COVID19 - CheatSheet To Fight Corona Well

This is based on the detailed post available here and lessons learned on my own when it did hit at my doorstep:

(If you don't understand something in the table given below, you need to read this post again)

S. No.	Tasks	Status	Output Details
1	Pre-Requisites	To Do	Oxymeter, Thermometer medical insurance etc.
2	Care Circle	To Do	contact numbers, agreement details etc
3	Isolation Area Identification	To Do	Washroom, utensils, fan, bed ready.
4	Online Medical Consulting	To Do	Apps installed, doctor's code obtained - fill it here.
5	Doorstep Pharmacy Delivery	To Do	Fill-in the contact details here.
6	Doorstep Grocery Delivery	To Do	Fill-in the contact details here.
7	Diagnostic Lab is set	To Do	fill-in for home sample collection for COVID testing
8	COVID19 Pvt and Govt Hospital Listing	To Do	fill-in the contact details here.
9	ICU Ambulance providers	To Do	fill-in the contact details here.
10	Remdesivir Authorised Dealers	To Do	fill-in the contact details here.
11	PlasmaTherapy	To Do	filll-in the list of potential donors here.
12	NABL Accredited Labs for Antibody testing	To Do	fill-in the contact details here.
13	Understanding of Medical Jargons	To Do	Link
14	Understanding of well-being of patient in ICU for 2nd/3rd opinions	To Do	Link
15	Home ICU Care Support	To Do	fill-in the contact details here
16	Home Sanitisation	To Do	fill-in the contact details here

In hope that the planning saves your time and stress when the pandemic hits at your doorstep. Be Alert and be prepared to give it a good tight fight!! and come out as a "CoronaYodha". Best of Luck!!

COVID19: Advance Planning To Fight Corona Well

Few thousand year back, when Noah was building his Ark by the command of supreme God, everyone around him was laughing but he kept doing it anyway, and the time came when flood has moved the ship. 

This example demonstrate the importance of prior planning, if you are observing that something inevitable is happening around you. 

Looking at the wider and wider spread of Corona everyday, it seems like sooner or later everyone might experience it at some or another level. While you feel that sometime either you, family, friends, near and dear ones might fell prey of this fatal pandemic, it is important to think through it earlier, evaluate the condition and situation around you and do some prior planning in advance to fight the Corona Situation well under stress. 

Reason is the nervousness, confusion, dilemma to think through the next step when the pandemic hit around you and believe me or not such indecisiveness make the condition worse and it hits harder in that case. Getting emotional, or doing something in nervousness without thinking of the results help this disease to spread its spectrum more in your family.

IMHO, it is very important to plan in advance for the Corona situation so that you may look at your cheat sheet and have the next steps ready to follow-on. 

What I am going to present, more look like a flow chart but instead of using the flow diagram, I am trying to keep it in a bulleted form so that it's equally easy for non-IT personals to understand the content better.

1. Complete these PRE-REQUISITES - (Checklist)

Keep these arrangements ready in advance, while you are completely healthy and not navigating through any stressful condition - 

1. Oxymeter - this would help you figure out the breathlessness issues, common for COVID patients.
2. Thermometer - contactless thermometer to avoid any saliva exchange.
3. Blood Group Report - keep the blood group report handy with you. Required at multiple places.
4. Medical Insurance - buy a top-up to increase the insurance coverage supporting up to 14L-20L.
5. A good smart phone with 4G data plan.
6. Keep scanned copy of your and family's Aadhar Card, Pan Card, DL, Medical Insurance TPA card, Passport ready in your mobile phone to share through email and whatsapp instantly. Better to keep this shared under your "care circle" in a common document set.
7. Setup PayTM, BHIM/UPI, Google Pay or other online payment methods.
8. If possible, keep a credit card handy with a limit of 3L-5L
9. Also have a setup of printer and photocopy machine in your "care circle".
10. Disposable Masks (>100) , Sanitisers (5L bottle) , Disposable Hand Gloves Box should be bought and be available in reserve. 
11. Keep one or two sets of PPE with you as well. This might be required under some situations.
12. Isolation Area - Keep a place ready for isolation either in your home, or vicinity. If there are no such place in your house, then advise to keep something on rent as an isolation home. Rental for this isolation house might be bear by individuals or "Care Circle" (explained below).

2.  Create "CARE CIRCLES" - 

1. This is important, and applicable equally whether you live alone or live with family and kids.
2. To create circles, 3-4 different families need to come together and commit towards taking care of each other if Corona hits to any of these families. 
3. Asymptomatic, Home Isolation use-case -- If both the parents or one of the parent is found positive for Corona, while kids are negative - in such case, these kids could be temporarily shifted / accommodated by one of the families in circle. 
4. Asymptomatic, Home Isolation use-case -- If entire family is experiencing Corona, then other families in Circle may divide the work and help with Breakfast, Lunch , Dinner, Nutritious Food, supplying medicines, necessary groceries for the home, getting important registrations done on behalf of this family,, obviously keeping and taking the necessary measures of hand-washing, mask, sanitisation etc.

3.When to run for Corona Testing - full details here

1. Corona is highly contagious in starting 3-5 days, it shows its symptoms of fever etc within 2d-3d.
2. As soon as someone has started feeling feverish - it is advisable to separate himself in the Isolation Area already planned (as explained in point 6 in the previous heading)
3. If fever subsidises easily, and no other person has caught it - you may safely assume that it was not Corona given that your oxygen level remains above 95% all the time. 
4. If fever has subsidised easily, but there is a pain or weakness in your body not going away, feeling a little of headache all the time, nervousness, uneasiness - then in that case, keep yourself isolated atleast for 14d+ and then proceed for Corona Testing. Assuming that there was no shortage of breaths at any point of time by Oxymeter and condition doesn't get worse.

4. Online Doctor Consulting - 

1. This also need to be done in advance as a part of your Corona Planning.
2. figure out what all doctors in your area are providing consultations using online methods or Tele-consultation. 
3. There are multiple apps, but it is difficult to find out local doctor in your area or your favourite doctors using these apps, therefore as an important step keep the online consulting detail of your doctor, this is the time when you would need to pay him using the online methods as detailed above in 1.4
4. Few apps that you may use for online consulting are - Practo, Healthplix, Docon, Navia, iCliniq.
5. Doctors have separate specific codes for Healthplix, Docon, Navia etc.
6. Try to book an appointment in case if nothing works out with your doctor and be there on-time, so that exposure is minimum. Do not sit on the chair, it must be infected badly.

5. Doorstep Pharmacy Delivery -

1. This also need to be setup in advance while you are all well. 
2. Figure out from your nearest medical shop if they can deliver medicines at doorstep if required. In that case, keep their number stored in your mobile with the pharmacy name, so that you may search it easily at the time of need. 
3. Keeping visiting cards or number on paper won't be useful.
4. Keep 3-4 numbers so that you are not dependent on a single Pharmacy store for the delivery of medicines.
5. Assuming that you are not very sick by this time or you are just doing the home isolation.

6. Doorstep Grocery Delivery -

Same as above as explained in the Pharmacy Delivery section. 

7. Doorstep Diagnostics Tests - full details here

1. This need to be setup in advance.
2. Figure out if your nearest diagnostic testing centre may collect the blood sample from your home in case of no COVID19 testing, keep their number and call them for the blood testing whenever needed.
3. Also figure out what labs are doing the COVID19 testing and who can collect the sample from your home. For my hometown, Kanpur based patient the detail is available here
4. Find out how they would share the report. You might need to upload these reports for your online doctor.
5. Also

8. Registration as COVID19 +ve and home isolation - details here

9. COVID19 Pvt and Govt Hospitals Listing - 

1. This also need to be setup in advance.
2. Figure out what all Pvt and Govt Hospitals are accepting the COVID19 patients in your and the neighbouring cities.
3. Govt keep cancelling the Pvt Hospitals licenses for Corona for not completing the SOPs properly. You need to keep an eye for that. 
4. List such hospitals somewhere for your easy reference.
5. Kindly note that, all pvt hospitals are NOT accepting the COVID19 patients.
6. Searching these hospitals later on is stressful and need to be done in advance. This would also help you avoid the huddle of shifting when a non-COVID hospital figures out that the patient is Corona +ve and refuse to provide any treatment.

10. COVID19 Hospitalization - 

1. Your "Care Circle" might help you during this period.
2. Depending upon the situation, you might need a normal or an ICU ambulance support to go to the Hospital. Keep a list ready of the Ambulance providers like the one available here for Kanpur.
3. In a worse scenario where the disease has hit severely, due to breathlessness, Typhoid or pneumonia symptoms it might be needed that you need to rush to the Hospital.  
4. These days all Hospitals are testing patients for COVID19 before starting the treatment. Although, they do accept <72 hours old RT-PCR Corona test report as well. 
5. During the Hospitalization, you need to understand Medical Summary and jargons , please go through this post to understand the important glossary being used there.
6. Hospital might put the normal gas mask with the oxygen cylinder, BIPAP or in ICU based on the condition of the patient.

11. Buying Remdesivir - detail is being posted here, you need to keep the list of authorised dealers ready with you in advance.

12. Plasmatherapy - 

1. Medical term for PlasmaTherapy is = Convalescent Plasmapheresis
2. This treatment is increasingly getting popular for patients with Mild and moderate symptoms.
3. You need to figure out donors for Plasma in this condition.
4. Please look at the post here to understand what all documents are required by Blood bank to issue the Plasma for the patient.
5. PlasmaDonor has certain criteria to be fulfilled as discussed in this post.
6. If you have someone in your circle having a doubt that the person had Corona in past, you may go for Antibody IgG testing as described in this post. Keep contact details of the labs who can do the Antibody Testing. Also get this person tested for negative COVID19 report.
7. Hunting for donor is the most tedious task and is explained in this post to help in the search. 

13. Going through the ICU/Ventilator Phase - details are posted here to understand the well-being of the patient during this period.  You also need to accumulate sufficient data to explain your patient's case for 2nd or 3rd opinion at other Hospitals and Doctors.

14. Returning Back To Home - If everything goes well, you might return back to your home safe and fine. Sometimes, weak patient might need some home care support for few months. Detail is being posted here for Kanpur. You may enquire and keep a detail for your respective city.  

15. Home Sanitisation - 

It make sense to do the Home Sanitisation once a Corona Patient leave for Hospital or return back from there with the negative test report. This would ensure Airborn suspended Virus Particles are grounded well. Details for this service in Kanpur city is posted here.

COVID19 : Enquiring well-being of patient in ICU or Ventilator

COVID19 patients - especially severely affected in Lungs are admitted to ICU and put on Mechanical Ventilator sometimes if the condition worsens. Ventilator machines help patients to maintain the oxygen level by pumping the very saturated oxygen measured by FiO2.

During this time, it feels like we can only pray for the patients easy and fast recovery, but there are still some parameters that you should keep asking to the doctors to actually understand about the condition of patient -

Enquire about the improvement in lung infection -

Figure out the FiO2 value, SpO2 value, lungs X-Ray

FiO2 - 0.2 to 1.0 -- Higher the FiO2 supplied from Ventilator machine worse the condition of the patient.

1. This is Oxygen enriched air - more oxygen than available in the atmospheric air or 21%
2. Ranges between 0.21-1 i.e 21% - 100% ,, this means the air being given to patient has oxygen saturation more than 21% of oxygen saturation in the Air.
3. Ventilator pumps enriched Air Oxygen from Ventilator to the patient,, 
4. 100% or FiO2 = 1 means that patient is on full ventilator support, and the air given to him has 100% of Oxygen.
5. FiO2 should decrease gradually from 100% to 50% or from 1 to 0.5 to switch off the ventilator machine while patient should maintain sufficient SpO2 values as described below.

SpO2 - Should remain more than 95% all the time, higher the value better is the condition.

1. This is the oxygen concentration maintained by lungs in the blood. 
2. This value should remain more than 90% all the time. 
3. If patient is maintaining more than 90% oxygen concentration in his blood on lower FiO2 value approx 0.2 - 0.5 , then patient is out of danger and might safely be move out of ventilator. 

Lungs X-Ray -  

• Looking at the improvement using Lungs X-Ray is not much useful during this moment as X-ray would get clear by the time patient would already be surviving without the mechanical ventilator machine.

Supine or Prone Position - 

Details here. Figure out from the hospital if the patient is put on bed in a supine position or in the prone position. Prone positioning help patient regain and maintain the oxygen level better, patient is put on the bed stomach side down and back portion up for the prone position. If they haven't put the patient in a prone position, check for the reasoning from the Hospital side. 

Suction -

In case if cough or mucus is accumulated there over the lungs, it needs to be removed via the suction process. Make an enquiry to ensure that same is being done.

Enquire About The BP and Heart Conditions -

Norad Support - 

1. Doctors might tell you that they are using Norad support for maintaining the BP. 
2. This means patient's BP is going down without the medicine supplied by Norad machine. 
3. Medical staff might tell you that they are running Norad on 5ml/hr to maintain the normal BP. 
4. Higher the value of Norad support (goes up to 30) to maintain Normal BP, severe is the condition of the patient.
5. If doctor is telling you that they have removed the Norad that means patient is maintaining the BP by himself and is out of danger for now from the BP side.

Figure out ECG and ECHO are doing fine - don't think that they take these reports of a patient on ventilator.

ADR - this is another support using which they maintain the heart and pulse rate.

Enquire About The Kidney Function -

Figure out if the Urine is being discharged normally for the patient. Also ask doctor about the creatinine levels. Creatinine should remain under 1.5 limit. Creatinine is a poisonous substance being produced in blood and Kidney removes it completely with the Urination. 

Sometimes ICU staff uses Dytor or Inotropes to improve the urination of the patient. 

Enquire About the Liver Conditions - 

Keep checking for Bilirubin levels and that no "Jaundis" is being formed in the patient's body.

Enquire if Blood Thinners (AntiCoagulant) are being supplied to the patient -

Patient in ICU or Ventilator is given the Blood Thinners (also known as AntiCoagulant) to ensure that blood remains thin, as patient is not moving therefore there is a high chance that blood clotting might start happening deep inside the veins. This condition is called "Deep Vein Thrombosis aka DVT" . This is a fatal condition as it might start deteriorating other vital parts of the body. Medical staff should use "DVT Pump" to keep the body massaged and keeping the blood flow in control without the coagulation or clotting inside the body. 

Anticoagulants such as heparin or warfarin (also called Coumadin) slow down your body's process of making clots. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from clumping together to form a clot.

Others:

Medical Summary - for 2nd/3rd opinions

Ask Hospital to keep issuing you a medical summary every 24hrs min, detailing the patient condition, test reports, medicines provided and other vitals. You may use the same for 2nd and 3rd opinion from other medical practitioners and hospitals.

Antifungal Medicines - For high-cost medicines, advisable to check from outside Pharmacies

For a person there for a prolonged period on Ventilator, hospital give them Antifungal Medicines, in our case the medicine name was "Tocilizumab Monoclonal Antibody Medicine".  This was a high-cost medicine costing around 40K per vial, and they used 2 vials of this medicine. A consent was also taken from thee attendant. Although, when enquired outside the hospital, same medicine was available in 10K. This was a huge difference, so it make sense for such costly medicine to make available for your patient from outside pharmacies.

TLC - 

Keep an eye on TLC count in Blood Report as high amount i.e. greater than 10,  it leads to the fatal sepsis condition. Sepsis and TLC is explained on this page here

Tracheostomy Ventilator

You need to figure out if Hospital is giving ventilation open mouth or from the Tracheostomy. 

It involves creating an opening in the neck in order to place a tube into a person's windpipe. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs.

A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow blocked or reduced. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to help you breathe. Read this as 10d+ on the ventilator with open mouth, then doctor might suggest for the Tracheostomy procedure.

Central Line --

This is the next level of Vigo, to ease out the process of injection. A consent is taken by the Hospital from the attendant before this purpose. 

A central venous catheter, also known as a central line, is a tube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly.

COVID19 - Home Sanitisation Services

Once you found that your family members are affected by Corona having positive report of same. It is important and Covid-safe to call for home sanitisation services for fogging and clean-up purpose. 

I have one such contact as of now in Kanpur and add more as and when I receive more feedbacks, please help via comments too - 

• Baba Sanitisation - Sagar, Kanpur - 09026601769

1. They do charge 500/- Rs per room for the fogging purpose. 
2. For one room it might take up to an hour where they first switch on the AC at full speed for sometime before starting the fogging.
3. They also provide clean-up services on top of fogging, it's better to take that service as they do clean-up of everything properly.

Cautions/Precautions -

• It is important for you to take a copy of their Aadhar Cards and ask for their photographs without masks.
• Reason being, they would go to every nook and corner of your house for fogging and cleaning purpose that would give them a lot of idea about your rooms, interiors, cupboards and this might not be safe.

COVID19 Testing via UPHC (Urban Primary Health Care)

Additional Info -- These PHC testing are doing RAT and RT-PCR both free of cost, you have to choose one of these two ,,, RAT results are announced immediately, whereas for RT-PCR results -> one need to visit Ursula Hospital COVID19 Control Room to look at the list. You won't find it under GSVM lists.

UP Govt is planning to increase the penetration of COVID-19 testing via establishing testing on Primary Health Care Offices (PHC or UPHC) as listed below -

• PHC = पीएचसी = प्राथमिक स्वास्थ्य  केंद्र 
• UPHC = अरबन पीएचसी  = नगरीय / शहरी प्राथमिक स्वास्थ्य केंद्र 
• CHC = सामुदायिक स्वास्थ्य केंद्र 

List of Zonal In-charge for all the 17 ZONE Divisions : 

REVISED LIST -> 0512-2333810

ORIGINAL LIST

Mohallas under different ZONES -- with LAB APKEY DWAR (Home sample collection Initiative by Amar Ujala) Supervisor details

CoVID19 - HOME Healthcare & ICU Providers

Corona patients, sometimes even after returning back to home needs Oxygen or ICU support for a prolonged duration. There are few Home ICU providers who have trained staff and nurses to support such patients - 

Care & Home by Adnan, Civil Lines, Kanpur - 09838001124

Have nursing staff to help elderly cares, provide oxygen cylinder, hospital beds, ventilators etc.

Variable price ranges based upon different packages from 250/- per day up to 14500/-per day. Packages are modular and can be tailored for the patient needs.

Sample Package -

• ICU SETUP PACKAGE-1
• STAFF:-
• 24 Hours ICU Specialist Nurses
• 24 Hours HealthCare Attendants 
• -Physiotherapy(1 visit Daily)
• EQUIPMENT INCLUSION:-
• -Hospital Bed(Manual)
• -Suction Machine
• -Oxygen Concentrator
• -Multi Para Monitor
• -Portable Ventilator/Bipap/Cpap

Shakti Medical Store, Swaroop Nagar, Sanjay Mehrotra - 09839114889