When to take antiretroviral drugs, anticoagulants or warn to be hospitalized… are common questions asked by patients with Covid-19 when self-medicating.
Ask your doctor a question here
After a peak week of home F0 support, at least 100 F0 each day, both new and old, Specialist I, Nguyen Huy Hoang, Hyperbaric Oxygen Center of Vietnam – Russia Tropical Center, Ministry of Defense received get a lot of questions. However, in some cases, doctors find it unnecessary to consult a specialist because currently information in the mainstream media is very complete, asymptomatic or mildly symptomatic F0s can completely learn how to treat themselves, only about 10% – 15% need real support from a doctor.
Here are 6 important questions that need expert companionship during F0 self-treatment at home, according to Dr. Huy Hoang:
1. Do I need to take antiviral drugs?
This problem depends on many factors such as: whether the viral load is high; have had enough vaccines; whether there is an underlying disease; good resistance no; Is there a risk of infecting many people?
Present, Favipiravir and Molnupiravir are recommended for home treatment of Covid-19.
Whether to use antiretroviral drugs or not, which type to use, really needs a unified exchange between doctors and patients based on the guidance of the Ministry of Health (latest dated 12/12/2021) but sometimes also not as expected (eg the patient is allergic to the drug). These drugs often cause fatigue, allergies, may need more liver tonics, anti-allergic drugs… Antiviral drugs will be for the first stage, within 7 days from the onset of symptoms.
2. When to take antibiotics?
Some people are prone to pharyngitis, bronchitis, pneumonia… Normally, they are already susceptible to respiratory infections, when infected with nCoV, the risk of infection increases. For these people, it may even be necessary to take prophylactic antibiotics, since there are no signs of infection. Those who need to take antibiotics include: children, patients with many underlying diseases (especially diabetes), patients on long-term immunosuppressive drugs…
In other cases, antibiotics should only be used when there is an infection. It is not easy to determine if F0 has an infection without tests. If possible, the patient should have a complete blood count and some other indicators of inflammation before deciding to use antibiotics. When deciding to use antibiotics, which type to use, how much dose, whether to combine the two… In addition, the patient also needs to take more drugs to reduce the harmful effects of antibiotics. such as: need to use more digestive enzymes if you are children, the elderly. This is really a problem that needs the knowledge of doctors combined with information from patients (have used any type, have allergies…). Antibiotics may need to be taken for the duration of the Covid-19 infection.
Doctor Huy Hoang said, around the 7th – 10th day, after the appearance of symptoms, a small number of F0 may experience immune disorders that affect their life. In which, prominent are blood clotting disorders and inflammatory response disorders, first in the lungs, then the whole body.
3. Anticoagulation used for what case?
Except for some contraindications such as: patients are bleeding (menstruation, gastrointestinal bleeding…) or have thrombocytopenia, bleeding easily… then anticoagulants are relatively safe. Patients after stroke, ischemic stroke, coronary stent, heart valve disease… often have to take antiplatelet drugs, anticoagulants for many years continuously.
Some studies suggest that prophylactic use of low-dose anticoagulants may be effective in preventing “cytokine storms” in patients with Covid-19. The current orthodox recommendation is to use anticoagulants when SpO2 drops below 95% continuously without being able to rise. The specific dose should be carefully considered and calculated based on the expertise of the physician and the patient’s condition.
4. Should anti-inflammatory corticosteroids be used?
Corticosteroids, specifically Dexamethasone, have emerged as a cheap (which is quite common) but very effective in the treatment of immune response disorders caused by Covid. Later, scientists found that not only Dexamethasone but other corticosteroids such as Prednisolone or Methylprednisolone also have similar good effects.
Unlike anticoagulation, there is no suggestion that corticosteroids should be used to prevent “cytokine storms”. All studies show that early use of corticosteroids (when no oxygen is required, when SpO2 is above 95%) causes a higher rate of severity and mortality from Covid-19 (compared to no use of corticosteroids). .
Anti-inflammatory corticosteroids are actually drugs that suppress the immune system, it reduces the body’s resistance.
In the early stages, when the immune system is fighting against the virus, but using immunosuppressive drugs “is no different” to the virus, making the disease worse. Using corticosteroids also makes people more susceptible to bacterial and fungal infections. In patients with diabetes and hypertension, corticosteroids exacerbate the severity of the disease. Not only that, corticosteroids also have a series of dangerous side effects.
Normally, when taking anti-inflammatory corticosteroids, the patient will have to be accompanied by gastric protective drugs (reducing acid secretion such as omeprazole, esomeprazole or antacids such as aluminum hydroxide, magnesium hydroxide…) and antibiotics to prevent bacterial superinfection. . How much dose to use is not simple, with the F0 at home is not too complicated, but when it is severe, in the hospital, there are many different options for using corticosteroids.
6. Signs to be hospitalized?
This is a very important question in the current situation of Hanoi. In general, when SpO2 keeps decreasing but cannot get above 95%, hospitalization is recommended. However, in the near future, when hospitals are overloaded, we will have to accept the decrease in SpO2 and still no room for hospitalization.
Usually, when SpO2 decreases sustainably below 95%, or when lying on the stomach, SpO2 increases significantly compared to when lying on the back (about 5%), there are signs of the beginning of a “cytokine storm”. At this time, the patient needs to breathe oxygen, with a compressed air oxygen tank or an oxygen generator, to maintain SpO2 above 95%, immediately take anticoagulants, anti-inflammatory drugs, the specific dosage depends on the doctor’s judgment. doctor.
While waiting for hospital transfer, family members need to find out the regulations on treatment stratification (of the Hanoi Department of Health) to see what their family members are eligible for, which hospitals can be treated at, from there. vehicle preparation plan and contact the ward health, with 115 or directly with the hospital.
In addition to anticoagulants and anti-inflammatory drugs, when hospitalized, antibiotics are almost mandatory to prevent hospital-acquired infections. In addition, the patient will often have to take drugs to protect the stomach, sedatives.
Also, with questions like: “I or my family members become F0, how can others not infect?”; “I’m positive, what should I do?”; “What should I do when I have symptoms of Covid-19”… Doctor Huy Hoang affirmed, people can completely find information on the Internet. The Ministry of Health has issued very specific guidance from the care of asymptomatic or mild F0 at home; how to perform isolation, sterilization, waste treatment… to avoid cross-infection with other people in the family. See more advice here