Published in IJCP June 2020
From the Desk of Group Editor in Chief
Mortality Reduction in CMAAO Countries – Drug Protocol for Treating Doctors
June 22, 2020 | KK Aggarwal
     


CMAAO GUIDELINES

  • Evidence of fever, hyperimmune inflammatory response (high erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] or ferritin): Tab Hydroxychloroquine (HCQ) 400 mg 1 tab twice on first day, 400 mg 1 tab once a day based on acute phase reactants response.
  • Tab Doxycycline (DOXY) 200 mg first day and 100 mg from Day 2 to 7 or Azithromycin 500 mg daily for 5 days (antibiotic with antiviral response).
  • Anti-parasitic Tab Ivermectin 12 mg 1 tablet once only (by all family).
  • If severe hypoxia or pneumonia with very high D-dimer and Ferritin give IL-6 pathway inhibitors (Actemra 400 mg 50K) IV: 8 mg/kg as a single dose (NIH 2020b; NIH 2020e).
  • In high risk cases in first 3 days of onset: Favipiravir or Fabiflu 1600 mg twice daily on Day 1, followed by 600 mg twice daily for a total duration of 7-14 days (Cai 2020; NIH 2020a).
  • Inj Clexane 0.6 mL o.d. or b.i.d. in all above age 58, heart patients, hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease (COPD), post cancer, on oxygen, sudden drop of oxygen on rest or exertion.
  • Prednisolone 1 mg/kg stat if sudden development of hypoxia on exertion or rest (3-7 days).
  • Inj Remdesivir 200 mg Day 1 and 100 mg Day 2-5 at the development of oxygen requirement.
  • Sleep prone on your abdomen.
  • Prone oxygen by oxygen concentrator, minimum rate to get 92-96% oxygen levels.
  • Vitamin D Cap D-Rise 2000 IU once a day for 3 months.
  • Elemental Zinc 75 mg daily.
  • Vitamin C 500 mg twice daily for 3 days and then 500 mg daily.
  • Tab Ranitidine 150 mg twice daily till the duration of illness.
  • Tab Meftal 200 mg or Naprosyn 500 mg or Indomethacin 25 mg or Nice 100.
  • SpO2 and pulse monitoring regularly, especially Day 4-7 three times daily.
  • Inform your local authorities, if COVID positive.
  • Inform if temperature >103°F or lasts >14 days or breathlessness, SpO2 falls by >4 after 6 minutes walking, persistent chest pain.
  • Sudden loss of smell and taste is not a serious sign, may persist for some time, may come and go, may come before fever.
  • Conjunctivitis may occur in one eye and is not a serious sign.
  • Rash may occur on any part of body (more in women) and is not a serious sign.
  • Pus cells may be present in urine, indicate cystitis and not secondary infection (total leukocyte count [TLC] will remain low).
  • Monocytes presence indicates high viral response.
  • High CRP >100 means very high inflammatory response.
  • Loose motions (70% women) means super spreader and often a mild sign. May come and go. Take ORS.
  • Whole family may get COVID or COVID like illness, all may have different symptoms, at least one will get loose motions.
  • All should do betadine (povidone-iodine) gargles twice daily and povidone-iodine nasal wash.
  • Get complete blood count with ESR, CRP, lactate dehydrogenase on Day 1 and Day 5 onwards every third day.
  • If lymphocyte count is low (<1,000): LOPIMUNE twice a day for 2 weeks (Ritonavir and Lopinavir).
  • Review with reports at hcfimedicalreports@gmail.com
  • 9th day onwards you have nonreplicative virus and cannot pass on the infection to others.
  • Reverse transcription polymerase chain reaction (RT-PCR) test may remain positive for up to 48 days.
  • Those who are 65 plus or have underlying diabetes or heart disease should wear three-layered fabric mask.