Introduction: The second wave of COVID 19 has hit India hard. In India 2.27 crore cases affected by the disease, 1.83 crore recovered and about 2.5 lakhs death. Worldwide, there have been 157,897,763 confirmed cases of COVID-19, including 3,287,082 deaths, reported to WHO.1 Below is the Case series of few such cases treated at Homeopathy Point. The cases are in acute format of case taking comprising of short presenting complaints, investigations and repertorisation/ indications of the medicine. Change of medicine was done, where ever there was change in acute totality.
Pathophysiology: It is very important to remember the day wise symptoms and understand the pathophysiology in cases of COVID 19 cases. In the rapid progressive and life-threatening form of viral pneumonia, the underlying pathology process is diffuse alveolar injury, coagulopathy and multiple organ failure.
Events below depict most common pathology sequence in Covid-19 cases
The pathologic changes evolves from alveolar capillary dysfunction and platelet activation
Followed by ↓
Intravascular fibrin and micro- thrombus formation
Left uncontrolled, it triggers ↓
Systemic dissemination and secondary fibrinolysis
Result in ↓
Platelet and coagulation factor depletion
Leading to ↓
DIC (disseminated intravascular coagulopathy) ↓
Multiple organ failure
Here’s how symptoms progress among typical patients clinically, though a typical patient may be infected without showing symptoms for five or more days.
- Day 1: Patients run a fever. They may also experience fatigue, muscle pain, and a dry cough. A small minority of them may have had diarrhea or nausea one to two days before.
- Day 5: Patients may have difficulty breathing – especially if they are older or have a preexisting health condition.
- Day 7: This is how long it takes, on average, before patients are admitted to a hospital, according to the Wuhan University study.
- Day 8: At this point, patients with severe cases (15%, according to the Chinese CDC) develop acute respiratory distress syndrome (ARDS), an illness that occurs when fluid builds up the lungs. ARDS is often fatal.
- Day 10: If patients have worsening symptoms, this is the time in the disease’s progression when they’re most likely to be admitted to the ICU. These patients probably have more abdominal pain and appetite loss than patients with milder cases. Only a small fraction die: The current fatality rate hovers around 2%.
- Day 17: On average, people who recover from the virus are discharged from the hospital after two-and-a-half weeks.
- DAY 19: shortness of breath resolves on this day.
The patient may not report any symptoms in the first 4 to 5 days and already in the full blown stage, by the time reporting to the doctor.
It is important to know the day of disease, to predict with certainty, the outcome of the disease. Some patient and attendants present with panic and anxiety, when they are already on the path of recovery.
Investigations and Importance
Investigations are important to know about the progress, severity and recovery of the patient. Especially when many patients are in home isolation, it’s important to know about the progress of the disease and prognosis of the case. Some of the commonly advised investigations are
(I) CRP/ C reactive protein: Of these clinical parameter, serum C‐reactive protein (CRP) has been found as an important marker that changes significantly in severe patients with COVID‐19. CRP is a type of protein produced by the liver that serves as an early marker of infection and inflammation. In blood, the normal concentration of CRP is less than 10 mg/L; however, it rises rapidly within 6 to 8 hours and gives the highest peak in 48 hours from the disease onset.Its half‐life is about 19 hoursand its concentration decreases when the inflammatory stages end and the patient is healing. When the inflammation or tissue damage is resolved, CRP concentration falls, making it a useful marker for monitoring disease severity.3
(II) Platelet: Low platelet count is associated with increased risk of severe disease and mortality in patients with COVID-19, and thus should serve as clinical indicator of worsening illness.
(III) D Dimer: D-dimer is a fragment of protein produced by the break-up of fibrin clots that are typically linked to each other. This is a biomarker of importance in suspected thromboembolism.
(IV) S Ferritin: Higher ferritin levels can be detected during an acute-phase response and may also play an important role in inflammation regarding development of a cytokine storm. Serum ferritin level was significantly higher in severe cases. 4
(V) Interleukin 6: High levels of inflammatory cytokines were observed in COVID-19 patients with more severe disease and were associated with pulmonary inflammation, lung damage and multiple organ failure
(VI) HRCT and ct score: the 5 lobes of the lungs and with each lobe divided into 5 segments. So, out of 5X5 = 25 segments, the hrct accesses the involvement of number of segments and severity of lung involvement. The CT score is expressed out of 25.
- 7 or less: mild
- 8 to 17: moderate
- 18 or more: severe
Other investigations include CBC, ESR, Neutrophil/lymphocyte ratio, Troponin I, ALT etc.
Second wave of COVID 19 in India is different than the first wave. In the last wave, usually one or few members of the family were affected. In this wave, all family members are affected in majority of cases. So, last year we had published few case reports at Homeopathy point but in this wave we are overwhelmed by the multiple members of the family presenting with the symptoms of the disease. So, this year we have compiled case series comprising of 5 acute/short cases of COVID 19 treated at Homeopathy Point.
It is important to mention here that not all patients show fall in oxygen, though oxygen monitoring is recommended in all patients. Some of the points we have observed at Homeopathy Point regarding oxygen saturation in second wave of COVID 19.
- It has been observed that many patients will see drop of oxygen levels less than 90 % from 9th to 11th day.
- After some of the patients had failed to secure admissions in the hospitals, we have observed that most people with mild to moderate pneumonia and mild to moderate thrombo-inflammation will have drop of oxygen levels upto 85% on 10 and 11 day and after that gradual increase in oxygen level is seen. The levels became above 93% by 13th to 14th day.
- Not all patients will show sharp decrease after 85%, but its recommended to keep a close watch on all patients, especially who have no access to hospitals and oxygen cylinders.
- Once improved above 93%, we have not observed any second time dipping of baseline Spo 2 in any patient. so, once improved it’s a positive sign of recovery.
With this case series on second wave of COVID 19 cases, we have attempted to cover wide range of symptom presentation of COVID and its homeopathic treatment in our compilation.
Case 1: A 54 year old male presented with cough and lethargy since 5 days, he showed rapid deterioration in oxygen saturation levels (up to 80%) and was given carbo veg 30, repeated doses. Patient showed partial improvement and there was no further dip in his saturation levels. His HRCT score on same day was 14/25. He was shifted to hospital for supplemental oxygen. Since the family has been taking homeopathic treatment with Homeopathy Point, they continued homeopathic treatment. The whole family was COVID positive at that time.
After hospitalization patient showed signs of panic and delirium with low grade fever. He cautioned his son, to not to go to corners of the room as he can see some shadows. Most of the times he was babbling, and others were not able to understand him. He expectorated bloody sputum in front of his attendant. He refused to get up from bed even for eating as he complaint of vertigo and generally he felt worse on getting up from bed. He was able to maintain saturation of 86% with oxygen supply 10L/minute
On the basis of reportorial totality, patient was given Phosphorus 200 in divided doses and told to report after 2 days. After 2 days, his family reported that” he came back to his senses”. He had no sputum, he was able to get up and eat. His oxygen supplementation rate gradually came down to 3L/minutes and he was able to maintain oxygen saturation to above 90%.
Patient complaint of pain around the lower area of chest and dry cough only. He is given Bryonia 30 for the present complaint. The patient is still under observation and reporting consistent improvement in pain in lower chest.
Case 2: 70 year old female taking treatment for Myasthenia gravis presented with low oxygen saturation level of 87 %. Her husband informed that she is having difficulty in breathing, nausea and feels as she have to pass stools. She was getting irritated on being told repeatedly to lie down in prone position. She was given Nux vomica 200 and was asked to report in the evening. She was better, her Spo2 rose to around 92. She was not having nausea and was able to pass stools. She complaint of weakness after 3 days and given Gelsemium 30, twice a day for 2 days. Her spo2 was maintained around 95 on 13th day.
Case 3: A 38 year old male presented with cough, cold and fever after washing clothes in cold water. He was given Aconite 30, repeated doses. Meanwhile his RT-PCR report came positive. Patient showed signs of rapid worsening of symptoms. He was advised to get blood reports and HRCT chest done. His LDH level was 605. His HRCT showed COVID 19 pneumonitis with CTSS of 11/40
Patient was prescribed Tuberculinum 200/in divided doses. Points of prescription for Tuberculinum were Pneumonia after influenza and mucus rattle in chest without expectoration. He showed improvement in cough and other symptoms after 3 days. He was given Antium Tart 30, twice a day for 4 days after he again complaint of lot of phlegm which he was not able to expectorate. He was better in 10 days. The patient never showed any decrease in oxygen saturation. We would like to emphasize that the early use of homeopathic medicines, helps in easy recovery and helps avoiding complications.
Case 4: A 49 year old male patient presented with pain in throat, with mild cold, fever and running nose since 5 days. He had got first dose of COVID vaccination 3 weeks back. Since he was having typical symptoms of COVID 19, he got the RT PCR test done, which came out to be negative. He consulted Homeopathy point with above symptoms and was advised to get Rapid Antigen test done, which came out to be positive.
He had pain in throat while swallowing. Fever with chilliness and sneezing. He never had cough. So, he was not advised HRCT. He was given Hepar sulphur 200/1 dose. After 2 days there was relief in all symptoms but he complaint that there is still some pain left, so it was repeated. He reported relief in all symptoms and no appearance of any new symptoms after 5 days.
Case 5: A 42 year old male presented with loss of smell and loss of taste with no other symptoms. His whole family of 5 people presented with same symptom. They all tested positive for COVID 19.
The whole family of 5 was given Pulsatilla 200/1 dose. The complete repertory also mentions Pulsatilla in epidemic loss of smell. All of them reported return of smell and taste in 3 to 5 days. The whole family passed the 14 days without any other complaint.
The cases in this case series covers various presentation of the COVID 19 cases in second wave. We will publish the second case series soon.
Dr Renu Pande, MD
Founding Member – HomeopathyPoint
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Bibliography:
1 WHO corona virus Dashboard
3 https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.26097