Post COVID management protocol

Background

COVID – 19 disease caused by SARS-CoV-2 Coronavirus is relatively a new disease, with fresh information being known on a dynamic basis about the natural history of the disease, especially in terms of post-recovery events. After acute COVID-19 illness, recovered patients may continue to report wide variety of signs and symptoms including fatigue, body ache, cough, sore throat, difficulty in breathing, etc. As of now there is limited evidence of post-COVID sequalae and further research is required and is being actively pursued. A holistic approach is required for follow up care and well-being of all postCOVID recovering patients. Scope This document provides an integrated holistic approach for managing patients who have recovered enough from COVID for care at home. It is not meant to be used as preventive / curative therapy. The recovery period is likely to be longer for patients who suffered from more severe form of the disease and those with pre-existing illness.

Post-COVID Follow Up Protocol

At individual level

• Continue COVID appropriate behaviour (use of mask, hand & respiratory hygiene, physical distancing).
• Drink adequate amount of warm water (if not contra-indicated).
• Take immunity promoting AYUSH medicine (details of medicines and their dosage is at Annexure I) – To be practiced and prescribed by a qualified practitioner of AYUSH. 
• If health permits, regular household work to be done. Professional work to be resumed in graded manner.
• Mild/ moderate exercise o Daily practice of Yogasana, Pranayama and Meditation, as much as health permits or as prescribed. o Breathing exercises as prescribed by treating physician. o Daily morning or evening walk at a comfortable pace as tolerated.
• Balanced nutritious diet, preferably easy to digest freshly cooked soft diet.
• Have adequate sleep and rest. 
• Avoid smoking and consumption of alcohol. 
• Take regular medications as advised for COVID and also for managing comorbidities, if any. Doctor to be always informed about all medicines that the individual is taking (allopathic/AYUSH) so as to avoid prescription interaction.
• Self-health monitoring at home - temperature, blood pressure, blood sugar (especially, if diabetic), pulse oximetry etc. (if medically advised)
• If there is persistent dry cough / sore throat, do saline gargles and take steam inhalation. The addition of herbs/spices for gargling/steam inhalation. Cough medications, should be taken on advice of medical doctor or qualified practitioner of Ayush.
• Look for early warning signs like high grade fever, breathlessness, Sp0₂ < 95%, unexplained chest pain, new onset of confusion, focal weakness.

At the level of community

• Recovered individuals to share their positive experiences with their friends and relatives using social media, community leaders, opinion leaders, religious leaders for creating awareness, dispelling myths and stigma.
• Take support of community based self-help groups, civil society organizations, and qualified professionals for recovery and rehabilitation process (medical, social, occupational, livelihood).
• Seek psycho-social support from peers, community health workers, counsellor. If required seek mental health support service.
• Participate in group sessions of Yoga, Meditation etc. while taking all due precautions like physical distancing.

In healthcare facility setting

• The first follow-up visit (physical/telephonic) should be within 7 days after discharge, preferably at the hospital where he/she underwent treatment.
• Subsequent treatment/follow up visits may be with the nearest qualified allopathic/AYUSH practitioner/medical facility of other systems of medicine. Poly-therapy is to be avoided due to potential for unknown drug-drug interaction, which may lead to Serious Adverse Events (SAE) or Adverse Effects (AE).
• The patients who had undergone home isolation, if they complain of persisting symptoms, will visit the nearest health facility. 
• Severe cases requiring critical care support will require more stringent follow up.

Immunity promoting AYUSH medicine

(to be prescribed only by practioners permitted under law for prescribing the medicine/therapy under specific stream)

• Ayush Kwath (150 ml; 1 cup) daily, Samshamani vati twice a day 500 mg (1 gm per day) or Giloy powder 1 -3 grams with luke warm water for 15 days, Ashwagandha 500 mg twice a day (1 gm per day) or Ashwagandha powder 1-3 grams twice daily for 15 days and Amla fruit one daily/Amla powder 1-3 grams once daily.
• Mulethi powder (in case of dry cough) 1- 3 gram with luke warm water twice daily
• Warm Milk with ½ teaspoonful Haldi in (morning/evening)
• Gargling with turmeric and salt 
• Chyawanprash 1 teaspoonful (5 mg) once daily in morning (as per directions from Vaidya) It is also suggested by the Ministry of AYUSH that the use of Chyawanprash in the morning (1 teaspoonful) with luke warm water/milk is highly recommended (under the direction of Registered Ayurveda physician) as in the clinical practice Chyawanprash is believed to be effective in post-recovery period.

Source : Ministry of Health and Family Welfare