KUCHING: There is a need for the Ministry of Health (MoH) to review Covid-19 home quarantine and self-monitoring guidelines, says a private medical practitioner.
Dr Boo Cheng Hau pointed out that MoH should refer to the United Kingdom’s National Health Service guidelines and incorporate tachycardia or bradycardia as a criterion for Covid-19 patients to be admitted based on the latest clinical studies.
Tachycardia is defined as heart rate that exceeds the normal resting rate and in general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults.
Bradycardia refers to a condition typically defined wherein an individual has a resting heart rate of under 60 beats per minute in adults.
“The Covid-19 Assessment Centre may have missed certain cases that need early intervention because this early sign of ‘happy hypoxia’ is not being brought to attention,” he explained in a social media post.
UNDERSTANDING ANTIGEN RAPID (RTK) AND POLYMERASE CHAIN REACTION (PCR) TESTS
Dr Boo said none of the RTK and PCR tests were 100 per cent accurate so there was a need to repeat the test.
“The accuracy of RTK test on average is between 80 and 90 per cent, but if the result is positive then its accuracy is almost 100 per cent.
“Public health authorities would be notified and you must be quarantined immediately. However, if the result is negative, you still have to be monitored closely and the test is repeated depending on your exposure risks.
“In Malaysia, 89 per cent of Covid-19 positive persons are asymptomatic or pre-symptomatic at the time of testing.”
On conducting home saliva tests, Dr Boo stated that it must be carried out with caution and in seclusion to avoid spread of infected droplets to other family members.
“The test must be repeated frequently even if the result is negative. If the result is positive, you must inform your private general practitioner (GP) or public health authorities.
“If you belong to high-risk groups or having any suspicious symptoms, you may need to repeat testing frequently given that all types of tests are not 100 per cent accurate.
“In some cases, there may be positive findings on chest X-ray or computed tomography scan despite repeated negative test results.”
Dr Boo said new variants of Covid-19 could have an incubation period as long as 21 days.
“Thus, home quarantine for 21 days is recommended unless a PCR is done at Day 14 of quarantine, it shows negative or positive results with CT values of 35 and above which indicates non-infectivity.
“Many patients who have recovered from the acute phase would go on to have ‘long Covid’ or post-acute Covid syndrome. This includes incidences of blood clotting increase such as coronary heart disease, stroke, and deep vein thrombosis among others.
“Therefore, a continuous monitoring of various organ functions by doctors may need to continue for further six months.”
Guardian Australia recently reported that the Delta variant’s particles could linger in the air in aerosolised form for up to 16 hours, which means ventilation is vital.
Prof Raina Macintyre, an epidemiologist, stated that people were still stuck in the mindset of hand sanitizer and washing of hands.
“The actual message that we need to be getting out there is it’s the air you breathe. In an indoor space where ventilation is not adequate, somebody with the infection could have come and gone, but the virus is still lingering in the air.
“So, if you walk through that area and you breathe that air, you could get infected. If you’re having people over, open the window.
“If you’re driving in a car with people, open the window even a little and wear masks. It’s the shared air that matters the most.”
After testing positive, Dr Boo said undergoing home quarantine and isolation from family members and the public was crucial.
He advised that the individual stay in a bedroom that has a bathroom and to always wear double masks except while eating, drinking or bathing.
“You must separate your food, drinks and cutleries from your family as well as remind them to wash their hands frequently.
“Your house must be well ventilated with windows opened. It is also necessary to clean all furniture surfaces, doorknobs, and contact surfaces with normal detergent with a few drops of bleach diluted in clean water.
“All of your linens have to be washed with normal detergent and bleach which then must be dried under the sunlight.”
He noted that anyone confirmed positive with existing chronic illnesses such as hypertension, diabetes mellitus, high cholesterol, heart disease, kidney failure, cancer, obesity, and more than 60 years old would usually be admitted to hospital for treatment as soon as possible even though without any severe symptoms.
Dr Boo warned about the ‘silent or happy hypoxia’ which often leave patients feeling comfortable even though their blood oxygen is below the critical level.
He said the British Medical Journal dated last Oct 27 reported that the death rate of patients was 13 per cent when the blood oxygen level dropped to 93 to 94 per cent while the death rate was 28 per cent when the oxygen level dropped below 93 per cent.
Thus, he noted that a pulse oximeter would be useful for the purpose of self-monitoring and often available in pharmacies.
“The normal blood oxygen level is 95 to 100 per cent. If it is 94 per cent and below, immediate medical attention is needed.
“It is simple to use, all you have to do is insert an index finger or the middle finger into the pulse oximeter and make sure that the sensor’s red light is shining through the nail bed.
“For infants, you may use the big toe for readings. It is important to record all readings, including the blood oxygen level, pulse rate, time, and date as well as any uncomfortable symptoms. You are advised to monitor the blood oxygen level at least three times a day.”
Dr Boo stated that a simple stress test could be conducted once a day to compare the blood oxygen levels and pulse rates before and after doing mild exercise.
He said the mild stress test was to simply sit on a chair then stand up, this should be repeated for one minute.
“If the blood level drops more than three per cent after exercise, it shows the lung function is compromised and you need immediate medical attention.
“If the blood oxygen level remains the same after exercise, but the pulse rate is more than 100 or less than 60 per minute at rest, immediate medical attention is needed.
“You should also seek immediate medical attention if the pulse or heart rate beeps sound irregular.”
He noted that irregular, be it too fast or too slow, heart or pulse rate showed the possibility that the heart tissues or the cardias sinus node might be infected by the virus itself.
He added that low blood oxygen level due to lung infection could also cause irregular or abnormal heart rate.
“You need to measure blood pressure and body temperature regularly too as persistent high or low blood pressure and/or body temperature also require medical attention.”
IDENTIFYING SEVERE SYMPTOMS
The coronavirus is known to have the ability to attack any bodily organs besides the lungs.
Dr Boo said those who experienced severe symptoms like difficulty in breathing or speaking must call 999 for ambulance, hospital hotlines or private GP.
Other severe symptoms included rapid breathing rates per minute and fever or chills continuously for more than two days.
“Moreover, poor appetite, persistent vomiting, diarrhea and repeated tummy ache indicate that the virus could infect the guts too. If you experience chest pain, the infection increases the risk of blood clots in the heart blood vessels and hence coronary heart disease.
“This could infect the heart tissues itself too. Acute kidney may account for these symptoms such as very little urine output, dehydration with dry skin and mouth as well as feeling weak and tired.
“Blood-stained phlegm or brownish, yellowish or greenish color phlegm may indicate secondary bacterial or even fungal infection.”
He added that feeling difficulty in breathing, gasping for breath or wheezes even upon mild exertion are also some of the symptoms.
He noted that excessive clotting and bleeding problems could happen with grave complications.
“Excessive clotting could also lead to pain and/or swelling of calf on usually one-sided leg or deep vein thrombosis.
“The brain or nerve fibers could be infected by the virus or associated inflammation of these tissues if the individual experience confused mental status, severe headache, numbness in any parts of the body, loss of taste or smell sensation and weakness in breathing.”
PROCEDURE FOR TAKING SERIOUSLY ILL PATIENTS TO THE EMERGENCY DEPARTMENT
Dr Boo said there were precautions that must be taken by family members who might have to take seriously ill patients to the hospital emergency department.
“Besides the driver, only one more family member is allowed to accompany by taking the front seat. The patient should be seated alone at the back of the passenger seat and all passengers should put on two masks each.
“All of the car windows must be rolled down five to 10cm or two to four inches to allow good ventilation in the car while maintaining certain height of the window glass up to avoid any hard flying objects hurting any passenger during the journey.”
He also reminded that all contact surfaces in the car must be cleaned with detergent thoroughly after having sent the patient to hospital.