Clinical Cases

Covid 19 in a Man of 56

Drs. Amit Arora and Udesh Kumar share a case of Covid-19 in a Man of 56. Symptoms included irascibility, anxiety about health, dry mouth, fever with chill and chest pain while coughing.

A 56-year-old male, Mr. X, consulted us on 4th May 2021 with fever since that morning. The complaint started on 3rd of May with irritation in throat. He started doing warm water gargles and the irritation in his throat got better but then in the morning the fever appeared.

On taking further history, it was found that his son just recovered from COVID 19 and Mr. X was the one who was taking care of his son. Considering him as the high risk contact and a suspect case of COVID 19, as per the guidelines, he was advised to get isolated at home immediately and start following the guidelines of Govt Of Indian for home isolation, instructions for which was clearly given to him.

On taking further history, it was found that his son just recovered from COVID 19 and Mr. X was the one who was taking care of his son. Considering him a the high risk of COVID 19, as per the guidelines, he was advised to isolate at home and start following the guidelines for home isolation.

He was advised to get the COVID-19 test done. The following symptoms were reported:

  1. High fever (1020F) with chill since morning.
  2. Fatigue since the fever.
  3. No desire to eat.
  4. Mouth dry
  5. Urging remaining after stool since last 2 days.

The patient stated the thought of being COVID 19 positive has generated the following feelings:

  1. Anxiety that something bad may happen.
  2. Anxiety that other members of family may also get infected.
  3. Worry about what would happen if he gets severely affected.
  4. Feeling irritability since not well.

Medical history: For fever patient already started allopathic antipyretic.

Co-morbidity: Nothing significant

Physical generals:  Thermal reaction: In general hot patient, but presently chilly with fever.

Appetite: poor

Thirst: Normal

Stool: ineffectual urging

Urine: NAD

RTPCR report: Positive for COVID 19 (dated 05 May 2021)

Totality of symptoms:

Patient was properly counselled and motivated. The case was repertorised by Vithoulkas compass system. The following rubrics were taken (Table 1 – Repertorisation table)

  1. Mind –Irascibility
  2. Mind – Anxiety –Health about
  3. Mind – Anxiety –others for
  4. Mind –Fear –Misfortune of
  5. Mouth – dryness
  6. Stomach –Appetite –Diminished
  7. Rectum -constipation – ineffectual urging and straining
  8. Fever – chill with
  9. Generalities – weakness – fever during

(Repertorisation Table 1)

Selection of remedy: Sulphur

Potency: 200C

Prescriptions:

Date Follow up status Prescription Investigations if any Advice given
1st prescription 04-04-21 Sulphur 200C /BD/2 days

Ferrum phosphoricum 6x/2 hourly/2 days

 2nd prescription 05-04-21 Temperature: 1010F

SPO2: 98%

Irritability little reduced.

 

 

CST* RTPCR: Positive for COVID 19

 

Advised to stay away from bad news. Keep himself occupied with positive thoughts and positive news.
3rd prescription 06-05-21 Temperature maximum 1000F.

 

SPO2: 97%

 

Fatigue is there but a little reduced.

 

Stool: better

 

Cough started since a day. Cough < night

 

Chest feeling pressure

 

Pain chest on coughing.

Lycopodium clavatum 30C/QID/1 day

(See repertorisation table 2)

CBC-

TLC: 8200/cumm

N67L20M8E3

B0.5

ESR: 24mm/hr

 

CRP: 87.92mg/L (raised)

 

 

Keep monitoring SPO2 at least 3 times a day.

 

Record SPO2 after 6 minute walk test.

 

4th prescription 07-05-21 Temperature not more than 990F

 

Fatigue improved

 

Cough persisting.

Lycopodium clavatum 30C/QID/1 day SPO2: 97%

 

SPO2 after 6 minute walk test: 96%

 

5th prescription 08-05-21 Temperature 98.50F

 

Cough better

Lycopodium clavatum 30C/QID/1 day SPO2: 97%

 

SPO2 after 6 minute walk test: 96%

6th prescription 09-05-21 Temperature 98.60F

Cough better

 

Lycopodium clavatum 30C/QID/1 day CBC-

TLC: 8200/cumm

N68L23M7E0

B0.2

ESR: 24mm/hr

 

CRP: 15.16 mg/L (decreasing trend)

7th prescription 10-05-21 Feeling of well being

 

Temp: 98.60F

Lycopodium clavatum 30C/QID/1 day
8th prescription 11-05-21 Feeling of well being

 

Temp: 98.60F

Lycopodium clavatum 30C/QID/1 day
9th prescription 12-05-21 Feeling of well being

 

Temp: 98.60F

Lycopodium clavatum 30C/QID/1 day CRP: 6.33 mg/L (decreasing trend)

 

SPO2: 97%

 

 

10th prescription 13-05-21 Temperature: 98.6 0F

 

No specific complaint

Lycopodium clavatum 30C/QID/1 day SPO2: 98%

 

11th prescription 14-05-21 No complaint Sac Lac 30/tds/3 days Advised to consult if any new complaint arises.

As patient started feeling better and also clinically stable with normal SPO2 and no temperature since last 7days and CRP took decreasing trend with no appearance of new symptoms, and considering the stable clinical condition of the patient, no further investigation was advised and he was asked to follow normal daily routine along with following of COVID appropriate behavior.

On 20-05-21: RTPCR test for COVID 19: Negative (as per protocol, the test was not needed but patient got it done himself for his own satisfaction).

Basis of prescription:

Organon of Medicine, aphorism 73 states that:

As regards acute diseases, they are either of such a kind as attack human beings individually, the exciting cause being injurious influences to which they were particularly exposed. They are generally only a transient explosion of latent psora, which spontaneously returns to its dormant state if the acute diseases were not of too violent a character and were soon quelled.

Allied to these are those diseases in which many persons are attacked with very similar sufferings from the same cause (epidemically); these diseases generally become infectious (contagious) when they prevail among thickly congregated masses of human beings.

Thence arise fevers, in each instance of a peculiar nature, and, because the cases of disease have an identical origin, they set up in all those they affect an identical morbid process, which when left to itself terminates in a moderate period of time in death or recovery1.

So as per Aphorism 73, homeopathically, the early manifestations of COVID 19 can be a transient explosion of latent Psora. As the virus enters the human body, the body starts reacting to the virus and tries to eliminate it. Due to those reactions, the early symptoms like the general/physical symptoms start appearing, where the body tries to fight the virus and the virus tries to replicate. So, in the early stage of COVID 19, based on the symptomatology, an antipsoric homoeopathic remedy may need to be selected1.

So Aphorism 73, clearly stating the present day scenario of COVID 19, terminating in recovery or death. So as per this aphorism, the early manifestations of COVID 19 are only a transient explosion of latent Psora. As the virus enters the body, the body starts reacting to the virus and tries to eliminate it. Due to those reactions, the early symptoms like the general/physical symptoms start appearing, where the body tries to fight with the virus and virus tries to replicate. So in the early stage of COVID 19, based on the symptomatology, an antipsoric remedy is to be selected1.

Prescription 1: Sulphur

After repertorising the symptoms (Table 1), based on reportorial analysis, SULPHUR was selected which is an antisporic medicine.

Prescription 2: Lycopodium Clavatum

In COVID 19, as the disease progresses, the hyper-inflammatory reactions happen and thrombus formation starts in blood vessels and resulting COVID pneumonia develops2.

Homoeopathically, this phase of disease denotes the SYCOTIC state (Miasm) of disease and we need to understand that if we are dealing with this state of COVID 19, an antisycotic medicine may need to be selected based upon symptomatology of the case. In the next phase of COVID 19, when patients enter in the severe category of diseases, that phase may require a homoeopathic remedy which is anti-syphlitic.

Now in this case, on 06-05-21, the patient presented with high CRP3, appearance of cough, which is showing that disease has entered into an inflammatory stage. We needed to reconsider our prescription.

Repertorisation was done by Vithoulkas Compass system (Table 2) based on symptoms (refer to prescription table for symptoms) of patient at that time and an antisycotic remedy (LYCOPODIUM CLAVATUM) was selected.

(Repertorisation Table 2)

Conclusion: As COVID 19 is an acute disease and may rapidly progresses into worse manifestations, so the aim of treatment in this should be:

  1. To check the progression of disease to moderate/severe category, to prevent the hyperimmune reactions of body against the COVID virus.
  2. The recovery should be fast. As per aphorism 2, Organon of Medicine, it should be rapid, gentle and permanent restoration of health.
  3. Early recovery may lead to lesser or no post COVID 19 complications.

Disclaimer: This is a standalone case report and for the purpose of sharing knowledge. All the guidelines stated by the Government of India for management of home isolation cases of COVID 19 were followed in this case and along with that, homoeopathic medicines were given for the symptomatic recovery of the case. The remedies given are individualistic to this case and the same remedies may not be suitable in other case of COVID 19.

  1. Early recovery will lead to lesser or no post COVID 19 complications.

Reports:

1. RTPCR for COVID 19 (05-05-21)

2. CBC and CRP reports dated 06-05-21

3. CBC and CRP reports (dated 09-05-21)

4. CRP report (dated 12-05-21)

5. RTPCT for COVID 19 (Negative report)

References:

1. Dudgeon R.E, Organon of Medicine (Fifth and sixth edition) by Dr. Samuel Hahnemann, M Bhattacharyya & Co. (P) Ltd. 8th Indian edition, 1987.

2.  Koichi Yuki, Miho Fujiogi, Sophia Koutsogiannaki, COVID-19 pathophysiology: A review. Updated on June 2020 [Cited on 2021 May 22]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S152166162030262X?via%3Dihub

3.  Nurshad Ali, Elevated level of C‐reactive protein may be an early marker to predict risk for severity of COVID‐19. Updated on 2020 June 09 [Cited on 2021 May 22]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301027/#:~:text=A%20significant%20increase%20of%20CRP,mild%20or%20non%E2%80%90severe%20patients.

Repertorisation Software:

1.     Vithoulkas Compass

About the author

Amit Arora

Amit Arora

Dr. Amit Arora (B.H.M.S) has been working as Medical officer for the past 14 years in the Directorate of AYUSH, Department of health and Family Welfare, Govt of NCT of Delhi. He is presently posted as Chief Medical officer at Delhi Govt. Health Center, Dist. Court Dwarka and Kanganheri. He received a “Homoeo Icon Award” from the Delhi Homoeopathic Federation in 2019. He has experience teaching for three years in Dr. B R Sur Homoeopathic Medical College and Hospital.

About the author

Udesh Kumar

Udesh Kumar

Dr. Udesh Kumar (M.D) has been working as Medical officer for the past 13 years in the Directorate of AYUSH, Department of Health and Family Welfare, Govt of NCT of Delhi. He is presently posted as Chief Medical officer at Delhi Govt. Health Center, Delhi Secretariat and Nand Nagri. He received a “Hahnemann Award” from the Delhi Homoeopathic Board in 2018 and “Homoeo Icon Award” from Delhi homoeopathic Federation in 2019. He has experience of teaching for two years in Nehru Homoeopathic Medical College and Hospital.

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