darshan wrote:saip wrote:What is happening with Remidisivir? There seems to be huge black market. My brother in law's wife is in the hospital Guntur, AP and they can not get it. Someone has quoted 25k per injection (1.25 lakhs for five) and we have to arrange a car to get it from Hyderabad (180 km away).
Primus, DrRatnadip should chime in. Other alternatives have been introduced in the protocol. I have yet to find a concrete study that says that remidisvir is applicable to majority of cases. I have been on it since early March when GJ decided to stick with it and not change protocol. GJ eventually did change it to include others.
Darshan Ji, I do not manage COVID patients myself right now, but looking at the literature and talking to my colleagues who do, Remdesivir has not conclusively been proven to be of any benefit, but is still being used. The recommendation is grade 2C meaning it is a weak recommendation, the benefits being uncertain and grade C meaning evidence of benefit is based on observational studies and not clinical studies of the usual type for these things. Even then, in our local hospitals they are using it for hospitalized patients with O2 sats on room air falling to below 94% and who therefore require supplemental oxygen.
OTOH, dexamethasone is more likely to be of benefit as is some form of anticoagulation. This is all in hospitalized patients. For outpatient treatment Remdesivir is not indicated at all. The only thing useful as outpatient is monoclonal antibodies and possibly (not definite) convalescent plasma. Both require IV infusions and have their own set of problems - cost, availability etc.
Copying from teh American Lung Association's recommendations for breathing Improvement in general and also useful for COVID patients at home:
It has already been shown that 'proning', i.e. lying on your abdomen is beneficial in COVID because the larger portion of your lungs are in the back and get better aerated that way.
Breathing exercises that may help with dyspnea[
Pursed lip breathing exercises:
Sitting upright or slightly reclining, relax your neck and shoulder muscles.
With your mouth closed, inhale through the nose for 2 seconds, as if smelling a flower.
Exhale slowly (for 4 seconds if possible) through pursed lips, as if blowing out birthday candles. Repeat inhalation and exhalation cycles for 2 minutes, several times a day and when needed.
Deep breathing exercises:
Recline in bed or on a sofa with a pillow under your head and knees. If reclining is not possible, this may be done while sitting upright.
Place one hand on your belly, the other hand on your chest.
Slowly inhale through your nose; let your lungs fill with air, allowing your belly to rise. (The hand on the belly should move more than the hand on the chest.)
Breathe out through your nose, and as you exhale, feel your belly lower.
Repeat the inhalation and exhalation cycles for 2 to 5 minutes several times a day and when needed.