Even after testing negative for COVID-19 the patient cannot survive without oxygen support. Please help.

Question

Hi doctor,

These are the treatment details of a 54-year-old severe pneumonia patient with a height of 5 feet 4 inches and weight of 154.32 Ibs each day from testing COVID-19 positive of a patient. On the first day of the symptom, her blood sugar levels and fever were high. So COVID-19 kit was given by the doctor. For the first three days, she used the kit. On the third day, they gave glucose and saline. On the fourth day, she had a heavy cough without any breathing issues. On the fifth day, she got admitted to a hospital. On the sixth day, the blood sugar levels raised to 625 mg/dL. So they moved the patient to ICU; the spo2 level was 82 percent with one oxygen cylinder. On the seventh day, a Bevacizumab injection was given. On the eighth day, they gave Remdesivir's first dose. Ninth-day plasma was transferred to the patient and gave Remdesivir's second dose. On the tenth day, SpO2 became 95 percent, and the third dose of Remdesivir was given.

Eleventh-day Bevacizumab injection was given early in the morning. Twelfth day SpO2 was 85 percent with two oxygen cylinders. On the thirteenth day, the fourth dose of Remdesivir and the fourteenth-day fifth dose of Remdesivir was given. On the fifteenth day, 25 liters of oxygen was given, and SpO2 was above 90 percent with one half-cylinder. Sixteenth-day sixth dose of Remdesivir was given with SpO2 level between 95 percent to100 percent. After these two days, they provided no treatment, and the patient was under observation. After two days, the SpO2 was 70 percent with a one and a half oxygen cylinder. The next day SpO2 was between 95 percent to 98 percent with one and a half cylinder. Now the patient has recovered from COVID-19. Meanwhile, she tested negative in blood samples. COVID-19 infection is still there, and therefore oxygen consumption is still 30 liters, and without oxygen, the patient cannot survive. Please help.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for the query.

I can understand your concern. According to your statement, your patient has been suffering from severe COVID-19 (coronavirus disease 2019) pneumonia. Though your patient has become COVID-19 negative, she is now in the ICU (intensive care unit) and suffering from tachycardia, tachypnea, anemia, and severe pneumonia. She is in critical condition now. Corticosteroids like Dexamethasone, broad-spectrum antibiotics to prevent secondary infections, and iron supplements should be added to her current medication. Due to her raised blood sugar levels, and her body has not yet responded to her current medication regimen. So, her raised blood sugar level should be controlled strictly first while continuing her current medication. If her oxygen saturation becomes raised without oxygen inhalation therapy and persists above 95 percent, then she will recover from her present condition over time. Take care. In case of any other query, ask me.

Answer 2

Hi,

Welcome back to icliniq.com.

The patient needs energy. So, give her food, whichever she likes except sugar-containing foods. According to your description, your patient has received antiviral medications, monoclonal antibodies like Bevacizumab, etc. Most of the medicines usually used in the treatment of COVID-19 infection have already been given. Some medicines like Dexamethasone to reduce inflammation and improve respiratory functions, broad-spectrum antibiotics to prevent secondary infection, antihistamines, and leukotriene receptor antagonists like Montelukast for improving bronchospasm, etc., can be given if they have not been added to her treatment regimen. Your patient can repeat HRCT (high-resolution computed tomography) of the chest to exclude pleural effusion, pulmonary fibrosis, or other COVID-19 associated complications or consequences.

In the case of pleural effusion, diuretics should be added, and lung fibrosis reducing drugs should be added in the presence of pulmonary fibrosis.

Your patient can take the medication as follows with her current medications,

Tablet Azee (Azithromycin) 500 mg once daily at night for seven to ten days.
Tablet Dexamethasone 4 mg morning and night after food for ten days.
Tablet Allegra (Fexofenadine) 120 mg at night for ten days.
Tablet Singulair (Montelukast) 10 mg at night for 15 to 30 days.
Tablet Levolin (Levosalbutamol) 1 mg thrice daily for 15 to 30 days.
Nebulization with Levosalbutamol and Budesonide for two to three times daily if needed.

You can give the medications mentioned above along with her current medications. It is necessary to find out the exact cause for which her present condition is not improving. So repeat HRCT of the chest to exclude pleural effusion, lung fibrosis, or other respiratory complications. Take care. In case of any further query, knock me.