Excerpts from my Covid-19 diary…
Dr. Sidhartha Satpathy (guest blogger)
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.
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