The new strain of the virus is causing more and early hypoxia. People are suffering from low oxygen levels suddenly. Hypoxia occurs due to thromboinflammation.

The hypoxia that was occurring on the 5th day due to early strain it is now occurring on the 3rd day due to new strain. 

Sleeping in the prone position with early blood thinners and early steroids as these medications can prevent early hypoxia.

The new strain of the COVID-19 virus that is spreading in India is leading to very high CRP levels in the body compared to the previous strain. CRP is the response of the body to the virus, so this means that body has a strong response to the virus. 

If virus load is more, it is indicative of more viruses in the body hence more is the TH-1 response leading to increased CRP levels. The new strain is causing more rise in CRP levels which indicates more inflammation. 

In the new strain, COVID-19 infection the CRP level is increasing from day 1 to day 3 but the peak is earlier and it is rising much more and much earlier. The D-dimer level also increases on day 2 and day 3 while there is a fall in platelet count on day 4 and day 5. 

Most of these resolve but this virus is causing more inflammation and thromboinflammation therefore early steroids and early blood thinners are much more important in this strain than earlier strain.

This is Dr. KK protocol 44 approved by the confederation of medical association of Asia and Oceania and Heart care foundation of India round table sutra.

Post-vaccine COVID-19 infection can be primary or breakthrough. Primary infection is the one in which a person has not developed antibodies and got a COVID-19 infection. 

Breakthrough infection occurs when the person has COVID-19 antibodies but still gets infected and hence has antigens in the body and is an actual post-vaccine COVID -19 infection. 

Post vaccine COVID-19 infection is more contagious, has lower cT value, has an early incubation period, has a high fever, often have spared lungs, has a cough and cold, have high CRP values, have children involvement, it’s a spreader, R0 value is anticipated to be high. This pattern is usually seen in post-vaccine COVID-19 infection.

This pattern can be divided into two types that are primary vaccine and breakthrough vaccine. 

The primary COVID-19 infection occurs immediately after the vaccination and is more contagious with a Lower cT value, and an early incubation period with full-fledged COVID-19 symptoms. 

If after 2 weeks when antibodies have developed in the body and antigen has entered the body leading to systemic inflammation with which indicates very high fever, high CRP levels, and lung non involvement is called breakthrough COVID-19 infection

This is a COVID-19 FAQ 43, Sutra 10 approved by the Confederation of medical association of Asia and Oceania and Heart care foundation of India round table and association of health care provider of India and the patient safety group.

How can we suspect COVID-19 infection after vaccination? 

If a person is suffering from cough, nasal symptoms, throat pain, and breathlessness after getting the vaccination, these symptoms are not due to the vaccine; this has to be a COVID-19 infection.

The vaccine can have different side effects but not cough and throat pain so rule out COVID-19 infection.

When can a person who developed COVID-19 infection after the first dose take his/ her second dose of vaccine?

This Dr. KK Covid Protocol 42 This is a COVID-19 FAQ approved by the Confederation of medical association of Asia and Oceania and Heart care foundation of India round table.

The answer to this most frequently asked question is; wait for 8-12 weeks before getting the second dose of vaccine. According to Dr. KK Aggarwal if a person has developed COVID-19 infection after the first dose of vaccine he/ she should wait for 3 weeks before getting the second dose. 

The most common question people are asking is whether they have suffered from COVID-19 infection or not should they take their second dose of vaccine at 6 or 8 weeks. 

According to the government, the covaxin second dose should be administered between 4 to 6 weeks interval while the covishield vaccine second dose should be administered between 6 to 8 weeks interval.

During the present scenario, with the very high rate of infections and vaccines, to prevent post-vaccine COVID -19 infections, high-risk individuals with co-morbidity, may consider taking a second dose as early permissible by the government as mutations are possible due to such high rates of infection.

If vaccine should be administered between 4 to 6 weeks person with high risk should get vaccinated in the 4th week while if the vaccine should be administered between 6 to 8 weeks high-risk person should get vaccinated in the 6th week.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 8) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 40.

When giving blood samples for Covid testing, first give samples for CBC and CRP and only then for RT-PCR. 

RT-PCR will only tell you whether the virus is presently infecting your body or not. But CBC and CRP help you understand how severe is the infection and whether you can deal with it at home in quarantine, or you need hospital care.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 7) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 39, i.e. Home self-monitoring of CRP.

CRP is the earliest marker of inflammation, that rises in 4 hours, peaks at 36 hours, and crashes in 17 hours.

Qualitative test strips are available like blood sugar tests, and cost around Rs. 10, and glucometer-like tests cost around Rs. 60.

The market cost has increased from Rs. 150 to Rs. 1000 due to shortage.

Qualitative tests only tell you whether CRP is <6 or >6. Test CRP at home by yourself and aim to make it negative.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 6) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 38.

All diabetics when given oral steroids (not inhaled steroids) will have high PP sugar and will need sublingual oral anti-diabetic drugs in addition or insulin 0.3 units/kg/day in divided doses.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 4) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 36, i.e. control the inflammation by Day 3 and thrombo-inflammation by Day 5 of Covid-19.

Covid inflammation is at its peak on Day 3 - pneumonia occurs, time for CT scan, CRP is at its peak, and TH1 response inflammation occurs.

By Day 5, if inflammation is not targeted, one may develop TH17 response, neutrophil recruitment, and thrombo-inflammation.

Bring CRP to <5 by Day 5. If this target is missed, try to bring CRP to <10 by Day 10. If even this target is not attainable, then the prognosis is poor.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 4) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 36, i.e. control the inflammation by Day 3 and thrombo-inflammation by Day 5 of Covid-19.

Covid inflammation is at its peak on Day 3 - pneumonia occurs, time for CT scan, CRP is at its peak, and TH1 response inflammation occurs.

By Day 5, if inflammation is not targeted, one may develop TH17 response, neutrophil recruitment, and thrombo-inflammation.

Bring CRP to <5 by Day 5. If this target is missed, try to bring CRP to <10 by Day 10. If even this target is not attainable, then the prognosis is poor.

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 3) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 33, i.e. preventing deaths during Covid.

If not contraindicated in high risk, comorbid Covid confirmed or suspected people, starting early low dose steroids (Prednisolone 40mg) and blood thinners (Aspirin 75mg or Warfarin 2-2.5mg or newer anticoagulants) may not harm or may prevent complications.

Steroids are needed for 10 days and blood thinners for at least 4 weeks

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 2) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 33, i.e. preventing vascular heart and non-heart complications, i.e. heart attacks, strokes, abdominal vascular complications, etc.

In case of no contraindications (hypersensitivity or GI bleeding), in comorbid or high risk individuals with suspected silent or confirmed blockages anywhere in the body, consider low dose Aspirin (75mg) before, during and after Covid or Covid vaccination

After the discussions that took place in the Confederation of Medical Association in Asia & Oceania (CMAAO) followed by the round table at Heart Care Foundation of India (HCFI-RT), the following Sutra (Sutra 1) was passed. This now becomes a part of Dr. K. K. Aggarwal's Covid protocol no. 33, i.e. preventing vaccine clots in women.

There are reports of vaccines causing clots from all around - Astrazeneca (available as Covishield in India), Johnson & Johnson - and vascular thrombotic complications being reported for several other vaccines out there. This is specifically affecting women of varying age groups. 

In case of no contraindications, consider using low dose Aspirin (75 mg), which is very cheap in India, for hormone bearing women, i.e. women who are menstruating, bearing children, or on hormone replacement therapy (HRT) before and after the Covid vaccination to prevent clots.

This is a much better alternative than avoiding vaccination in this population group altogethe

The most frequently asked question today is that should I consult my doctor or not before getting vaccinated. According to Dr. KK Aggarwal the answer is both yes and no as many vaccination centers may bear to provide doctor for consultation. 

Here is the conversation between serum Institute Company and the patient. The patient has mailed his query as follows:

Person:

Covishield is contraindicated in case of hypersensitivity to the active substance or to any of the excipients listed below:

1. L-Histidine

2. L-Histidine hydrochloride monohydrate

3. Magnesium chloride hexahydrate

4. Polysorbate 80

5. Ethanol

6. Sucrose

7. Sodium chloride

8. Disodium edetate dehydrate (EDTA)

Serum Institute:

Since you have mentioned that your mother is taking steroids, we anticipate that she may have relatively weaker immune response to the vaccine regimen compared to immunocompetent individuals.

Please consult your mother’s physician for a risk benefit assessment based on clinical judgment before she takes the vaccine.

Person should consult his/ her physician before taking vaccine is associated with both risk and benefit and hence it should be weighed.

According to WHO the benefits should outweigh risks in every individual. Individuals with more benefits compared to risks should be vaccinated. If risks outweigh the benefits the vaccine should not be administered to the person. 

Many cases are being reported that after vaccination severity of rheumatoid arthritis and psoriasis has increased and many other cases are reported whose symptoms have been cured so the vaccine can behave either way. 

Symptoms have been resolved in patients who have COVID-19 infection from a longer duration that is long haulers. Long COVID-19 infection and autoimmune symptoms can increase or either decrease. 

The vaccine can kill the leftover virus and its fragments and can decrease immune system damaging that is can reset the immune system. So we don’t know how the vaccine will respond in every person.

The person should report whether his/her underlying disease severity has increased or decreased as after getting appropriate data the pattern of vaccine effect on people can be studied. 

Currently, both types of patterns are being observed as in some people underlying diseases symptoms are increasing and in some people, underlying symptoms are decreasing.

The most important question these days is how often I should repeat the CRP test.CRP test is of two types qualitative and quantitative test.

 A qualitative CRP test is a strip test that tells whether the person is COVID-19 positive or negative that is CRP is either more than 6 or less than 6 respectively. A qualitative CRP test is important for follow-up because the aim is CRP should be less than 6.

Normally by the 5th day, if the qualitative CRP test is negative there is no need for further follow-up. Doctors expect CRP should be less than 5 by the 5th day or at least less than 10 by the 10th day. 

If a person is not COVID-19 positive, two CRP tests should be performed within a 2-week interval called baseline CRP. If CRP is increasing and the person is COVID-19 positive, a CRP test should be performed every day because CRP starts rising within 4 hours and crashes within 17 hours due to injury or infection which means CRP crashes within one day.

If the CRP level is decreasing CRP test should be performed on an alternate day. If CRP levels are stable it indicates that the patient is stable. 

CRP tests should always be done in mg/l and not mg/dl. According to Dr. KK Aggarwal if the person is having CRP>10 get it done every day to check whether it is rising, falling, or stable. If CRP levels are increasing it is either due to inflammation or thromboinflammation. Normally CRP level should change within 17 hours and it must start crashing which is a sign of recovery.

The most peculiar situation these days is that visitors coming from abroad after getting both the dose of vaccine in their country and after arriving in India are tested positive when RT-PCR is done.

Here Dr. KK Aggarwal explains giving a situation that if an NRI visits India after getting both the dose of moderna vaccine in America and gets COVID-19 positive when RT-PCR is done in India. In such a situation get the test repeated to rule out any contamination. The test should be done in two different laboratories to get confirmation of the results. 

The person should get all the gene RT-PCR tests done that are ORF 1a, ORF 1b, E gene, S gene, N gene, and RDRP gene to confirm if it is a mutant virus. Check cT value, S gene target failure, and E gene target failure. If required genomic study should also be performed because the person has to return to the country after isolation. 

Post vaccine COVID-19 infection is already known, a person who has received moderna vaccine which has 90% efficacy in America still has 10% chances of getting infected with new strain in India. The person should also go for a Rapid antigen test (RAT) that tells whether he/ she is infectious or not. If the cT value is very high with a positive RAT test there are chances of infection, if the RAT test is negative there are chances that person is not infectious. 

C- reactive protein CRP should also be checked for testing the positivity of the virus which means whether the virus is causing any type of inflammation or disease in person or not. The person should also go for a D-dimer test to check for thromboinflammation. The same situation is applicable if a person goes from India to any other country.

Steroids are widely being employed as the mainstay of treatment for COVID-19. Prednisolone 40mg and Dexamethasone 6mg are equivalent steroid doses that require no tapering off if the duration of treatment is less than 10 days. If they need to be used for more than 10 days, tapering off is necessary.

The regimen of steroid treatment requires the doctor to prescribe Prednisolone 40mg or Dexamethasone 6mg for 10 days. Since both have abuse potential, these drugs can only be procured on presentation of a valid prescription.

Colchicine, a steroid sparing drug, is added to avoid having to use steroids for a prolonged period. 

Steroids should be continued as long as the CRP does not come down to <5 in 5 days or <10 in 10 days. If the CRP does not come down and pneumonia persists, then that is a sign of rising tissue inflammation.

In such a case, doctors should continue steroids, add colchicine and blood thinners, and ask the patient to get CRP testing done daily. Employ Vitamin D and Artemisinin as well if required. 

But, if CRP continues to rise despite using steroids, it is essential to rule out thrombo-inflammation. Then, use non-heparin blood thinners for anticoagulation.

Normally, steroids are not used in viral diseases. However, Covid is a notable exception to this rule. The dose and period will be decided by your doctor.

An oxygen concentrator is the need of the hour in India. All NGOs, RWAs, companies and even families should try and buy an oxygen concentrator for themselves. 

The Heart Care Foundation of India Sameer Malik Heart Care Fund is distributing oxygen concentrators for free in Delhi. You are free to use them as required and then return them back. Contact the HCFI Sameer Malik Fund via SMS on the mobile number 8595041424.

Localities and housing societies are advised to put together money and buy an oxygen concentrator for the use of their people as and when required.

Are you totally confused regarding which COVID vaccine to take? Is Covishield the right choice for you, or would Covaxin suit your body better? Or should you wait for Sputnik, Pfizer or Moderna to start being administered in India? Watch Dr. K. K. Aggarwal explain how you can think clearly amidst all this confusion and make the right choice for yourself when it comes to Covid vaccines.

Dr. K. K. Aggarwal suggests that you trust your doctor completely in this regard. He is the best person to take this decision on your behalf and in your best interests. Don't trust WhatsApp messages being thrown around. Don't even trust the company-generated biased reports saying one vaccine is more efficacious than the other.

Feel free to ask your doctor about the efficacy, safety, national and international case-based results of the vaccines. This will help in clearing all confusion regarding which vaccine to take.

Follow your doctor just like Arjun followed Krishna in the Mahabharata and you will find yourself in a much better position to take the decision, based on solid evidence rather than word-of-mouth.

In this video, Dr. K K Agarwal, will talk about the anti-allergic kit one should keep at home. Internationally and even in India it is stated that if anyone in your home has a history of allergies such as from honeybee, prawns, fish, pulses, from climate or sun or someone has allergic asthma, always keep a first aid anti-allergic kit at home. The kit should include Montair LC (montelukast 10mg + levocetirizine 5 mg), famotidine 20 mg, injection adrenaline, syringes, needles and spirit swabs.

In an emergency, if anaphylaxis happens, the patient should know how to take adrenaline injection, consult your doctor for this. Carry this box whenever you take any injection or vaccine as the hospital may or may not have it. So, you need to be ready with precaution. These medications are prescription drugs, hence take a prescription from your local doctor and keep this kit ready when planning to go for vaccination.

Dr. K K Agarwal, will talk about smell and taste gone during COVID infection and post vaccine too. Loss of smell and taste means that you have coronavirus infection and after the vaccine if there is no smell and taste then you have contracted the virus. Loss of taste and smell means it is a mild disease and will not have serious pneumonia.

This sensation can last for a week, a month or 9 months too. It can be partial or complete such as only smell or only taste can go. If it is possible, get a CRP test done. Start colchicine 0.5 mg daily and take symptomatic treatment. Fluticasone nasal spray can be sprayed in the nose. This will recover slowly. Try to smell different things in your home. There could be an altered sense of smell, do not worry, slowly it will recover.

Dr. K K Agarwal, will talk about what to do if the oxygen levels become low. Many people have questions related to low oxygen levels such as should I take the patient to the hospital, or keep at home, no beds or oxygen concentrator available, etc. All are confused. First of all, reconfirm whether the oxygen levels are dropped or not. Check if the machine is working properly and your finger is not shaking. The value has to be stable for 30 sec to one minute, before stating it as hypoxia. 

One can walk a bit and then check, if it comes normal then it is not hypoxia and if it is dropping then it is hypoxia. Recheck multiple times with different fingers. Hypoxia is common during night while sleeping especially in obese person, people who snore or in asthma and COPD patients.

If it is confirmed that SpO2 levels are low, then immediately sleep on stomach, it will come to normal. Make provision for an oxygen concentrator and start oxygen at home 2 litres/min. Iif still the oxygen levels are dropping then it is due to pneumonia. Consult with your doctor and immediately start 40 mg prednisolone or 36 mg predmet. Along with this take mefenamic acid 500 mg and colchicine 0.5mg. if you have fever then normalise it. First rule out the false alarm of hypoxia and then talk to the hospital.

In this video, Dr. K K Agarwal, will discuss the antibodies that formed after the coronavirus infection or vaccine. There are no guidelines given by ICMR yet about the antibodies.

Dr Lal PathLab has a neutralizing antibody test that shows it neutralizing properties. Another test is IgG S1/S2 antibody test which indirectly shows that your antibodies are neutralizing. Till date, we don’t know how much antibodies are required and till when the vaccine has its power. Everything has been assumed. 

The best way to prevent the coronavirus infection even after taking both the vaccine shots is to take all the necessary precautions. If the antibodies are formed then the infection rate will be low as three types of antibodies are produced: neutralizing, binding and non- neutralizing. So, one should take the vaccines and also follow all the precautions that are necessary.

In this video, Dr. K K Agarwal, will talk about when one should take the second shot of COVID-19 vaccine. The Government of India has stated that Covishield 2nd shot to be taken after 6-8 weeks and , Covaxin 2nd shot should be taken after 4-6 weeks. Sputnik V vaccine should be given after 3 weeks.

Dr. K K Agarwal suggests that if there is no contraindication, then the second dose should be taken as early as possible whenever available. If the authorities say that 6-8 weeks, then take after 6 weeks and if it is 4-6 weeks, then take after 4 weeks. There is a rapid increase in the coronavirus infection. There is a pressure on viruses and it can mutate. Therefore, the vaccination should also increase. If you wait for long, the virus might mutate and one can get post vaccine COVID infection. 

When you take the second dose of vaccine, you shouldn’t have COVID infection, no acute illness, blood pressure, diabetes, cholesterol levels should be under control. Also, rule out silent inflammation and  blockages before going for vaccination. Also evaluate the side effects caused during the first dose of vaccine and discuss it with your doctor

If you've done or are about to do the RTPCR test, ask the technicians which test they are performing.

The genes mostly tested are:

1) E gene: Negative test doesn't always mean Covid-negative (E gene targeting failure). Other genes should also be tested.

2) RDRP gene

3) ORF 1a/1b genes

4) S gene: S gene targeting failure is caused by the UK variant.

5) N gene

Ask for the cT value of each gene tested for.

What if you have extra-pulmonary systemic inflammation from Covid? It can happen in Covid as well as after taking the vaccine.

The presentations are:

1) High fever not responding to a single NSAID

2) Very high CRP

3) Lungs are spared

4) Skin rashes may be seen

5) Loose motions may occur

6) Eye inflammation

7) Hearing loss

8) Uncontrolled diabetes complications

9) Blood pressure may increase

10) SGOT and SGPT may rise

If you have Covid or recently got vaccinated, and your fever is continuously high in the range of 101-106 degrees Fahrenheit.

High grade fever can mean pneumonia or systemic inflammation.

Do the following:

1) Sponge and sit under the shower

2) Take Mefenamic acid tablets (Paracetamol might not work)

3) Take Paracetamol with Mefenamic acid if fever doesn't subside

4) Talk to your doctor before taking steroids in case of very high fever

5) Don't rely on SPO2 in case of really high fever. The primary aim should be to bring the fever down, as equipment measuring SPO2 often fails to give accurate results.

6) Colchicine may be taken if needed.

The patient should continue his/ her Covid-19 appropriate behavior because after the first vaccine the chance of Covid-19 infection is maximum as cases are increasing. The patient may not be having any side effects so the patient should keep watch on themselves. On the first day, the patient is kept under observation for 30 minutes at the vaccination center.

The patient should observe after 4-6 hours whether he/ she is having any skin rashes if yes, the patient should consult a doctor. The patient is given a montelukast or H1, H2 blocker as a treatment for rashes. After 3 to 4 days patients should check for redness or rashes at the site of injection due to cell-mediated hypersensitivity reaction which is not a serious condition. On the 5th -day, patients need to check for swelling in any body part, persistent headache,  rashes, or blue-colored patches.

If these are present, the patient should test whether his/her platelet count is low, or the D-dimer levels are increasing. If the patient is having a simple allergy take medication. In case they have systemic inflammation like a high fever on the 2nd or 3rd day,.

the patient’s CRP test it will come very high but without any lung involvement. If lung involvement is not there then it is not Covid-19 infection, it is systemic inflammation and can be corrected by meftal. If after vaccination patient is suffering from respiratory symptoms like cough, sore throat, or fever then it is Covid-19 infection. This infection may occur before, during, or after vaccination as sore throat, cough, or sputum cannot occur due to vaccination.

Many people have a question: I have to go for vaccination but have an active Covid-19 patient in my family, what should I do? This is a very common situation. The patient should go for a CRP test as it can be possible that the patient is suffering from asymptomatic post-vaccination Covid-19 infection.

Many cases are getting infected with Covid-19 even after the vaccination. The patient should get his/her Rapid antigen or RT-PCR test done and check for symptoms like sore throat, fever, or cough which shows the increased chances that patient is suffering from Covid-19 infection.

If the person is suffering from asymptomatic infection and goes out for vaccination he/ she can have chances of systemic inflammation and can also infect people at the vaccination center. This is a peculiar situation as the vaccine is available and family members are getting infected. Consult your family doctor before getting a vaccination if a family member is infected.

CRP more than 10 after 10 days of covid-19 is a peculiar condition and this can be possible in 15%-20% of patients. Normally CRP should start declining by day 5 that is it should be below 5 on the 5th day. If CRP is >= 10 on the 10th day it is the sign of persistent inflammation in the body due to virus, formation of persistent clots , or a secondary infection due to mycoplasma or any other bacteria or fungus. For CRP levels, it is tested whether the mefenamic acid formation is stopped, whether Colchicine was given or not or stopped, is steroid dose less and needed to be increased as usually it is given for 10 days, is blood thinner dose less or they are not available, whether vitamin D was given or not. Mefenamic acid is considered as NLRP blocker, steroids as PLA-2 blocker, Colchicine as nuclear factor kappa β blocker,

a Blood thinner for neutrophilic induced clot formation, Vitamin D as IS-17 TH-17 inhibitor, and artemisinin as a TGF β blocker. Therefore CRP should be < 5 by the 5th day if not then it should be <10 by the 10th day.

The WHO stated that shortage means non-availability of essential drugs. Essential drug is one without which a patient can die. Remdesivir is not an essential drug and does not save lives. In mild to moderate cases, it decreases the recovery and hospitalization of the patients by 1-2 days. So, do not end up in guilt, if you could not get it. The WHO tells doctors not to use Gilead’s Rremdesivir as a coronavirus treatment in hospitalized patients. That is, it can be given in mild to moderate cases but in severe cases it does not have an advantage.

The WHO group said currently there is no evidence that Rremdesivir improves the survival rates or the need for ventilation. The recommendation was published in the British Medical Journal (BMJ). According to the FDA, doctors can use Rremdesivir as a coronavirus treatment. Its usage depends on the doctor’s experience and the severity of Covid-19 infection.

The first one is primary Covid-19 which is routine while the second one is mutant Covid-19 like the U.S. strain occurring in children leading to R-gene target failure. The one that is spread in Punjab is mutant Covid-19 while South African mutant is not spreading in India till now. It is highly contagious and the vaccine may not work on it but there are no shreds of evidence where it is spread in India. The Brazilian strain has a higher mortality rate in Brazil but is not spreading in India.

It can also be a 448452 double mutation that is spreading in Maharashtra. E-gene target failure vaccine in which RT-PCR comes negative but the patient still experiences Covid-19 symptoms.  The third one is re-infection which is when a patient who has suffered from Covid-19 infection again gets infected. The chances of re-infection are mostly due to mutant Covid-19 infection and can either be pulmonary or systemic. Pulmonary means pneumonia and systemic means eyes, skin, GIT, liver, or blood inflammation.

Another one is an interaction between the vaccine and Covid-19 infection., The first one is post-vaccine Covid-19 that occurs after the first or second dose of vaccine and can be of both types pulmonary, that is, . primary Covid-19 and non-pulmonary (or breakthrough Covid-19). Breakthrough Covid-19 means that both antibodies and antigens are present in the body as the vaccine is also administered and after that Covid infection also occurred. If the post-Covid-19 vaccine is administered after Covid-19 infection patient can suffer from systemic inflammation. All these types can be mild, moderate, or severe, and then pulmonary and Non-pulmonary. 

In this video, Dr. K K Agarwal talks about Dr KK COVID Protocol 9. He will talk about risk free vaccines. If you are a woman between the age group of 18 and 48 years or premenopausal, the chances of clot formation is higher. Such women should take 75 mg of aspirin as a prophylaxis.

For other people, do a 6-minute walk test and if you walk more than 500 metres in this duration without fall of oxygen levels (SPO2) and breathlessness, if you don’t have any abdominal obesity (<80 cm in females, <90 cm in males) or your C-reactive protein (CRP) is less than 1, then one can go ahead with the vaccine. There is no need for any test.

But if you cannot walk for 500 metres in a 6-minute test, abdominal obesity is more, then get a C-reactive protein test done (mg/L). If your CRP is more than 2 and you have liver or skin problems, gastric disorders, or eye problems, then also it is fine to get vaccinated. After vaccination, one can get high grade fever or an increase in internal inflammation . Premedicate such people with colchicine 0.5mg once a day to reduce the CRP levels. 

If one has high blood pressure or uncontrolled diabetes, of if they person is a chronic smoker or bypass patient or with stents, then it is best to consult the doctor to premedicate with colchicine, aspirin and statin before getting vaccinated. If CRP is more than 2, then there could be silent blockages in the heart.

Statins are given for high cholesterol. One should consult their doctor before getting vaccinated.

In this video, Dr. K K Agarwal will talk about the blood clots after receiving Covishield vaccine. Clot formation has to be prevented in women aged between 18 and 48 years. The blood clots are mostly seen in the age group of 18 to 48 years. 

Till date Covaxin and Sputnik V have not shown such side effects. It is not known whether the virus is from gene or vector. If it is from gene then everyone should get it. If the virus is from vector, then how which adenovirus vector one should know such as OX1, AD 26, or AD5.

If women are in pro-coagulative state and there are more hormones in their body, then a low dose aspirin should be taken before the vaccine shot and continued till the 2nd week of receiving the second shot . If they want more prevention, then this can be continued till the 3rd week of vaccination. This will help to prevent blood clot formation in women.

In this video, Dr. K K Agarwal talks about the Dr KK Covid Protocol 7. The most common query nowadays faced is that one has serum IgE levels high. Generally, the IgE levels should be less than 200 IU/L, but in some people, it can be more than 1000 IU/L.  Asthma patients can also have high IgE levels.

Many people have this confusion whether they should take a vaccine or not. If one has a history of allergy, then check your eosinophilic count.

If the eosinophilic count is more, i.e., 5%-7%, then deworm yourself. Albendazole 400 mg for three days is given. Every six months one has to do deworming.

If your absolute eosinophilic count is more than 1500 IU/Land you live in an area where there is tropical eosinophilia, (for example, Vidarbha in Maharashtra) then one has to take hetrazan full course to reduce the levels. Sometimes even steroids are given to few patients. 

If there is nothing as mentioned and still you have high IgE levels, then you have a history of allergy. In this case, you need to premedicate yourself as per vaccine allergy protocol. If your IgE is more than 1000 IU/L, then it doesn’t mean you have severe allergies but multiple allergies.

If you have multiple allergies, then steroid is given before the vaccine shot. Even adrenaline drip is kept ready if you have a history of severe allergy. For people with allergies, an allergy kit should always keep ready with adrenaline injection in it.

The most common question asked is how can a person know if they are reinfected with COVID-19. Earlier it was reported that reinfection occurs after 90 days but now ICMR has changed it to 104 days. If a person is diagnosed negative for COVID-19 after treatment and again tests positive for the infection after few days, then it is clinically called reinfection. This can also occur before 104 days but requires genomic study.

According to ICMR, 4.5% of people are reinfected with COVID-19 in India. It is unlikely that a similar strain virus will cause re-infection; mutant viruses like the UK, South African, Brazilian, and E gene target failure strains, and the Indian 484452 double mutation virus can cause reinfection.

The severity of the reinfection depends on the type of mutant strain. It is studied that if a person is infected with COVID-19 i once, it triggers gamma interferons in the body which does not allow any other virus to get severe. However, COVIDovid-19 is an unpredictable virus and both mild as well as severe re-infection are visible in the population.

The chances of severe infection are less since there are only 2-3 examples in the literature where there is death due to re-infection. Theoretically, re-infection can be mild, moderate, or severe and can be of two types: pulmonary or classical pneumonia COVID-19, or non-pulmonary systemic COVID-19 infection in which predominantly the GI tract is affected.

This leads to loose motions and inflammation in any body part like skin, liver, or heart. These two types of re-infection can occur as initially the COVID-19 virus entered the body, then again the mutant entered the body. Therefore, the two types of virus are present in the body.

In such a case, the D-dimer test is performed to prevent excessive clotting and C-reactive protein (CRP) testing is also done to determine increased CRP levels in systemic inflammation but not in pulmonary COVID-19. A complete blood count (CBC) test is performed to determine whether the response is TH-1 indicating low lymphocytes or TH-17 indicating high polymorphs to check when they are increasing or decreasing. TH-17 response occurs on the 5th day and TH-1 response occurs on the 2nd day.

RT-PCR CT value test is also performed if CT value is low then it indicates re-infection. The RT-PCR test helps determine whether there is E gene target failure or S gene target failure. That is, multiple gene testing is done to make sure that all the tests are performed in the laboratory as sometimes labs do not perform all the tests. For example, only E gene target test is performed which is negative and hence negative COVID-19 report is given to the patient while they have a positive N gene. S gene target failure indicates a positive E gene, RDRP, and negative S gene in the UK strain. Other types of gene target failure can also occur in the future. Treatment is similar for both first COVID-19 infection and re-infection and it cannot be said that this will not be contagious and has to be treated similar to a primary infection.

C-reactive protein (CRP) is the marker of inflammation. Its level increases within 4 hours; the peak is attained within 36-48 hours and collapse within 17 hours in the body. This means by the 4th day of any injury or inflammation in the body, the CRP should crash and settle down.

If this does not occur then the patient either has baseline systemic inflammation or current inflammation. It is necessary to make sure that CRP is < 5mg/dl and qualitative CRP test is negative by the 5th day. In such cases, the patient is safe. Fever > 101oF indicates continuing systemic inflammation or pneumonia. 

If by the 5th day, the 6-minute walk test shows a decrease in Spo2 levels, it means there is an increase in pneumonia severity. Usually, pneumonia occurs by the 3rd day so if the severity increases by the 5th day, it indicates that D-dimer is increasing and platelets are decreasing. Usually by the 5th to 7th -day, lymphocytes should start increasing and polymorphs should start decreasing. However, during this phase, lymphocytes decrease and polymorphs increase. 

Initially, D-dimer and platelet levels increase but then D-dimer increases but platelets decrease by 30%. Thus, if pneumonia is complicating by the 5th day, then it is clotting pneumonia as inflammation pneumonia occurs by the 3rd day.

It is therefore  necessary to take oral anticoagulants with antibiotics on day 5th pneumonia. During this time most people take Enoxaparin or low molecular weight heparin but in Dr. K K Aggarwal's protocol low molecular weight heparin is not used as in some clot cases heparin-induced thrombocytopenia can precipitate and vaccine-induced thrombocytopenia (VIT) can also occur in some cases. Therefore if CRP is >5mg/dl, Fever is > 101oF, increase in pneumonia severity, the patient is unable to walk due to breathlessness, Spo2 level falls, increased D-dimer levels, decrease in lymphocyte levels with increased polymorphs, and platelet count is decreased by 30% by the 5th-day patient should immediately contact their doctor. The majority of patients should settle down by day 5th.

Majority of population can have different allergies exacerbated by various triggering factors. 

The most common allergies include:

• Food allergy such as sea food, animal proteins  

• Dust allergies, which can precipitate asthma

• Insect allergies (cockroaches, bees)

• Pollen allergy

• Animal allergies (hair or dendrites of animals) 

• Allergy from oral drugs like penicillin, sulpha group, cipro group etc. 

It is important to note that oral drugs can cause allergies unlike injectable ones, which can cause anaphylaxis. The difference is mainly attributed to the fact that oral drugs do not contain preservatives which can cause anaphylaxis. However, injectable drugs may contain preservatives such as polysorbate and polyethanol glycol, which can lead to anaphylaxis, for which a Scratch test is required.

What needs to be done before taking a vaccine, if I have an allergy?

The key to preventing any anaphylaxis in case an individual has an allergy is to premedicate.

The protocol that needs to be followed is:

• Montelukast 10 mg

• H1 blocker levocetrizine 5mg

• H2 blocker famotidine 20mg

These medications should be started 2 days before vaccination and continued for 3 days after the process so as to prevent any anaphylaxis. However, it is crucial to remember that if you take a stag dose of the abovementioned protocol, it can subdue and delay anaphylaxis but will not completely prevent it. 

Therefore, it is mandatory to continue these medications for 3 days after vaccination in order to prevent anaphylaxis.

General complaints after vaccination

If a patient complains of throat pain or sore throat, nasal symptoms, mild cough or mild breathlessness after getting either first or second dose of vaccination, is it because of vaccination?  

The answer to the above-mentioned question is “No”. This is because, the vaccine cannot cause these symptoms as it is administered only in the muscle. Hence, you can get a muscle COVID-19 instead of respiratory COVID-19 after either first or second dose of vaccination. If you experience the above symptoms after first or second vaccination, it cannot be induced by the process.

Other reasons of pulmonary symptoms

• Flu or 

• Covid infection acquired before, during or after vaccination. 

Prevention from Covid infection during vaccination

In order to prevent yourself from being infected during vaccination, wear double masks at the vaccination centre. 

Do not remove your mask while registering yourself, but rather talk through it. 

It has been reported that people are getting infected with the COVID-19 virus at the vaccination centre by patients who are COVID-19 positive yet asymptomatic .

In summary

Although some patients may complain of sore throat, cough, shortness of breath, and nasal symptoms after getting vaccinated against COVID-19, it may not be vaccine induced. You cannot get a pulmonary or respiratory COVID-19, but muscle COVID-19. This is because the virus, genes or proteins are introduced in the muscle, not anywhere else in the body.

Contact refers to being around a person with suspected or confirmed COVID-19 for greater than 15 minutes. If someone comes in close contact with a suspected or confirmed case in a crowded or ill-ventilated place without a mask then it is confirmed that the person has a COVID-19 infection.

In such a case, the person should themselves. After isolation, it is important to go for a CRP test to check baseline inflammation in the body. If contact is strong enough to get infected, then the person should start taking Ivermectin 12 mg once daily. Since it is a longer-acting drug,one tablet is sufficient in a day.

One should also take, Doxycycline 100 mg once daily for 3 days as it is an anti-viral and anti-inflammatory drug and also stabilizes the plaque. The person should also start taking 0.5% to 1% Povidone-iodine Betadine gargle two to three times a day. If the CRP of the person is greater than 1 with a greater risk of infection the doctor will add colchicines 0.5 mg daily. 

Here, the at-risk  patients are those with uncontrolled diabetes mellitus, obesity, higher cholesterol, uncontrolled blood pressure, angina, heart blockages or fatty liver, etc. Vitamins like zinc vitamin C and D should also be started so doctors prescribe multivitamins and wait for symptoms.

If the person starts showing symptoms, they should go for RT-PCR or RAT tests and if symptoms don’t appear till the 5th day the person should go for RT-PCR or RAT on that day. If tests are negative on the 5th day, it indicates they did not get infected or have minor severity. Thus, the close history of contact can be of a single person or multiple people in a family.

DAY ONE: CONFIRMED/SUSPECT/PROBABLE

Day one means that the patient may have confirmed, probable, or suspected Covid-19 infection. Suspect means that the patient may have a very high degree of suspicion means he/she has come in contact with somebody. Probable means that the patient is not a positive case of Covid-19 but having classical symptoms and confirmed means the patient is already a confirmed case of Covid-19.

The first test to be done is CRP that is done in mg/L that is from the baseline CRP, simultaneously with CRP CBC is also done in which neutrophils to lymphocytes ratio is tested.

Serum IgG antibody test is also performed and finally RT-PCR or RAT test. CRP tells the severity of inflammation in the body and if CRP>10 it indicates pneumonia or systemic inflammation.

If the N/L ratio> 3.18 it is observed whether neutrophils increased or lymphocytes decreased as increased N indicates TH-17 inflammation and low L indicates TH-1 inflammation. If serum IgG antibodies are already present in the body it indicates re-infection.

Positive RT-PCR indicates confirmed Covid-19 infection but it does not tell that whether Covid-19 infection was in past or present as sometimes it can be positive for 3 months.

If RAT is negative with positive RT-PCR then there are chances that the patient is not infected.

A higher cT value in RT-PCR shows a low infection, If the E gene is negative and other genes are positive it indicates E gene target failure while E and RDRP gene test are positive with S gene failure then it is U.K. strain. If the cT value is very low it is also the suspect of U.K. strain.

The patient should take Ivermectin 12 mg, Doxycycline 100mg, and colchicine as a treatment on the first day of infection after consulting the doctor.

There are two types of CRP tests qualitative and quantitative, qualitative indicates positive or negative CRP, and if CRP< 6mg/L it shows low-grade inflammation.