C Reactive Protein based early intervention for home quarantined COVID-19 patients to avoid complications and hospitalization.

Arjunan, M.; U.R, A.; Verma, K.; Manimarane, O.

Background: As India was reeling under the relentless onslaught of the second wave of COVID -19, the hospitals were over-crowded and resources were inaccessible. Many COVID -19 positive patients had to stay at home and reach out to their family physicians for guidance. This gave us an opportunity to observe a group of patients in home quarantine. The challenge was daunting. We could not afford to allow these patients to deteriorate as hospital beds and oxygen support were not readily available. Therefore, we developed an innovative approach to monitor these patients and to intervene at the optimal time to avoid hospitalization. Based on objective biochemical tests like elevated CRP and clinical signs like persistent high-grade fever, we initiated early low dose steroids and antibiotics prior to the onset of hypoxia. None of the home quarantined patients deteriorated because of the timely medical intervention. These patients neither required oxygen support nor hospitalization. We therefore present our new treatment model for home quarantined COVID-19 patients along with our suggestions for implementing the model at the community level. Methods: 25 patients under home quarantine who contacted online for medical guidance underwent clinical and biochemical evaluation. CT radiological examination was done whenever indicated. Treatments were initiated under medical guidance based on the CRP values and clinical presentation. Results: Among the 25 patients, 40% of the patients (10/25) had mild symptoms with normal CRP. 24% of the patients (6/25) had mild symptoms with elevated CRP. 36% of patients (9/25) had elevated CRP with persistent high fever. All the 25 patients recovered over the next four weeks. Conclusion: We propose an early objective assessment of inflammatory markers like CRP prior to the onset of hypoxia during home quarantine and early, need-based intervention under medical guidance to avoid complications and hospitalization. Keywords: COVID-19; Home quarantine; C-Reactive Protein (CRP); D-Dimer, Early intervention prior to onset of hypoxia.