Covid 101

I sort of understand everyone trying to understand what to do with Covid with a few questions. I mean you have all been listening to Covid experts talk about the disease for nearly two years. But you sad to say, you can't distill Medicine of a complicated disease in pts with complicated medical histories on several medications chronically.

A buddy's sister called me and asked what she should ask if she goes to the ER. Lil Sis doesn't have a complicated medical history, but she doesn't live near me, so I cannot control things when she goes to the ER. Obviously, I like...need to control things.

I explained to Lil Sis that I need data to give her good advice. I emailed Lil Sis that these are things I want.

"Of course, vital signs and pulse oximetry are very important.

Vital signs = temperature, pulse, respiratory rate and blood pressure.

Pulse oximetry reading or percent oxygen saturation is very important as well.

Every ER does vital signs and pulse oximetry.

For lab testing, the list below is my routine panel. I can explain to an ER doc/PA/Nurse practitioner, if they'll speak to me

I am looking for a few different things with this panel, including ruling out blood clot, evidence of secondary bacterial infection, severe dehydration, and presence of absence of antibodies against Covid or SARS-CoV-2. Most hospitals can get the results of these tests back within a few hours, except the cultures which take a few days.

CBC

CMP

INR/PT

Urinalysis

Urine creatinine

Urine sodium

Urine osmolality

D-dimer

Ferritin

LDH

Procalcitonin

Chest X-ray

Blood cultures x 2 sets

Urine culture

Covid antibody against SARS-CoV-2 nucleocapsid

Covid antibody against spike protein (semi-quantitative)."

Ok, all of that above is for the not-so-sick patient without diabetes or other risk factor. Throw in a few more comorbidities and my list grows a lot.

What are they are for?

Well, CBC and CMP measure the basics of your blood's cellular and chemical components. INR/PT is a measure of your blood's clotting system.

Urine creatinine, sodium and osmolality are used to check for dehydration.

D-dimer is used to rule out blood clots. It's helpful when negative, but in Covid, it isn't negative very often.

Ferritin and LDH - Like D-dimer, they go with Covid. They give me an idea of where you are in the disease process. For instance, a very high LDH is a very bad prognostic indicator.

Procalcitonin - is supposed to only go up in bacterial infections. Sadly, it goes up in Covid as well. But if the procalcitonin is negative, it is unlikely that the pt has developed a secondary bacterial pneumonia and JUST has Covid.

Chest X-ray - occasionally helpful, when I see something I shouldn't.

Blood and Urine cultures - just being thorough. Again, pts with Covid can get secondary bacterial pneumonia and they can also have Covid and get a UTI unrelated to Covid.

Covid antibodies - these tests tell me if your own immune system has started to respond to the virus or not and, if vaccinated, the spike protein antibody appears to correlate with good outcome.

So, that's the minimum. If you have a few underlying medical problems, then I have a dozen or two more.

BTW, if you stay home, keep track of your pulse ox, your pulse and drink a lot of water and eat salty foods. Your pulse or heart rate really should be between 60-90 beats per minute. Remember, there are no A-'s in pulse oximetry, anything below 94% is bad, assuming you don't have underlying lung disease or something. If you have any doubts about your oxygen saturation, go to the ER, quickly. And salty hydration helps a lot. Not just those water papooses.

Doc Brown