that they
would self-quarantine at home till the next test on Day-8; and I would continue
with my admission.
Fever
continued throughout the day, despite the paracetamol. A video chat with family
members at 8 pm was the high point, as it enabled some ‘family time’. I decided
to go to sleep early to give myself the much-needed rest. Unfortunately, that
was not to be, as the patient in a nearby room needed an X-ray at midnight. The
consequent ruckus woke me up and I could not go back to sleep. I tried using a
new app “Calm Sleep” which had white noise of natural rainfall, but still did not
succeed. After about an hour and a half, finally called up the nursing staff,
who gave me Clonazepam 0.25mg which finally settled the issue.
Day
3
Woke
up early on Day-3, completed my daily routine of Pranayam, steam inhalation,
and warm saline gargling, and decided to change my room to another wing which
had less patients, and would hopefully allow me sound sleep. After discussing
with the treating team, and Nursing Supervisor, I shifted to my new room, just
after the morning rounds were over. Murphy’s law came into play a little while
later, when I discovered that the condensation water pipe from AC was hanging
from a height in the bathroom, with a bucket placed underneath.
There
seemed to be other minor plumbing issues, which were raised to the appropriate
level and rectified during the day on ‘personal’ basis. Being the in-charge of the
private ward has its benefits.
Meanwhile,
during the evening, the virus probably decided to attack my gastrointestinal
tract with gusto, and I had abdominal pain, flatulence and loose stools. It was
not clear though, whether this was due to the drugs I was taking, namely
Ivermectin, HCQ and Doxycycline or due to the virus, and I hoped it would
settle down eventually.
After
the third round of Pranayam and steam inhalation, I decided to have early
dinner followed by gargling, and tried to go to sleep early.
Day
4
After
my first night of sound sleep in the hospital, was surprised to wake up and find
throat pain while swallowing (odynophagia) in the morning. The creepy virus had
changed its strategy, and was targeting my pharynx and tonsils. They must have
resisted the Chinese incursion, but fallen prey to the brutal attack!
Immediately, I went for couple of rounds of warm saline gargles, after which the
pain was less. Friendly advice in the form of Kaadhaa, doodh-haldi, ginger tea
etc came from multiple sources, which was added to the armamentarium.
The
day was uneventful, except for a stray centipede making a surprise appearance
while I was bathing, and in my sheer panic it had to be sacrificed. My fever
was still around 100 F and intermittent, coming down with paracetamol. Talked
to several of my batchmates from medical college who had tested positive in
different parts of the country. After all, there is a sense of comfort in numbers.
I registered for inner engineering course by Sadhguru, and also started reading
Raag Darbaari- a novel set in UP in 1960-70s.
Day
5
On Saturday
(25th July). I woke up with increased odynophagia which implied that
the Chinese fortifications were becoming like the Depsang valley incursions,
which seemed ominous. After a couple of rounds of gargling, kaadhaa and
doodh-haldi, it became tolerable, and I continued with my modified daily
routine.
Interestingly,
I observed that my blood pressure, which otherwise was high, had now settled
down to 110-120/74-80, as I was not checking any emails or official
work/correspondence. This probably implies that our hectic working schedules
are the primary reason for elevated blood pressure
Post
lunch that day, my loose motions increased, probably exacerbated by the
additional doodh-haldi that I was taking. By night, it was pretty exhausting.
Discussions
with my treating team could not identify the main reason for this, as there
were far too many contenders. Finally, I pinned my hopes on ORS and Tab
Racecotdril, which had been added, and went to sleep with fingers crossed.
Fortunately, it seemed to be effective, as it calmed my gut, and allowed me the
luxury of third night of uninterrupted sleep. It was evident by now that my
fight with SARS Co-V2 was on two fronts, viz G I tract, and lymphoreticular
system.
Day
6
I woke
up to my first Sunday (Day-6) in the hospital, with the battle raging in my
pharynx/tonsils with sharp pain while swallowing. Immediately, I tried gargling
with betadine and warm saline to lessen the same, before continuing with my
daily routine.
I decided
to take a short walk in the adjacent courtyard which has a Peepal tree,
reminding me of sweet home. Our frame of mind more or less colours our
perception, and even the breakfast of bread, milk, eggs and corn flakes tasted
insipid and the entire process monotonous. My better half has always been
telling me that I have a streak of anxiety embedded in my personality, and
hence I cannot “let go” completely and relax. So, I decided to try this out and
junked the laptop and novel and watched videos/posts on my mobile phone, thanks
to WhatsApp University.
Lunch
was soup, khichdi, dal without salt, boiled vegetables, bread thanks to my loose
motions, and I wondered whether the treatment is worse than the malady!
A
siesta after lunch improved my state of mind, and I went about calling up
relatives to catch up. By evening, my loose motions seem to have settled down.
I continued with my third round of Pranayam, steam inhalation and gargling.
Surprisingly, by evening, I developed mild temperature, which gradually
increased to 99.6 F by night. It became a cause for concern. While going to
sleep, I was wondering if I had made the cardinal mistake of underestimating
the crafty virus?
Day
7
Woke
up fresh on Day-7, after sound sleep, albeit with throat pain and found myself
afebrile. Went for my daily routine, followed by breakfast of poha, a welcome
change from the routine. Being apprehensive of a resurgence of fever the
previous evening, I asked the resident doctors during their morning rounds
about the duration of fever. Found comfort in the statistics, which stated that
the median duration of fever was 10-12 days. After bathing, I developed fever
with sweating and was shocked to find it crossing 100F for the first time in 6
days, and decided to call up HoD Medicine to discuss and allay my fears. I must
admit that this unfortunate turn of events had unnerved me, and shaken my
confidence.
Post
lunch, I insisted on a repeat X-ray, which was carried out, and reported to be
normal, which to some extent, allayed my fears. Based on discussions with HoD
Medicine, it was decided to add the steroid Dexamethasone tablet orally, which
would also take care of my seronegative spondyloarthropathy (a type of
rheumatologic disorder that gave me aches and pains earlier too) symptoms.
I
took the it around 4 pm and waited for my fever to subside. These few hours
were emotionally and mentally draining, and I could not concentrate on either
Inner Engineering or Raag Darbari. However, Pranayam, Bhajans, WhatsApp
and social media were the only succour in this time of relative crisis. By
evening, my temperature had dropped a notch to 99.7 F, and by night to 99.4 F,
and I had reason to be happy.
However,
my day wasn't over yet, as I received information of my brother having fever
and cough at Keonjhar, with the factory being declared a “containment zone” due
to some workers testing positive. After discussing with family members and
friends, we decided to get them to AIIMS Bhubaneswar for testing and admission,
if required. I went to sleep around 11pm after a long and gruelling day and
prayed to Lord Jagannath for His divine blessings. I had disturbed sleep due to
my “turbo-charged” state, courtesy the steroid, and had to take Clonazepam to
fall asleep.
Day
8
I woke
up early on Day-8 to find my joint pains almost gone, I was afebrile, and the
pain in the throat had considerably reduced. Feeling fit and active, I went
ahead with my daily routine. All my investigations were repeated along with
Widal test and urine culture, in case of any lurking infection anywhere else.
On the advice of my colleagues, I also sent sample for my serum Interleukin-6
levels to gauge the impending cytokine storm (an aggressive inflammatory
response of the body’s disease fighting mechanism) which has been the main
cause of mortality in Covid.
After
breakfast, I caught up with family members regarding the impending trip from
Keonjhar to Bhubaneshwar. Dr.Arvind called up on video and informed that he had
discussed with HoD Medicine and it had been decided to continue Dexa for 5
days, followed by tapering.
However,
by evening these instructions had probably not been mentioned in the treatment
chart, hence not provided. A bit of prodding the residents did the trick, and
my chart was updated. However, my request to switch Dexa after breakfast, so as
to eliminate the use of Benzodiazepines for sleep was turned down which I had
to accept as a patient!
By
evening, I was relieved to find most of my reports, including interleukin-6,
were within the normal limits, and with renewed vigour, I coordinated the
admission of my brother at AIIMS Bhubaneswar. Also came to know that another of
my batchmates and his family had tested positive and had opted for home
isolation, even though his elderly parents stay with him. This worried me.
I
found my sore throat considerably diminished, and temperature after dinner was
99.3F which was tolerable. Went to sleep with the help of Mirtazepine as advised,
due to the previous night’s experience.
Day
9
I woke
up on Day-9 after a sound sleep, fresh, afebrile, and with hardly any sore
throat. I went about my daily routine. Dexamethaosne had succeeded in reducing
my symptoms considerably, and my ‘home stretch’ seemed to have begun.
After
breakfast, I got a call from HOD Medicine asking about my wellbeing, and
advising me to take Dexa after breakfast. I was tempted to inform him about my
discussion on same lines with the senior resident the day before, but chose to
keep quiet. I requested him to instruct the
residents to amend the treatment chart.
Interestingly,
when the Residents came for physical rounds during fore-noon, they were not
aware of this new development, but were happy to note my progress. On asking
about discharge protocols, they informed me that Dr. Arvind would be coming for
physical rounds that day, and I should discuss with him.
My
family members were to go for their final testing that day, and I coordinated that
remotely. My office staff called up to inform about some files which had
arrived, and change of Duty Roster from 1st August, hence I had to
sort them out by talking to concerned Faculty members. This was the first time
when I had done some office work after getting admitted.
Dr. Arvind
came for rounds, and we discussed about my reports which were normal, and he
informed that if no symptoms would be there for three continuous days, they
could consider discharge on Day11 or 12. He also advised subsequent home
isolation for 7 days with use of mask, social distancing, tapering of Dexa, and
to continue with my daily routine after discharge.
Post
lunch, I watched the second National Grand Round for about an hour, and found
it to be very informative, and well conducted by Prof. V.K. Paul and Prof.
Randeep Guleria. By the evening, got information that my family members had
tested negative through RT-PCR, which was great relief. Subsequently, I received information that my
brother’s family had tested positive, and hence had to co-ordinate for their
admission at AIIMS Bhubaneswar too.
Day
9 was coming to an end and I got some home cooked food for dinner, and relished
it. I hadn’t had home-cooked food since a while.
I
did not have fever throughout the day, and was looking forward for discharge in
a few days. With these happy thoughts, I fell asleep without any medication.
Day
10
I got
up early on day 10, after a sound sleep, was afebrile, had no sore throat and was
feeling fit and fine. I went about my daily routine, and increased strolling in
the courtyard to about 20 minutes. After breakfast, I received a call from
personal staff of some Hon’ble MP who had developed fever, and wanted to show
at AIIMS, New Delhi.
I
informed politely that I was on medical leave after testing positive for Covid-19,
and was surprised at his question as to how even at AIIMS faculty members are
getting infected, and how terrible the pandemic was. The SR who came for
physical rounds informed me that if everything was fine that day, being the
third consecutive symptom free day, they would discharge me the next day after the
morning rounds. One of our Residents called up to request me to go through his research
protocol, as it was the last day for submission. As I was feeling much better, I
went through his protocol on WhatsApp, and sent back my comments for incorporation
and submission, all thanks to digital technology.
After
lunch, I decided to discuss with my colleague about accidental transmission of
infection to family members during home isolation on Day 11, and sent him a
short summary of my course in hospital. He assuaged my fears, and said that
generally by the 11th day, the virus becomes un-replicable, and no
testing is required before discharge as per current guidelines.
I decided
to carry out literature search in this regard, and found some studies with
similar findings. I decided to check my emails and discovered, to my horror,
that my Google one 100 GB space subscription had expired on 24th
July, and my mail box was full with no space. I tried to renew the subscription
but could not succeed due to some technical error, and decided to keep it
pending for the time being.
Throughout
the evening and night, I did not have any symptoms, and continued with my daily
routine, and read few more chapters of Raag Darbaari which were
enjoyable. By evening, I came to know that my brother had developed breathing
problems and fever, and was being shifted to the Covid 19 ICU for better
management. I discussed with my friends at AIIMS Bhubaneswar regarding his
treatment and early recovery before going to sleep.
Day
11
I woke
up on Day 11, after a sound sleep, fresh, afebrile, with no symptoms and
completed my daily routine. Breakfast tasted monotonous, as my mind had already
decided about getting discharged. During morning rounds, the SR asked if I
wanted discharge today, or would like to stay one more day to start tapering
Dexa. When I asked him if in his experience, any patient had developed fever
with tapering of Dexa, he stated to the contrary. My discharge formalities were
completed, and I came back home post lunch in the same ambulance that had taken
me to the hospital.
The
confident salutes of security guards while I stepped out of the ambulance was
ample evidence of the lack of “stigma” for Covid-19 patients in the campus, and
the warm smiles of family members was my prize for home-coming.
Summing
up my Covid-19 experience
Summing
up my Covid-19 experience, I would like to focus on five important aspects for
early recovery of patients with mild/moderate symptoms:
1)
Get yourself tested early, and have a low
threshold for suspecting Covid-19 when you have symptoms, catching the disease
early is half the battle won.
2)
Once tested positive, decide regarding home
isolation or hospital admission as per convenience and resources available.
Hospital admission is preferable when age is more than 50, with co-morbidities,
but choose a hospital with ICU facilities just in case it is needed.
3)
Use the entire armamentarium of pharmacological (medicines)
and nonpharmacological means (pranayam/deep breathing exercises, steam
inhalation, awake proning for 3-4 hours/day) available to fight with the virus,
as both are complementary and have synergistic effect. Here, discipline is the key, and
under-estimating the virus or any laxity can have disastrous consequences. We
are still learning about the long-term complications this novel coronavirus can
cause!
4)
Take adequate rest, and sleep for at least 7-8
hours every day. Most of us tend to ignore this, and suffer the consequences.
If need be, discuss regarding use of anxiolytics/benzodiazepines with the
treating team.
5)
This fight is also at the mental level,
especially if admitted to a hospital. Hence, one has to be in a positive frame
of mind, keeping track of symptoms,
having open communication channels with the treating team, and being “involved”
in the care.
*******
