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Covid19 Info

Doctors247 Online, powered by Medical City Online, UK
Doctors247 Online, powered by Medical City Online, UK

VERY USEFUL MSG. I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know. 

Clinical course is predictable. 
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma. 

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical. 

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this *** has told all other disease processes to get out of town. 

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails. 

Diagnostic 
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox. 

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated. 
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner. 

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that. 

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation. 

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. 

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal. 

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back. 

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation. 

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020. 

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle. 

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post. 

We are also using Azithromycin, but are intermittently running out of IV. 

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry. 

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps. 

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed. 

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours. 

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room. 

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. 

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads. 

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many. 

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

Wash your hands frequently

Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water.

Why? 

Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.

Maintain social distancing

Maintain at least 1 meter (3 feet) distance between yourself and anyone who is coughing or sneezing.

Why? 

When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.

Avoid touching eyes, nose and mouth

Why? 

Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.

Practice respiratory hygiene

Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

Why? 

Droplets spread virus. By following good respiratory hygiene you protect the people around you from viruses such as cold, flu and COVID-19.

If you have fever, cough and difficulty breathing, seek medical care early

Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

Why? 

National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent spread of viruses and other infections.

Protection measures for persons who are in or have recently visited (past 14 days) areas where COVID-19 is spreading

  • Follow the guidance outlined above.
  • Stay at home if you begin to feel unwell, even with mild symptoms such as headache and slight runny nose, until you recover. 
  • Why? 
  • Avoiding contact with others and visits to medical facilities will allow these facilities to operate more effectively and help protect you and others from possible COVID-19 and other viruses.
  • If you develop fever, cough and difficulty breathing, seek medical advice promptly as this may be due to a respiratory infection or other serious condition. Call in advance and tell your provider of any recent travel or contact with travelers. 
  • Why? 
  • Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also help to prevent possible spread of COVID-19 and other viruses.

COVID-19 virus can be transmitted in areas with hot and humid climates

From the evidence so far, the COVID-19 virus can be transmitted in ALL AREAS, including areas with hot and humid weather. Regardless of climate, adopt protective measures if you live in, or travel to an area reporting COVID-19. The best way to protect yourself against COVID-19 is by frequently cleaning your hands. By doing this you eliminate viruses that may be on your hands and avoid infection that could occur by then touching your eyes, mouth, and nose.

Cold weather and snow CANNOT kill the new Covid-19.

There is no reason to believe that cold weather can kill the new Covid-19 or other diseases. The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather. The most effective way to protect yourself against the new Covid-19 is by frequently cleaning your hands with alcohol-based hand rub or washing them with soap and water.

Taking a hot bath does not prevent the new Covid-19 disease

Taking a hot bath will not prevent you from catching COVID-19. Your normal body temperature remains around 36.5°C to 37°C, regardless of the temperature of your bath or shower. Actually, taking a hot bath with extremely hot water can be harmful, as it can burn you. The best way to protect yourself against COVID-19 is by frequently cleaning your hands. By doing this you eliminate viruses that may be on your hands and avoid infection that could occur by then touching your eyes, mouth, and nose.

The new Covid-19 CANNOT be transmitted through mosquito bites.

To date there has been neither information nor evidence to suggest that the new Covid-19 could be transmitted by mosquitoes. The new Covid-19 is a respiratory virus which spreads primarily through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose. To protect yourself, clean your hands frequently with an alcohol-based hand rub or wash them with soap and water. Also, avoid close contact with anyone who is coughing and sneezing.

Are hand dryers effective in killing the new Covid-19?

No. Hand dryers are not effective in killing the 2019-nCoV. To protect yourself against the new Covid-19, you should frequently clean your hands with an alcohol-based hand rub or wash them with soap and water. Once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer.

Can an ultraviolet disinfection lamp kill the new Covid-19?

UV lamps should not be used to sterilize hands or other areas of skin as UV radiation can cause skin irritation

How effective are thermal scanners in detecting people infected with the new Covid-19?

Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new Covid-19.

However, they cannot detect people who are infected but are not yet sick with fever. This is because it takes between 2 and 10 days before people who are infected become sick and develop a fever.

Can spraying alcohol or chlorine all over your body kill the new Covid-19?

No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes or mucous membranes (i.e. eyes, mouth). Be aware that both alcohol and chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations.

Do vaccines against pneumonia protect you against the new Covid-19?

No. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new Covid-19.

The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against 2019-nCoV, and WHO is supporting their efforts.

Although these vaccines are not effective against 2019-nCoV, vaccination against respiratory illnesses is highly recommended to protect your health.

Can regularly rinsing your nose with saline help prevent infection with the new Covid-19?

No. There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new Covid-19. 

There is some limited evidence that regularly rinsing nose with saline can help people recover more quickly from the common cold. However, regularly rinsing the nose has not been shown to prevent respiratory infections.

Can eating garlic help prevent infection with the new Covid-19?

Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new Covid-19.

Does the new Covid-19 affect older people, or are younger people also susceptible?

People of all ages can be infected by the new Covid-19 (2019-nCoV). Older people and people with pre-existing medical conditions (such as asthma, diabetes, and heart disease) appear to be more vulnerable to becoming severely ill with the virus. 

WHO advises people of all ages to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene?

Are antibiotics effective in preventing and treating the new Covid-19?

No, antibiotics do not work against viruses, only bacteria.

The new Covid-19 (2019-nCoV) is a virus and, therefore, antibiotics should not be used as a means of prevention or treatment.

However, if you are hospitalized for the 2019-nCoV, you may receive antibiotics because bacterial co-infection is possible.

Are there any specific medicines to prevent or treat the new Covid-19?

To date, there is no specific medicine recommended to prevent or treat the new Covid-19 (2019-nCoV).  However, those infected with the virus should receive appropriate care to relieve and treat symptoms, and those with severe illness should receive optimized supportive care. Some specific treatments are under investigation, and will be tested through clinical trials. WHO is helping to accelerate research and development efforts with a range or partners?

 

  1. Should I go to mosque if I “develop” have symptoms of Covid-19 infection according to Islamic Ideology Council of Pakistan?

According to Islamic Ideology Council of Pakistan No you should NOT go to mosque if you have symptoms of cough, sneezing, fever, sore throat because you will infect others.

  1. What are symptoms of COVID 19

Fever, dry cough, sore throat are the most common symptoms of Covid-19 infection. Some people will have no symptoms at all. Some people may have severe body aches, nausea, vomiting and diarrhea.

  1. What to do with Sore Throat and fever

If you have high fever, sore throat and painful glands in the throat, it means you most likely have bacterial core throat and will need antibiotics. In Covid-19 patients have cough which is absent in bacterial sore throat.    

  1. What to do with mild fever, body pains, runny nose, sneezing, and productive cough?

Runny nose, productive cough and sneezing may be signs of common cold, not Covid-19 infection. But there is no need to worry about differentiating common cold from Covid-19 during an outbreak because treatment and prevention of both conditions is same. So practically both patients will receive symptomatic care a home with precautions

  1. Where to get test for COVID-19

It is best to call laboratory person to come to your home and collect sample from home. Government testing service at 1166 also provide home based Test for Covid-19

  1. How should I go to hospital?

One should be very careful in going to hospital if one develops symptoms of Covid-19 or common cold because in hospital they can spread infection to others and may also get other hospital acquired infections. It is better to call 1190 or Edhi Ambulance to take the patient to hospital designated for Covid-19 infection. One should not just walk in to any general hospital.

  1. Where are services in my area across?

The best services in Covid-19 outbreak are the Telemedicine services which are either through Telephone or through Internet. In mild cases one should stay at home.

If condition is severe, then one should call 1190 ambulance service to take you to the Hospital designated o Covid-19 infecion.

If you want to go to your Family Doctor, then inform him on phone about your symptoms, take an appointment to minimize waiting time, go with mask on, wash your hands before entering the clinic and do not touch anything in the clinic. Sit at least one meter (3 feet) away from the doctor

  1. From where can I get Masks and Hand sanitizer in my area?

Masks and sanitizers are available a Medical Stores and General Stores. Unfortunately due to shortage, these may not be available. You can make mask from cloth at home. You can use three layers of normal tissue paper as mask. You can use soap and water to wash your hands.

  1. Do I need Mask?

Mask is essential for those people who have symptoms. Mask is essential if there is a patient at home. Mask is essential if you are taking care of any patient with Covid-19 infection.

For those who do not have symptoms mask is not essential but a good step.

  1. What is Travel advice from and to and Pakistan?

The general advice and the Islamic advice in any outbreak are to avoid all unnecessary travelling till the outbreak ends. But if there is no choice and travel is essential then all the preventive measures must be observed during travel and ravel details must be shared with the health authorities. If you are quarantined on arrival, you should cooperate and observe all precautions during quarantine.

  1. When to call Ambulance and what kind of other services available?

Only call Ambulance service on 1190 or Edhi Ambulance service if you have severe disease. Severe symptoms means that you have severe shortness of breath, you can’t complete one sentence, you are drowsy, have chest pain, severe vomiting, decreased urine etc, then call Ambulance service to pick you from home.

  1. I am exposed to Chinese products and Chinese staff what should I do?

Travel history to China in the last 2-4 weeks is important. Chinese staffs who have not travelled to China after August 2019 are just like Pakistani people. Chinese products other than meet products are safe unless the product’s surface is contaminated by respiratory droplets of an infected person in Pakistan.

  1. Government other help lines 1166 not helping and advising to go to hospital, and also saying on media to stay home and away from others if you are suspect stay away from others. What should we do?

This is alarming to have mixed messages from different sources. You should know that there is no treatment available for Covid-19 infection even if you go to hospital. You also know that most people will safely recover from Covid-19 infection. But you can stop the spread of infection if you say at home. So message is clear that if it is mild stay at home and protect others and if it is severe, go to hospital for admission.

  1. How many cases in my city or region?

No one knows the exact numbers of cases in your area and there is no method to know this. This concern is not important, because we have to take all he precautions regardless of numbers of cases in the area.

  1. We are scared what should we do as a family and community?

It is understandable that one can be scared in an outbreak like Covid-19. It is the talk of the town everywhere. There is no point in being scared if we know that Covid-19 is mild disease in most cases and most people will recover safely from it. All the hue and cry is to stop the spread of Covid-19 and we all have a role to play i.e., to take precautions and advise precautions, not to be scared

  1. How much distance should I keep from others at home and in office to protect from Covid-19 infection?

At least 1 meter (3 feet) from a person who is coughing or sneezing if the contact is brief and if you have to say there for longer period than 2 meters (6 feet) is recommended  

  1. Which hand sanitizers are better for prevention of Covid-19 infection?

Any hand sanitizer which contains at least 60-70 % alcohol is good enough to kill Covid-19 virus

  1. Can I use normal spirit swabs to clean my hands during Covid-19 outbreak?

Yes, if hand sanitizers and soaps and not available, spirit swabs may be used to clean hands. Since it causes dryness of skin, then you need to use a clean skin moisturizer or cream

  1. Which soaps are better for prevention of Covid-19 infection?

All soaps are equally good if used properly with plenty of water for at least 20 seconds

  1. What are the indications for testing for Covid-19?
  2. WHO recommends testing of all persons with symptoms and then isolation.  It also depends on the disaster management policy of the country. In Pakistan Government recommends self-isolation of those with symptoms without testing as testing would not change the management. But any serious patient at home or brought to hospital must be tested
  3. What the diagnostic tests available for Covid-19 infection?

Real Time Polymerase Chain Reaction (RT-PCR) is the test of choice to diagnose Covid-19 infection

  1. Where are the diagnostic tests for Covid-19 available in Pakistan?

All major laboratories in Pakistan provide Covid-19 tests. Governments provide free testing a designated hospital. For home based testing Government of Punjab has provided a dedicated number of 1166. For further details one can call 1133, 1166, 1190

  1. What is the cost of Covid-19 tests?

The cost of test varies from laboratory to laboratory ranging from 3000 PKR to 6000 PKR. Governments are providing free testing

 

 

  1. How long does it take for the Covid-19 test to give result?
  2. Normal tests take 6-12 hours to give results. Cloud based point of care tests developed in Canada gives results in minutes but this is not yet available in Pakistan
  3. What is prognosis of Covid-19 infection?

Prognosis depends on age and health status of the infected person. People younger than 60 years of age and those without chronic medical conditions have excellent prognosis with mortality less than 2%. Morality increases with advancing age and poor health status of the infected person

  1. Is there any vaccine available for Covid-19 infection?
  2. Vaccine development is being done on war footings but it is not yet available
  3. What is Self-Isolation?

When a healthy person develops symptoms of Covid-19 infection or symptoms of common cold, he voluntarily distances himself from other and says a home to protect others.

  1. Is Self-Isolation a recommended treatment?

Yes, self-isolation is recommended treatment for all mild cases of Covid-19 infection. It should by no means be considered as “denial” of health care services to people, instead it is the best thing for the patients and the population at large.

  1. What are the benefits of Self-Isolation?

It prevents the spread of infection to others. It also prevents getting of other hospital acquired infections if someone goes to hospital. It curtails infection from spreading. It is the proven method of controlling C0vid-19 infection

  1. What arrangements need to be made for Self-Isolation?

No special arrangement is required. Only the standard respiratory precautions, social distancing and surface cleanings are required just like for any other infected person

  1. What things should be avoided in Self-Isolation?

Overcrowding and family gatherings should be avoided. Patients should not be stigmatized. No dietary restrictions should be advised. No self medication should be done accept taking Paracetamol and safe herbal home remedies.

  1. When should a patient in “Self-Isolation” contact a doctor?

When danger signs of serious infection develop in any person in self-isolation like severe shortness of breath, blue discoloration of fingers or lips, chest pain, decreased urine, drowsiness, vomiting, generalized swelling or sick look

  1. What symptomatic treatments should be given to mild Covid-19 infection during Self-Isolation?
  2. Tab Paracetamol two tablets here times a day. Children should have syrup Paracetamol according to weight. Safe herbal home remedies like Joshanda, herbal syrups may be used
  3. What diet should I take during Covid-19 infection?

Here is no special dietary advice for Covid-19 infection. One can take normal healthy diet according to one’s taste

  1. What is the role of vitamins in treatment of Covid-19 infections?

Role of vitamins is not proven but based on available data vitamin C present in fresh fruits seems beneficial. Multivitamins will not harm even if they do not help

  1. I have small children at home, what special precautions should I take for my children?

No need to worry about children as Covid-19 has very low mortality and morbidity in children

  1. I have old parents at home, what special precautions should I take for them?

This is a genuine concern. One should immediately distance from elderly and observe strict precautions to protect the elderly

  1. I am heart patient already, what special precautions should I take if develop symptoms of Covid-19 infection?

This is a genuine concern. One should immediately distance from heart patients and observe strict precautions to protect the cardiac patients

  1. What are the treatments options for patients with serious Covid-19 infection?

There is no specific treatment for Covid-19 infection. Care is mainly supportive based on the condition of patients. This makes the prevention even more important

  1. Should I go to mosque if I “do not” have symptoms of Covid-19 infection according to Islamic Ideology Council of Pakistan?

According to Islamic Ideology Council of Pakistan Yes, you can go to mosque for only Farz prayer if you “DO NOT” have symptoms, but must observe respiratory precautions and should not shake hands. Before going to mosque and after coming back must wash hands for a leas 30 seconds

  1. How much distance should I keep from others at home and in office to protect from Covid-19 infection?

At least 1 meter (3 feet) from a person who is coughing or sneezing if the contact is brief and if you have to say there for longer period than 2 meters (6 feet) is recommended  

  1. Which hand sanitizers are better for prevention of Covid-19 infection?

Any hand sanitizer which contains at least 60-70 % alcohol is good enough to kill Covid-19 virus

  1. Can I use normal spirit swabs to clean my hands during Covid-19 outbreak?

Yes, if hand sanitizers and soaps and not available, spirit swabs may be used to clean hands. Since it causes dryness of skin, then you need to use a clean skin moisturizer or cream

  1. Which soaps are better for prevention of Covid-19 infection?

All soaps are equally good if used properly with plenty of water for at least 20 seconds

  1. What are the indications for testing for Covid-19?
  2. WHO recommends testing of all persons with symptoms and then isolation.  It also depends on the disaster management policy of the country. In Pakistan Government recommends self-isolation of those with symptoms without testing as testing would not change the management. But any serious patient at home or brought to hospital must be tested
  3. What the diagnostic tests available for Covid-19 infection?

Real Time Polymerase Chain Reaction (RT-PCR) is the test of choice to diagnose Covid-19 infection

  1. Where are the diagnostic tests for Covid-19 available in Pakistan?

All major laboratories in Pakistan provide Covid-19 tests. Governments provide free testing a designated hospital. For home based testing Government of Punjab has provided a dedicated number of 1166. For further details one can call 1133, 1166, 1190

  1. What is the cost of Covid-19 tests?

The cost of test varies from laboratory to laboratory ranging from 3000 PKR to 6000 PKR. Governments are providing free testing

  1. What aspects of communication should be kept in mind during telemedicine communication?

Show empathy to the patient by keeping yourself on his place a lay person

Address the concerns of the patients

Demonstrate kind and caring attitude

Respecting the patient’s autonomy

Guide according to the circumstances of patients and assure continuity of your support

  1. What are the expected clinical findings in a mild Covid-19 infection?

There are no specific clinical features that can yet reliably distinguish Covid-19 from other viral respiratory infections.

  1. I am a smoker, should I stop smoking?

Yes, it is the time to quit smoking as smoking may increase the risk of severe Corona virus infection

  1. How should doctors protect themselves from Covid-19 infection during clinic hours?

Wear face mask, wear gloves before examining a patient, use hand sanitizer, keep a distance of 3 feet from a patient, clean the high touch surfaces with bleach solution or other recommended cleaning agents, keep equipment clean. If dealing with Covid-19 patient along with the above measures doctor should also wear protective gown and goggles.

  1. How much distance should I keep from others at home and in office to protect from Covid-19 infection?

At least 1 meter (3 feet) if the contact is brief and if you have to say there for longer period then 2 meters (6 feet) is recommended.

  1. How does Covid-19 spread from one person to the other?

Respiratory aerosols and droplets spread after coughing, sneezing, blowing nose by an infected person. 

  1. What Personal Protective Equipment (PPE) are required at community level?

No special Personal Protective Equipment is needed at community level. Only masks and Washing hands with soap, or hand sanitizer with 60% alcohol and bleach to clean surfaces are needed

  1. What Personal Protective Equipment (PPE) are required at hospital level?

Gowns, gloves, goggles or eye shields (not personal eyeglasses or contacts), N95 or a face mask

  1. What is the infectious period of Covid-19?

The infectious period of Covid-19 starts from incubation period till complete recovery of the patient (up to 14 days incubation period and up to 6 weeks recovery period)

  1. What travel history is important in history of Covid-19 evaluation?

International travel to any country in the last 14 days is relevant in Covid-19 evaluation; with local spread in Sindh travel to Sindh is also important.

  1. What are Corona viruses?

Corona viruses are a large family of viruses which may cause illnesses in animals or humans. Some important diseases caused by Corona viruses are SARS, MERS and Covid-19

  1. What is Covid-19 virus?

Covid-19 virus is a type of corona virus which causes respiratory illness; it was officially named Covid-19 by WHO after causing the outbreak in Wuhan province of China in Dec 2019

  1. What is a Pandemic?

An epidemic that spreads in different continents of the globe is a pandemic.

  1. How did the covid-19 epidemic start in Pakistan?

It started when infected people returning to Pakistan from countries with outbreaks of Covid-19 brought infection to Pakistan. Most cases came from Iran and others from Middle east and Europe.