Case
A 45-year-old woman reported to the outpatient department (OPD) on 21st October 2020, complaining of fever, body-ache, headache, cough, and loss of taste sensation since 5days. She started treatment prescribed by her family doctor, but the breathlessness continued to exacerbate. Her elder son of 32 years of age was suffering from COVID-19. On examination her pulse was elevated, measuring 110 per minute, blood pressure (BP) 160/80 mmHg, respiratory rate 38 per minute, bilateral crepts were heard over both the lungs. She denied having respiratory distress despite suffering from severe dyspnoea. Her temperature was 99.4 degrees Fahrenheit and oxygen saturation was 76% at ambient air. Investigation showed haemoglobin at 11.3 gms/dl, total leucocyte count at 6080/ microL (N=4000-10000), lymphocyte count at 970.8/ microL (N=1500-4000) , lymphocytes 12.2/microL (N=40-600), c-reactive protein 63mg/L (N=0-6), serum ferritin as 86.87ng/ml (N=4.63-204), D-Dimer quantification 1837.39 ng/ml (N= <500), HbA1c 5.7%, serum B-12 as 270 ng/ml(N=197-771), vitamin D 15.7ng/ml (N=30-100), TSH 7.15 mIU/L (N= <4.5). A High-Resolution Computed Tomography of the thorax revealed 75% (23/25 score) involvement of both lungs (figure A1). She was administered nasal oxygen at 4 litres per minute on an OPD basis and her spO2 raised to 84% within one hour, but relatives and the patient denied indoor hospitalization. She was advised regular treatment at home for which they agreed. Treatment given was oral favipiravir 1800 mg 12 hourly on the first day and then 400 mg twice a day for one week. , ivermectin 12mg twice a day for five days, doxycycline 100 mg twice a day for five days, aspirin 150 mg once a day after food, metformin 500 mg once a day, dexamethasone 1mg/kg body weight and subsequent tapering doses in next two weeks, low molecular weight heparin 60 mg subcutaneously twice a day for seven days. levothyroxine 25microgram on an empty stomach. Her elder son was given practical training on how to inject heparin subcutaneously from a prefilled syringe and she was subsequently isolated in a separate room. Her nasal swab was positive for SARS-CoV2 –RNA virus. She reported on 23rd October with no complaints except for mild weakness; her SpO2 was 91% at ambient air and 88% at the end of six minutes brisk walk. Respiratory rate was 20 per minute. On 27th October, her SpO2 was 99% at rest and was 98% after a six minutes brisk walk. She reported to hospital on 7th November with no complaints, SpO2 at rest was 95%with ambient air. Her HRCT showed on 28th November she felt almost normal; her vitals too were stable with BP of 110/70 mm hg and respiratory rate 16 per minute with no crypts in chest SpO2 was 100%. Lastly seen on 9thDecember 2020 with no complaints with SpO2 at100%. Her HCRT done on 9thth December 2020 showed patchy areas intermixed with thickened interstitial (figure A2).