Serological antibody testing done on a patient suspected to have severe symptoms of CoViD19 disease. And was medically managed at home…
Introduction:
It is a known and accepted fact that CoViD19 patient/s with severe symptoms and those with critical illness had a high rate of in-hospital mortality and nobody can refute that, as provided by real world data, even patient/s that presented and displayed mild to moderate signs and symptoms of CoViD19 disease unexpectedly worsens and progressed to severe and critical illness in a short period of time which overwhelmed our healthcare industry and occupying the hospital’s intensive care units more than its maximum capacity and unable to function effectively to save patients lives.
The novel coronavirus spread globally which infects miilions and cause the deaths of people by the hundreds of thousands since December of 2019 in Hubei province Wuhan China, and many countries all over the world together with their respective health offices designed preventive protocols and strategies to curbed, stopped or decreased the novel coronavirus spread but to no avail…until now the cases continue to rise in an unprecedented scale. During the early months of the pandemic, the novel coronavirus disease ravaged the the old population with chronic illness or illnesses but 2 to 3 months ago, the novel coronavirus affected and put so much burden on the younger age group although the morbidity and mortality rate was low as shown by local and foreign CoviD19 registry. Many of the Covid19 cases now are in the asymptomatic group and there are a portion with mild to moderate CoViD19 disease…then a few with severe to critical illness.
And usually starting from those person/s with moderate signs and symptoms of CoviD19 disease warrants admission, especially if the patient/s is/are having chronic longstanding disease/s and or comorbidities such as old age, hyperglycemia or uncontrolled diabetes, uncontrolled hypertension, bronchial asthma, chronic kidney disease, liver disease, end stage renal disease (ESRD) in dialysis, cardiovascular disease, immunocompromise and immunosuppress persons, and obesity etc.
And person/s who are having CoViD19 severe disease and critical illness are immediately referred and admitted in a healthcare facility with adequate capability and is well adept enough in managing contagious diseases such as CoViD. CoViD19 positive person/s with mild sign/s and symptom/s and without symptoms are also isolated, quarantined and monitored for disease activity and progression in an assigned quarantine facility or place of confinement. But there are times or instances that a patient with signs and symptoms of anosmia( loss sense of smell ), ageusia( loss sense of taste ), associated with on and off fever, cough and occasional difficulty of breathing for almost seven to ten days was denied/refused of admission by a healthcare facility or hospital due to the above presentation of her disease. And this is her story…
On August 1, 2020, a 74 y.o. old woman was preparing for her daily morning routine activity of selling ” kakanin ” or foods in the neighborhood and after all the foods was sold, she immediately went straight for home. Then at home she felt occasional body malaise, dizziness, chilly sensation and easily gets tired of which… it was all attributed to old age and all in the days work. In the morning, a day before August 1, 2020 her nephew and niece arrived from Manila City and was quarantined for fourteen days since thay are labelled as locally stranded individual or as LSI’s, both underwent serological antibody testing for Sars CoV-2 last August 7, 2020. The niece turned positive for IgG and the nephew turned out negative for the serological antibody test. Then last August 10, 2020 her daughter a policewoman assigned as a local contract tracer for CoViD19 inter -agency task force beginning to felt gradual loss of sense of taste and loss of smell sensation associated with flu-like symptoms, body rashes with itchiness and throat discomfort with epigastric pain. The policewoman sought consult in a government run rural health clinic and was prescribed or given oral medications to a certain number of days which offered relief as claimed.
Approximately seven to ten days prior to the consultation the 74 y.o. woman felt unwell. the dizziness and body malaise with tiredness worsens associated with fever and chills, occasional cough, loss sense of smell and taste with poor appetite accompanied with bouts of difficulty of breathing was also observed, which prompted the patient to sought for consultation to her physician of choice. She wanted to be admitted in the same hospital of choice but was denied and refused as claimed. Then she was sent home that very same day, still with the above symptoms and occasional difficulty of breathing with chest tightness keeps on bothering her even at rest.
So the family contacted a local physician the next day ( August 22, 2020 ) to manage her medically at the comfort of her abode. At home when the local physician saw the patient, the advised was she must be admitted to a local hospital for immediate proper, adequate, quality medical care but she refused to be admitted in a local hospital due to lack of trust and confidence, likewise the local hospital also refused to admit her. And referral to other nearest hospital in the province or city was also refused by her due to a more than two to four hours travel from her place to the province or city respectively. So the best option of her doctor was, she will be managed at home.
The first or initial home visit and checked-up of the patient by her doctor. She was still up and about in this picture.
The patient’s initial or first visit vital signs ( V/S ):
Blood pressure =130/80mmhg, Cardiac rate =72bpm, Respiratory rate = 24-26cpm, Temperature =36.5 degree celsius.
Initial physical examination ( P.E. ) revealed…patient was acyanotic in mild cardiopulmonary distress, afebrile.
Cardiac P.E.: Adynamic precordium, regular cardiac rhythm, non-accentuated S2, no murmur noted.
Pulmonary P.E.: Symmetrical chest expansion, harsh breath sounds, bibasal crackles with decrease breath sounds, vocal and tactile fremitus right lower lung base, no wheeze noted.
Gastrointestinal P.E.: non-distended, normoactive bowel sounds, flabby. non-tender on deep palpation.
Upper and Lower Extremities P.E.: no rashes, hematoma, hyperpigmentation or discoloration, no clubbing or swelliing/edema noted.
Laboratories:
A ) Initial Chest X-ray ( CXR ) revealed cardiomegaly or enlarged cardiac shadow, pneumonia both lung base,
atherosclerotic aorta and minimal pleural effusion VS. Thickening right lung.
B) Complete Blood Count ( CBC ): Hemoglobin= 108 mg/L, hematocrit= 0.32vol/l, within normal white blood cell count including platelet count, and lymphocytes ( 17% ).
C) ECG/EKG= within normal limit.
The treatment plan of her doctor that day in August 22, 2020, the day of her checked-up :
1) Started her with intravenous fluids at a rate of one liter per day.
2) Intravenous antibiotic plus one oral antibiotic.
3) Plan of giving Oxygen inhalation if available.
4) Intravenous paracetamol every 4 hours-as needed and intravenous sodium bicarbonate if also needed.
5) Oral antihypertensive tablet since the patient is hypertensive.
6) Probiotic supplements.
7) Oral steroids.
8) Oral statin plus antiplatelet combination tablet.
9) Oral melatonin tablet.
10) Off-label used and giving of oral and injectable form of repurposed drug for CoViD19.
11) Patient was keep on an isolation room with good ventilation and one permanent responsible companion. Physical distancing at 2 meters must be maintain. The companion may stay near the patient within less than 2 meters but not more or longer than fifteen minutes duration during nursing care with wearing of proper personal protective equipment.
12) Proper hand washing, strict wearing of face mask and face shield, off limits to visitor/s temporarily,
13) Acetylcisteine powder or sachet.
14) Although not allowed by her doctor, occasional salbutamol nebulization per patient request because it help or offer relief as claimed by the patient…
Home admission daily treatment history:
August 23, 2020 ( day 1 of home medical treatment ):
The patient was having moderate grade intermittent fever with chills associated with cough and having difficulty of breathing with chest pain and having occasional slightly bluish discoloration of the lips with cold perspiration.
Vital Signs ( V/S): Blood Pressure=140/90mmhg Cardiac Rate=119bpm Respiratory Rate=26 to 34cpm
Temperature= 38.8 degrees celsius
Pertinent Physical Examination findings: Patient was slightly cyanotic, in moderate to severe cardiopulmonary distress, febrile
Head and Neck: Anicteric sclerae, no neck vein engorgement
Lungs: Symmetrical chest expansion, harsh breath sounds, bibasal lung crackles with slightly decrease breath sounds of the right lower lung base, no wheezing noted.
Cardiac: Tachycardic, no murmur or S3 gallop noted.
Abdomen: Non-distended, normoactive bowel sounds, soft, no direct tenderness on deep palpation on all quadrants.
Lower Extremities: No rashes or discoloration and swelling or edema noted.
Random Blood Sugar= 108mg/dl
Treatment was instituted and applied to the patient by her doctor and relief was observed except for occasional bouts of mild difficulty of breathing.
August 24, 2020 ( day 2 of home medical treatment ):
In the morning:
Dexamethasone tablet and injectable forms save lives in severe and critically ill CoViD19 patients admitted in the hospital.
Another episode of difficulty of breathing associated with cough and fever, then additional medical treatment was applied by her doctor and it offered temporary relief, then oral steroid was shifted to intravenous steroid ( dexamethasone ) and loading dose was given as soon as the medication was available with additional off-label used of available oral and repurposed injectable medication for CoViD19.
Vital Signs ( V/S ): Blood Pressure=160/90-130/90mmhg Cardiac Rate=122-114bpm Respiratory Rate:36-26cpm
Temperature: 38.9 degrees celsius to 36.8 degrees celsius
Significant Physical Examination Findings: Patient was having episodes/bouts of cyanosis, restless, in moderate to severe cardiopulmonary distress, febrile but oriented and able to conversed.
Head and Neck: Anicteric sclerae, cyanotic lips, no neck vein engorgement
Cardiac: Tachycardic, no murmur and S3 gallop noted
Lungs: Symmetrical chest expansion, harsh breath sounds, bibasal crakles with slightly decrease breath sounds,
decrease vocal and tactile fremitus of the right lung basal area, no wheeze noted.
Upper and Lower Extremities: no rashes or discoloration and swelling or edema noted.
Note: Oxygen inhalation not started including pulse oximeter due to unavailability in the area during that time. And
treatment was given and offered temporary relief.
In the afternoon:
The patient’s situation suddenly worsened, recurrence of severe difficulty of breathing associated with deep bluish discoloration of the lips, cold clammy sweats, with fever and episodes of near syncope or near loss of consciousness was observed. The patient was in a sitting position beside the table, held and supported by her companion to prevent her from falling. Patient was delirious and in severe cardiopulmonary distress.
Vital Signs ( V/S ): Blood pressure=160/100-130/80mmhg Cardiac Rate=142-112bpm Respiratory Rate=42-32cpm
Temperature=38.2 degrees celsius, Initial oxygen saturation=67 to 89% with HFNC at 6 liters of
oxygen. HFNC or High flow nasal cannula.
Significant Physical Examination Findings:
Head and Neck: Deep cyanotic lips, with neck vein engorgement at sitting position.
Cardiac: Tachycardic, no murmur noted.
Lungs: harsh breath sounds, fine crackles upper lung fields, course crackles middle to basal areas ( both lungs ), decrease breath sounds right lung base area, no wheezing noted.
Upper and Lower Extremities: no discoloration or swelling or edema noted.
Emergency Treatment or Therapy was given to the patient by her physician and relief was observed. The Department of Health representative performed a rapid serological test to her and revealed positive for IgM and IgG antibodies for SARS-CoV-2.The patient was constantly monitored by real time video from home by her physician.
August 25, 2020 ( day 3 of home medical treatment ):
Patient coughed out rusty-orange color early morning sputum for 3 episodes. August 25, 2020
The whole day was unremarkable and no worsening of symptoms except for two to three episodes of scanty hemoptysis.
She was awake but weak and able to sit in the bed with assistance and ate her breakfast.
Vital Signs ( V/S ): Blood Pressure=130/80mmhg Cardiac Rate=92bpm Respiratory Rate=26-28cpm
Temperature=36,9 degrees celsius Oxygen Saturation at 90-92% with HFNC at 6 t0 8 liters of oxygen.
Significant Physical Examination Findings:
Head and Neck: anicteric sclerae, acyanotic lips, no neck vein engorgement
Cardiac: Adynamic precordium, regular rhythm, no murmur, no S2, non-tachycardic
Lungs: Symmetrical chest expansion, bibasal crackles, decrease breath sounds right lung base, no wheeze noted.
Abdominal: non-distended, normoactive bowel sounds, no direct tenderness on deep palpation.
Upper and Lower Extremities: grade 2 bipedal pitting edema
August 26, 2020 ( day 4 to day 9 of home medical ):
The patient was on her fourth day home medical management still attached to oxygen inhalation.
The doctor examined her at home. The patient was awaked and alert, able to stand alone without assistance and was able to render a smile. The patient’s condition was improving daily.
Then in the succeeding days…no subjective complaints was observed by her attending physician. She was gradually weaned-off from her oxygen inhalation and then finally discontinued and stopped.
The patient was seen reading the holy scriptures during her convalescence period from CoViD19 disease.
The patient had good sleep and with good appetite and was able to read her bible at the bedside and attended virtual mass that was offered in the internet. As the days passed by, she recovered fast and can walked around her room and to the toilet without being helped, until such time that… when her physician visited and checked her that day, all the vital signs are within normal range.
.
The patient’s pulse oximeter registered at 95% oxygen saturation with 62 bpm pulse rate, while breathing normal room air.
The oxygen saturation level was 95% at ambient air or patient breathing normal room air with no abnormal
physical findings are observed. The patient was…Going To ” The ROAD Of Recovery !!! ” …
and on August 31, 2020 ( day 10 ), she was discharged by her doctor very much improved. And was only given oral medications for another 7 days to take by her doctor, she was then adviced to have another clinic visit or check-up after one week.
This is the second serological test taken from the patient last September 1, 2020.
Conclusion:
The ongoing rampage of the novel coronavirus around the globe which infects millions, kills hundreds of thousands, cripples the economy of so many countries, creates havoc and stigmas to those who survives, and likewise distabilized the unprepared healthcare industry in every country it affects. The true story of that old woman who was denied and refused of proper medical care as claimed by her, was a clear example of CoViD19’s devastating effect to the healthcare industry. The politically clouded healthcare industry was overwhelmed with so many patients infected with the novel coronavirus and sometimes patient/s can’t receive adequate medical attention and care due to the forever changing mind-boggling CoViD19 directives, policies and regulations that can’t easily be understand and comprehend by the laymen…was this case an example of disparity that happened in some countries? The good thing is that there was that good hearted doctor that risked his life and managed her medically at home…her case was a classic example of a CoViD19 patient that initially exhibited a mild to moderate symptoms and then progressed to severe form of CoViD19 disease. The severe form of CoViD19 as mentioned by experts roughly involved 14 percent of the population infected by the novel coronavirus and the chance of progressing to mortality and death is very high even in the most advance and well-equipped hospitals in the world. The use of lifesaving strategies and available repurposed drugs and medicine/s for treatment in CoViD19 patients must be individualize and clearly discuss by the physician in-charge to his or her patient/s. Since the novel coronavirus disease has no definite treatment as of the moment…it is very important that best practical home preventive tips and measures be followed and instituted at home in order not to be infected with the novel coronavirus. My question is…Can CoViD19 patient/s with severe symptoms be manage at home?. And I think she was very lucky enough to survived…in GOD’s guidance and grace!
By the way, the good doctor that accepted her and managed her medically at the comfort of her home is no other than…………………… your humble servant in health…
the author of this article…
Yours truly,
Laertes B. Amihan MD
Thanks so much for sharing a beautiful, informative article with us. The principal element of this article is CoViD19-home medical management. It’s really amazing that you covered this subject so well in your post. I have learned a lot from reading your post and gained a lot of knowledge about it. Just as everyone is at risk for the effects of the virus, so is the medical system. In this case, the only way to deal with this situation is to come up with heart doctors, otherwise the consequences would have been direr. This situation has also happened in our country as a result of which those who have been able to get treatment have been able to do so while the rest are being affected due to lack of treatment
Your most welcome Md Asraful…and yes…many had died because other patients was not treated properly due to the fact that severe and critically ill Covid19 patients can’t avail proper medical care…since many health care institution are overwhelmed with so many patients beyond their maximum capacity and added to that is the lack of medical supplies that is needed to support life…such as ventilators, PPE’s, oxygen inhalators, ECMO machines…etc. ..the used of cheap locally available drugs for the novel coronavirus can offer a lot of help to our patients with the disease as long as it must be adequately and timely given. Since definite treatment and vaccine for CoviD19 is a long way to go. Thank you and Keep safe always Md Asraful!
Thank you for your post. I learnt a lot about COVID-19 on your post. It’s very useful and informative, to let people know how COVID-19 is horrible. This super virus is very dangerous, because it happened in where I live as well, a lot of people died and because they didn’t realize how it spreads around. One of the reasons is, World Trade Organization released the information way too late, some countries could prepare and let public know how to prevent it in advance, but failed and this virus spreads around almost worldwide at the end. Stay Safe and you did a good job!
In my article …I clearly stated my interesting experienced of how a documented covid19 patient with severe symptoms survived whilst being medically managed at home since ideally it must be managed in the hospital’s ICU but that particular patient was denied such hospital accommodation due to the dreaded disease so was medically managed by me personally and as a doctor it is my obligation to attend to the sick and the needy. She was now very much improved and well, actually she just rendered a clinic visit just yesterday ( Sept. 9, 2020 ) after her 10 day severe covid19 disease ordeal. She was the first case of a patient with a documented severe symptoms of CoViD19 disease ( IgM and IgG positive) who was medically managed at home and survivied in our place, Thank you for the reading.
It’s very thoughtful of you to share this article here, it’s very true that coronavirus is affecting most part of the world and a lot of lives are being endangered everyday. I like the approach of home care, but what really makes it kinda not so advisable is how dangerous it can be too exposing some others to it. Thanks for sharing
Yes it is very true that it is dangerous and managing severe covid19 patient at home is very toxic and entails a lot of hard work and extreme care. As a doctor by profession, there are a lot of practical technique to be use or applied in order to decrease exposure and transmission of the virus if patient with covid19 disease be managed at home. Just connect with me and if you are interested then I can share it to you, Kindly share the article to others because it can offer help. Thank you! and keep safe always!
Hello Laertes,
Thanks for sharing such wonderful article with so much to benefit for everyone who comes across it anywhere in the world. The covid19 have been of so much damage to the world at large and learning some of the basics of it would be very helpful. I appreciate the information in this article and I am pleased to be here. I’ll love to share with my friends as well.
Please share it because it can offer help to others. thank you…and keep safe always!
Hello there! Thank you very much for sharing this article on Covid 19 severe home care. I’ve gone through it and it’s a really helpful article. I like the fact that you let the people know of how this virus is dangerous. It affected lots of persons close to me and only a few survived and it’s spread was very fast. A lot of persons didn’t know about it early enough. I’m glad you shared this article, let people know more about it. Thank you very much.
Yes Sophie kindly share it to others because it is very helpful…severe Covid19 patients can be managed iat home and have a big chance to survive if properly and timely treated . thank you Sophie!
I have to say that for me being treated at home is always then going to the hospital. Because there is a certain comfort of being your loved ones, even if in the case of covid you do not get to be physically close to each other.
In many countries, we have seen doctors using their phones to get covid patient’s sick ones to speak with their loved ones. Because it is important to have the presence of such people around you to get heal.
I am very impressed by the details you have provided here. And I am glad that your patient was able to improve daily until total remission.
Thanks for sharing!
I do agree with you that a big chance to heal faster if your love one/s is/are beside you and giving their corresponding support. Thank you for reading and the support. keep safe always!
Thnaks for writing this educating and instructive article on home treatment for a patient with severe Covid-19 case. I, for one, has really learnt more about Covid-19, especially for a severe case, from reading this article. I only hear about severe Covid-19 cases on the news and health reports programmes, not knowing what is feels or looks like. But haven read this article, I have gained the exposure of knowing more about severe cases of Covid-19 and the administered treatments.
Yes Kelvin, it is very true that severe covid19 patients can be managed at home…the strategy is to limit patients in going to the hospital in order not to overwhelm the hospital’s capacity to the maximum level.
Please share the article to others.
Hi,
From my research online the home care for covid-19 patient is to help the person who is sick follow their doctor’s instructions for care and medicine, see if over the counter medicines for fever help the person feel better, make sure the person who is sick drinks a lot of fluids and rests, help them with grocery shopping, filling prescriptions, and getting other items they may need, consider having the items delivered through a delivery service
Thank you.
Aluko.
Hi Aluko…this is a case of severe covid19 patient that was successfully managed at home and not in the hospital remember that this particular patient should be admitted in the hospital but was refused or was not accepted by some hospitals because of the stigma of covid19 disease. Being a doctor…I accepted to managed her at home and we are successful in doing so Aluko, maybe what your talking is a patient with mild covid19 disease that is manage at home. Please try to read again my article. Thanks!
Your article is very detailed and very technical. I learnt quite a lot about covid-19 home based care. This vrus has caused havoc all over the world. Countries have gone into several lockdowns trying to contain the virus. Healthcare systems have failed to cope and those that survive are stigmatised by their families and community. The solution can only be a vaccine or a cure. I hope one will be found soon.
Yes energy it is technical because it is the way it should be from a doctor’s standpoint. Kindly share it to others because it can offer help Energy Kadango. It was a first case of severe covid19 patient that was successfully managed at home. Thank you energy Kadango!