[vivek95]

Originally Posted by Kln

Just a request to the 'it's all fine' and 'look at the percentages, it's not that bad' people - everything is just a statistic till it hits home. Till a loved one dies. Till you don't get a bed for your family. Don't take this lightly, be doubly sensible, and take UTMOST precautions. The enemy isn't at your doorstep - it is inside your house. Stop trusting the official numbers. We as a country are running out of crematoriums, numbers be damned.

Being a Covid ICU Doctor, I would like to offer a solution which neither the Govt. nor the big tertiary
care hospitals would pay heed to. If we just implement a strict criteria of admission to hospitals for Covid-19 infected individuals , I bet you high this nation will see an overnight change in the availablity of ICU beds.

This rampant admissions of stable patients needs to be clamped down immediately in view of a pandemic. To hell with insurance companies and corporate tie ups

Originally Posted by carboy

Can someone recommend a decent & affordable brand & model oximeter for home use?

I would still recommend Dr. Trust brand. It was 4000 last year. Today the price on Amazon is 2499/-

- Dr. Vivek

[Thad E Ginathom]

Originally Posted by vivek95

... implement a strict criteria of admission to hospitals for Covid-19 infected individuals...

We may have our differences, but I do feel for you on this. It must be so frustrating to see these facilities, which could be life-saving, being taken up by people whose lives are nowhere near being in danger, nor are sick enough to need constant attention of medical staff.

[srishiva]

Originally Posted by Thad E Ginathom

We may have our differences, but I do feel for you on this. It must be so frustrating to see these facilities, which could be life-saving, being taken up by people whose lives are nowhere near being in danger, nor are sick enough to need constant attention of medical staff.

Agree, but then sometimes people want to make sure if something critical were to happen, they want to be in hospital. Its a peculiar situation which kind of all goes back to not having enough facilities

[ramzsys]

Bhpians

Off topic, but related to covid. For the sake of the mental health of everyone, I would suggest desisting from watching news in television. The dramatic graphics/background music/voice modulation of the anchors create quite a sensation of doom and panic.

And no, not trying to emulate the ostrich in sand. Paper and websites (worth paying to get rid of the ads) are much better. Paid 'IT team' from every faction organize trends so don't pay much heed to all the 'viral on twitter/social media'.

[poloman]

Originally Posted by ramzsys

Bhpians

Off topic, but related to covid. For the sake of the mental health of everyone, I would suggest desisting from watching news in television. The dramatic graphics/background music/voice modulation of the anchors create quite a sensation of doom and panic.

And no, not trying to emulate the ostrich in sand. Paper and websites (worth paying to get rid of the ads) are much better. Paid 'IT team' from every faction organize trends so don't pay much heed to all the 'viral on twitter/social media'.

Vulture politics over dead bodies have been started. They could not do this in phase 1 due to lockdown. If you watch these news channels or social media content your mental state will surely be affected.

Sit tight at home and hope for the best. Let us hope, the faster the infection rate goes up the faster it will come down.

[whitewing]

Originally Posted by vivek95

Being a Covid ICU Doctor, I would like to offer a solution which neither the Govt. nor the big tertiary
care hospitals would pay heed to. If we just implement a strict criteria of admission to hospitals for Covid-19 infected individuals , I bet you high this nation will see an overnight change in the availablity of ICU beds.

I know of cases where the near ones of some covid patients had to scramble for days to get an ICU bed with their SPO2 levels dropping dangerously. One sadly passed away after a desperate run about to different hospitals looking for a ICU bed with ventilator.
These people had corporate health coverage. If only they were swapped with the "stable" ones, lives could have been saved and that too at no loss to the hospitals.

If only the powers to be listen to people like you who are closer to the ground reality.

[Kln]

Originally Posted by vivek95

Being a Covid ICU Doctor, I would like to offer a solution which neither the Govt. nor the big tertiary
care hospitals would pay heed to. If we just implement a strict criteria of admission to hospitals for Covid-19 infected individuals , I bet you high this nation will see an overnight change in the availablity of ICU beds.

This rampant admissions of stable patients needs to be clamped down immediately in view of a pandemic. To hell with insurance companies and corporate tie ups




- Dr. Vivek

Our hospital does have strict admission guidelines. We admit only after triaging. It's not like each and every patient will get admitted. And this is the case with nearly all hospitals that I know of, due to dire shortage of beds.


On the other hand, plenty of stories from my colleagues, of ministers, babus, and their staff occupying 2-3 rooms together only to WFH - work from hospital - without masks and in stable condition. Such rooms could have easily accommodated 6-8 patients. Shame on them.

[Zen2001]

Originally Posted by hserus

Concentrators don’t work well for high flow needs right - beyond 6 litres.

And liquid oxygen is what is running out of stock due to covid load + for Delhi at least all the oxygen having to come from plants which are across a state border and the states are appropriating all oxygen in their borders for local use.

Note that huge corporate hospitals are running out not just small opd plus three or four beds type places.

O2 concentrators work for low flow requirements - 5L/min or so. Sufficient in wards, at home, but not for severely hypoxic cases and those on ventilation - however this fraction is less than 5% of total cases. The issue is more of mismanagement, reliance on external cylinders (that has been traditional), hype and politics.

Originally Posted by humyum

Population should panic because there is everything around that says you should panic, the center has raised its hands. Courts are stepping in to rap the government, High courts in different states are beating them down, hospitals are going to high courts begging for center to do something about oxygen and medicines what is there not to panic? They had a whole god damn year for capacity building, if they were caught napping and to add to that continue to do election prachar while people line up at crematoriums and hospitals, what is there not to panic?Why is there no money for us but money for all other frivolities like Central Vista, new parliament and even election rallies?
When they are not reporting the real numbers of infections and deaths, its only to save their skin, reputation and the next election, people dying are least of their worries or concern.

Do not panic. Doesn't help. 1% will die regardless - can do much to change that, but more will die of collateral damage - that can be at least minimised. Asking people to panic also is not the way to go.
Panic is important for politicians - it gives them the upper hand to control and manipulate; not for your benefit but theirs. Just remember when you vote next time.

Originally Posted by poloman

Increasing cases of doctors and hospital authorities crying on news media. Is this helping the fight in any way? Will this not create more panic and chaos? Why give out messages like 'oxygen available for half an hour' in media?

Not going to help. Reflects their lack of foresight, planning and judicious use of oxygen.

Originally Posted by Ankur@VNS

However, the earlier clinical guidance for management of covid-19, released on 7th April 2021, by Department of Medicine, AIIMS, New Delhi (version 1.6), had recommended remdesivir injection as antiviral therapy in moderate cases, which is to be admitted in the ward..

The recommendation even back then was "selectively use" , under "EUA" - not rampantly to everyone who gets admitted! Especially when worldwide trials concluded "no mortality benefit". In India, doctors who don't prescribe "trending" drugs are considered incompetent by the public. Got it?

Originally Posted by sachin2612

Need advice from past experience patients and professionals.
My oxygen level stays above 96. I have no cough or runny nose only symptoms are back pain and fever. Today is my 8th day of isolation. What should i do to reduce back pain ? Is ibrufen safe to take while taking dolo 650? And doc is advising remedisivir if fever continues tomorrow also.
Any advice would appreciated. Thanks in advance.

Do not take ibuprofen in addition to 650 paracetamol. Continue monitoring and save treatment. Follow up with your doctor - Remdesivir just for persistent fever without other symptoms/signs of concern is questionable.

Originally Posted by Thad E Ginathom

When I see SpO2 levels mentioned, under 93 is said to be dangerous, but should this not be adjusted for a person's individual "normal?" Mine is often only 95 anyway, so it wouldn't take much to fall to 93.
I'm supposing it is like temperature. Mine is a full F degree less than "normal" when I'm healthy, so when I see a temperature of 99, I compare it to 100 in textbook terms..

Take all readings with a pinch of salt. SpO2 of 85 could be normal for a COPD patient, 90 for a smoker or just with advancing age. Temp above 100 is generally considered "fever" or significant - in most viral illnesses, no medicines are prescribed of temp < 101°F

Originally Posted by Kln

Just a request to the 'it's all fine' and 'look at the percentages, it's not that bad' people - everything is just a statistic till it hits home. Till a loved one dies. Till you don't get a bed for your family. Don't take this lightly, be doubly sensible, and take UTMOST precautions. The enemy isn't at your doorstep - it is inside your house. Stop trusting the official numbers. We as a country are running out of crematoriums, numbers be damned.

Definitely, don't take it lightly and throw caution to the wind, but equally, dont believe everything that's shown in the media. Numbers are a reflection of our large population. That's why, as I mentioned in earlier posts, look for statistics that give you the population adjusted rates.

[drrajasaravanan]

Originally Posted by Thad E Ginathom

I'm imagining that this is concentration on an industrial scale.

The concentrator which is used in the patients room delivering continuous flow is different than the bigger equipment connected to the central supply which is fixed with an automated machine to switch to liquid oxygen after a particular limit. To be frank using a concentrator in hospital both industrial and portable makes much sense.

Originally Posted by hserus

And liquid oxygen is what is running out of stock due to covid load + for Delhi at least all the oxygen having to come from plants which are across a state border and the states are appropriating all oxygen in their borders for local use.
Note that huge corporate hospitals are running out not just small opd plus three or four beds type places.

Liquid oxygen for a tertiary care centre like mine which is not the biggest in chennai has 2 installations each of which lasts for a week. If it has not been done its the error of cost cutting. Large hospitals cannot rely only on single outlet and say we have only 30mins of oxygen left. I don't want to name any organization but these people had a timeline to prepare and had precedence for a whole year to reset and be prepared but did not.

Originally Posted by sachin2612

6. My oxygen level stays above 96. I have no cough or runny nose only symptoms are back pain and fever. Today is my 8th day of isolation. What should i do to reduce back pain ? Is ibrufen safe to take while taking dolo 650? And doc is advising remedisivir if fever continues tomorrow also.

Any advice would appreciated. Thanks in advance.

Note : i am 25 years old with mild obesity.

Hi,
Remdesvir is not recommended in your case. Paracetamol dosage can be increased to 1gm and you can take safely up to 4 to 6gms per day. Avoid NSAID if possible.

Originally Posted by Ankur@VNS

Joint National task force with All India Institute of Medical Sciences (AIIMS) New Delhi and Indian Council for Medical Research, working under the Ministry of Health and Family Welfare, Government of India, has come up with revised clinical guidance for management of adult covid-19 patient on 22nd April 2021.

It is pertinent to note that, they have omitted to recommend the Remdesivir injection, except only in specific circumstances.
).

Finally they have come around to it. When studies showed less than 4% improvement only in moderate cases people are in panic mode to stock this all over in India. Appreciate for sharing this.

[Indian2003]

Originally Posted by carboy

Can someone recommend a decent & affordable brand & model oximeter for home use?

I dont think you should think too much about brands. I have a cheap one I bought from Aliexpress and an expensive one I bought from the Prince Court 5 star hospital in Kuala Lumpur in Malaysia. This one uses 2 AAA batteries.

Both of them give the same readings. I took one with me to hospital with me and the readings were the same as the one connected to me at the hospital.

I have COPD and have been monitoring my oxygen levels since 2009. Today I am at 96%. Yesterday at 98.

[drrajasaravanan]

Originally Posted by vivek95

Being a Covid ICU Doctor, I would like to offer a solution which neither the Govt. nor the big tertiary
care hospitals would pay heed to. If we just implement a strict criteria of admission to hospitals for Covid-19 infected individuals , I bet you high this nation will see an overnight change in the availablity of ICU beds.
This rampant admissions of stable patients needs to be clamped down immediately in view of a pandemic. To hell with insurance companies and corporate tie ups
- Dr. Vivek

Hi,
Absolutely on dot. One of an established hospital in chennai triages and decides. I know personally they have sent a patient who is very high up in govt back home refusing admission and remdesvir with home care support for peace of mind. At least my organisation is very rationale in admission and discharges and understands the limitation of overriding safety concerns. I just wish the situation improves fast but looks like we are in this mire for another couple of months.In my extended circle I am yet to come across a situation where a very sick person has been denied bed while I know of such cases in North.

[jacobsam]

I hope that I am not asking answers to the questions answer before.

1. Is it advisable as precautionary to get oxygen concentrators at home?

2. What should be the criteria of selection since its some thing that would used in future?

3. Brands and types that should be preferred.

Looking forward to the guidance from doctors and medical equipment experts.

With prayer and hope that the situation improves quickly and we don't use our loved ones to this damn disease.

[Ankur@VNS]

There is chaos and mayhem in the streets which could have been minimised, had the govts and administration been prepared in advance with appropriate blueprints for SOPs, resources & required medical infrastructure. (Beds, ICUs, onsite oxygen plants & medicines). Onset of second wave of SARS-CoV-2 (thanks to various mutant strains), exposed our complacency in every aspects and we are paying dear price for that.

In critical situations like ongoing national health emergency, oxygen is the most critical shortage needed to help patients alive. Its absence has led to widespread political blame game of diversion & stoppage of its logistical supply chain at inter states borders. Even hospitals have to file petitions before Delhi High Court for intervention and even beg for it. When someone dies because of lack of oxygen, it is not a death during pandemic but murder by sheer negligence of lethargy and incompetence of governance.

One senior Doctor aptly quipped, "Sorry, but we weren't trained for oxygen politics in medical school. Only how to save lives."

Part of burden also shifts to the "fire fighting attitude" of our policy makers, who are caught off the gaurd, not only in anticipating deadly 2nd wave, but also, with their inadequate contingency plans to deal with it.

Meanwhile, from november (2020) to march (2021), strict implementation of covid appropriate behaviour in public places, was conspicuous by its absence ; be it in marriages or mass public gatherings during elections or during religious gatherings (Magh mela in January & Kumbh mela in April).

It shows that we have a tendency to make premature pronouncement of victory over any challenge that we desire to solve. We get tired very quickly. Within 15-20 days, India is worstly hit and just reported the world's largest single day spike, with more than 3,00,000 corona positive cases. (Please see the graphs for the reference and perspective)

I just hope, in critical areas like health care infrastructure, such 'trial and error model' of governance, needs to be replaced with comprehensive action plan and its strict execution. For this, expert persons with domain knowledge must be the incharge instead of career bureaucrats & politicians.

In the nut shell, this crisis is the bitter reminder that our system of governance is worthless during time when we need them the most. So, just hope for the best and be prepared for the worst.

[drrajasaravanan]

Originally Posted by jacobsam

I hope that I am not asking answers to the questions answer before.

1. Is it advisable as precautionary to get oxygen concentrators at home?

2. What should be the criteria of selection since its some thing that would used in future?

3. Brands and types that should be preferred.

Looking forward to the guidance from doctors and medical equipment experts.

With prayer and hope that the situation improves quickly and we don't use our loved ones to this damn disease.

Hi,
There is no two ways to answer your questions. If I am in your shoes i will consider if I have people in my family with multiple comorbidities which puts them in high risk of poor outcome,should they get COVID and the health infrastructure in my city or town can't support or can't be accessed, reliable support system is not in place and your place is in the red zone I would consider. Or else you will be denying access for a potential patient in need of the same. In my city till now we can rent which is easier or buy outright portable oxygen concentrators for weeks or months and though I have at risk conditions at home, I will not as I have access and support system in place. Hope I have not confused you.

[jayguar]

Even after taking ample precautions, I've got Covid positive. I have fever for a week, just fever. Cough comes just before fever and when fever reaches a high, cough goes off. No other symptoms. Last couple of days, the frequency of fever kept increasing even after taking medicines. Yesterday, confirmed through scan, it's positive. I was told it's between moderate and severe.