Mild breathlessness due to Covid-19? A personal guide to action at home

Every day now, thousands of people all across the country experience breathlessness due to the Covid-19 infection. Unfortunately, several hundred of them succumb in what is often an agonising death as oxygen supplies in many hospitals across the country run out.

Breathlessness due to Covid-19 is a condition where hospitalisation is strongly advocated. And it will be unavoidable in cases where the problem is severe as manifested by rapidly falling saturation levels. This requires immediate oxygen administration and fast acting injectable drugs. But with hospital beds increasingly hard to come by, oxygen supplies not able to keep up with skyrocketing demand and the medical infrastructure at breaking point, it has become urgent to prioritise treating mild and moderate breathlessness at home on a war footing. I strongly advocate it based on personal experience.

On March 26 2021, I was diagnosed Covid-19 positive after experiencing symptoms of a mild cough and low-grade fever. The next day, I started feeling breathless and my saturation (as seen on my handy pulse oximeter) dropped below 90 briefly. I was advised hospitalisation given I was knocking on the doors of 60 and had mild blood pressure and diabetes issues.

I checked into the Covid-19 ward of one of Bengaluru’s top 10 private hospitals and after an X-ray and blood tests was put on antiparasitic drug Ivermectin and antibiotic Doxycycline. After two days, I was told my infection markers like D-dimer, CRP Ferritin, etc. remained high and the treatment was changed to a five-day injectable dose of the steroid Dexamethasone and the by-now-famous antiviral Remdesivir.

On the seventh day, my infection markers were found to be at acceptable levels and since the breathlessness that took me to hospital had disappeared and the saturation was holding around 94/95, I was advised to go home and quarantine for another week. This despite a CT scan of the chest taken a day before my discharge showing that I had a severity of infection of 5/25. This is considered mild on a scale of mild, moderate and severe.

The treating doctor informed me the government-mandated protocol had changed from requiring a negative RT-PCR test before discharge as was the case last year. Meanwhile, I learned from the wonderfully helpful nursing staff that the real reason for hastening my discharge was a queue of patients waiting for a Covid-19 ward bed. The doctor was also candid enough to say that with no definite cure for Covid-19, hospitals were only treating patients to reduce the infection severity using various experimental therapies that worked well for some and not so well for others.

Back home where I continued to be on vitamins, zinc, a mild blood thinner to prevent Covid-19-induced clots, and my regular BP medication, the breathlessness again returned after a week. The pulse oximeter showed my saturation at 91/92 and a pulse rate of 120 plus, well above the normal 72. A pounding heart, that was obviously working harder given the oxygenation problem, literally gave me sleepless nights and raised new worries about how it would hold up should saturation dip further.

I decided to meet the consultant pulmonologist at the hospital where I was treated (surprisingly, it was only the duty doctor who saw me while in hospital with no visit by a pulmonologist) and gently suggested to him to put me on oral steroids. He put me on the steroid Methylprednisolone and a combination drug whose active ingredients contained a bronchodilator and one used to treat Chronic Obstructive Pulmonary Disease (COPD). Within a day, my breathing improved considerably, my resting pulse rate dipped to the 80s, and I felt a whole lot better. This treatment continues even as I write this though the challenge of getting my saturation levels up even closer to 100 remains.

I would suggest the following steps for anyone experiencing mild breathlessness as an alternative to rushing to the hospital.

If you are feeling breathless and your saturation is below 92, get a local doctor to prescribe a HRCT (High Resolution Computed Tomography) scan for you. Do this even if your RT-PCR is showing negative (there are far too many false negatives now).

Take the CT scan at your nearest hospital/diagnostic centre and see a qualified pulmonologist with it. If you are only mildly breathless, then your CT would indicate mild or moderate infection that can be treated through oral drugs. Gently suggest to the doctor that oral drugs are what you prefer over hospitalisation. I did.

Various studies/reports available online indicate methylprednisolone has shown good results. Leave it to the pulmonologist to determine the dosage and duration as also the accompanying combination of bronchodilator-COPD drug which in my case was branded Pulmoclear.

Steroid use pushes up blood sugar levels sharply and this can be dangerous if left untreated. Mine climbed to over 300 while in hospital, three times the normal level. So, invest Rs 1,500 in getting a good quality glucometer and monitor your blood sugar twice a day. Metformin tablets after breakfast and dinner helped keep my sugar levels in check. Similarly, calcium needs to be taken to compensate for bone loss, which is another undesirable effect of steroid usage.

With the rapid rise in Covid-19 cases and breathlessness becoming a life and death issue for thousands, it is high time governments at the Central, State and local levels start publicly advocating early treatment of such cases through oral steroid medication. This to prevent a mild and moderate infection turning severe and life-threatening. Those having mild to moderate breathlessness should be encouraged to register with the local municipal body and government doctors could be assigned to visit the patients at home at least once or twice over a week and ensure they are taking what is strong oral medication properly and adequately compensating for known side effects.

With the benefit of hindsight, I can definitely say it would have been far better for me to have taken a CT scan and seen a pulmonologist rather than rush to get myself admitted in hospital. Apart from getting questionably effective treatment in the hospital, there is also the affordability issue that will be important for millions in the country.

While the weeklong accommodation in a twin bedded non-AC room cost me Rs 1.2 lakhs (partly covered by medical insurance) with drugs, the option of home treatment costs less than Rs 8,000 with Rs 5,500 of this being the cost of a CT scan. In fact, the steroid methylprednisolone is one of the cheapest drugs available costing less than Rs 100 for the entire treatment. Hospitals have to earn their keep and do tend to prefer expensive medication like Remdesivir, which cost me Rs 20,000 for a five-dose regimen.

I remain cautious that, given my age and comorbidities, I may yet be in for what is called a long Covid-19 fight and there could still be some bumps on my road to full recovery. But I have no doubt based on my experience that the country needs to aggressively promote home treatment for those with Covid-19-induced mild breathlessness and prevent what is potentially a home-treatable problem from snowballing into a life-threatening crisis for tens of thousands.

(The author is a former Indo-China Correspondent and Kuala Lumpur bureau chief of Time Inc’s erstwhile Asiaweek magazine)

Disclaimer: The views expressed above are the author’s own. They do not necessarily reflect the views of DH.