The guidance in this article should not replace medical treatment or advice. Those who notice signs of Covid-19 should contact their GP to see if they require a test. If you are diagnosed and experience mild symptoms, this information may help you cope with it while isolating at home.
Dr Sandhya Ramanathan is an Auckland-based GP who published an 18-minute YouTube video guide to managing mild cases of Covid-19 last June and watched it take off almost overnight. Her video has been viewed millions of times on social media platforms and was this week described as empowering and fascinating by doctors much closer to home.
Last March Ramanathan was “panicking, as we were seeing all these doctors getting sick and dying” so she started researching the illness. “I like to hope for the best but prepare for the worst,” she says.
She read journals and scientific papers and realised most of the available information focused on the scale of the crisis, or on measures aimed at avoiding contracting Covid. For those with the virus, there was little of use. “I found myself asking: where was the practical information to help people?”
So she started drawing up a plan of her own. By June it had turned into an easy-to-follow method for managing mild cases of the illness.
In a conversation with The Irish Times, she repeatedly stresses she is not suggesting it as a cure or even a treatment but a way people can help themselves if they do not need to – or for some reason cannot – access medical treatment.
She splits her management system into the following sections.
Priming the immune system
The first – priming – is straightforward and relevant to both people with and without Covid-19. To build up our immunity, she encourages people to eat healthy whole foods and keep hydrated. She highlights the importance of sleep and the need to stay calm and keep a positive mindset. She also says people should take daily immune supplements including zinc, vitamin C and vitamin D. All of these can help boost immunity, and a number of studies have suggested vitamin D can reduce the effects of Covid-19.
Reducing the ‘viral load’
The second section focuses on reducing the amount of virus in the nose – or the “viral load” for those who have Covid-19. For this she advises people to use saline gargles, with a couple of drops of an antiseptic solution twice daily, combined with saline nasal sprays. She offers a recipe for a home-made nasal rinse: 250ml cooled boiled water, half a teaspoon of bicarbonate of soda, half a teaspoon of salt and a few drops of antiseptic liquid.
Ramanathan recommends steam inhalation with Vicks, especially for people who have lost their sense of smell, and use of a nasal decongestant such as Otrivine nasal spray, and antihistamine tablets.
The third section of Ramanathan’s guide outlines steps people with the disease can take to protect their lungs. People with respiratory illnesses including Covid-19 are at risk of “hypoxia” or low levels of oxygen saturation in the blood. It became clear in the early stages of the crisis that many people were unaware their oxygen levels were dipping until it was almost too late.
She encourages people to invest in an pulse oximeter, an easy-to-use and relatively cheap device that measures oxygen levels in the blood. It is important such devices are bought from reliable sources and meet all EU safety standards and are for medical use.
Ramanathan says oxygen saturation levels should be managed daily for the first 14 days of the illness. A normal range is 95-100 per cent. Medical intervention is needed if it drops below 93 per cent, she says, or if people develop shortness of breath.
Breathing and sleeping
Ramanathan puts a huge emphasis on breathing techniques to keep airways open and outlines a range of breathing exercises. She suggests that the simple act of blowing up a balloon while seated creates positive end-expiratory pressure similar to that created in mechanical ventilation, while blowing bubbles through a straw into a glass can also be helpful. This technique is not a substitute for a ventilator – a crucial treatment for serious cases.
A practice known as proning, or sleeping on the stomach, can help avoid the collapse of air spaces at the base of the lungs. Ramanathan says the trick with proning is to position pillows along the torso and up to the head rather than just under the head.
She recommends box breathing, which sees people breathe out for three seconds, then hold for three seconds followed by a second three-second inhale and a second hold for three seconds. Ramanathan says the key is to focus on complete exhalation to empty the lungs. This will produce a deep inhalation reflex, optimising oxygen intake.
“I am a GP but I never appreciated the important of exhalation,” she says. “When you focus on breathing out, the inhalation is a reflex.”
She stresses that her advice is evidence-based and won’t cause harm. She repeats that her management system is neither a cure nor a treatment for Covid-19 but a way to give people an edge in the fight against the disease.
“What frustrates me is no one is telling anyone anything. If you look on the WHO site on the Centre for Disease Control site, where are the instructions for home management of Covid? Why aren’t people being told to buy a pulse oximeter or take vitamin D?
“Around 80 per cent of the cases are managed in the home, and all we are being told is take paracetamol and maybe eat soft foods. It is the same in every country and it makes me furious.”
There is, as she says, science behind her plan.
A study at Connolly hospital in Blanchardstown has pointed to lower vitamin D levels in Covid-19 patients admitted to its intensive care unit, while another from Germany found that hospitalised Covid-19 patients had lower vitamin D levels than less sick Covid-19 outpatients and in-patients with a vitamin D deficiency were up to 15 times more likely to need to be admitted to ICU. A small Spanish study saw 50 patients with Covid-19 getting a high dose of vitamin D and another 26 not given it. Half of the second group ended up in ICU while only one patient given the vitamin was admitted.
Other experts weigh in
Dr Laura Lenihan is a Galway-based GP who describes much of Ramanathan's Covid-19 management plan as "fascinating".
She says it is “important to realise that getting a diagnosis of Covid 19 is anxiety-inducing for most people and having something that they can control or do to help is a great option for many”.
It has, she says, been known for years “that we can support the immune system with supplements such as vitamin D”, while vitamin C and zinc have been shown “to support the immune system and there is some research that suggests vitamin C may help reduce the length of respiratory tract infections”.
She says the idea “that we would be able to reduce viral load of the Sars Cov2 virus in our respiratory tract is hugely exciting. There have been lots of small trials, mainly in-vitro studies, looking at this, and some small clinical trials, but there is no definite evidence that it will work on a large scale.
“I think Dr Ramanathan’s points are really interesting and could potentially work, but there is lots more research to be done in this area before we have a definitive answer.”
She says there is “no harm in having a pulse oximeter at home to measure your oxygen levels. This can give reassurance to some, though the anxiety-prone might become dependent on it.”
The breathing exercises, Dr Lenihan says, are “used by chest physios in the hospital when people are suffering with pneumonia. They do help to keep the alveoli in the lungs open and so could help prevent lung collapse leading to worsening of the disease.”
Prof Sam McConkey, an expert in infectious diseases at the Royal College of Surgeons in Ireland describes the essence of Ramanathan's management plan as "very reasonable" and says it is full of what he describes as "grandmother treatments", a term he makes clear he is not using disparagingly.
He says prone sleeping is done with Covid patients in hospitals across Ireland, "with better results than we expected", and he adds to Ramanathan's advice by saying people managing Covid at home who find it difficult to sleep on their stomachs can simply switch the side they sleep on every four hours for some benefit.
He says deep breathing exercises are a good way of keeping the lungs open, and again he adds a tip of his own.
“What we are seeing are an increase in the number of blood clots among Covid patients, and they can be disastrous if they get to the lungs.” People in hospital with the illness are routinely injected with anti-clotting agents but that is not possible in home management. McConkey says people should keep moving and do simple toe-wiggling exercises. He also advocates wearing “those ugly decompression socks” to keep circulation flowing.
Like Ramanathan he advocates the pulse oximeters and points out some patients with Covid don’t develop symptoms of hypoxia such as shortness of breath or even coughing and report as being merely tired. But the illness can be silently ravaging their lungs, causing their oxygen levels to drop to dangerously low levels before they are even aware of it.
He describes the pulse oximeter as “a very useful home technology” but has some caveats warning that a device placed on a cold finger can give a misleadingly low result. He also suggests counting breaths, and if someone has more than 20 in a minute it is a warning sign.
He says balloon exercises can help open airways. Saline rinses when it comes to the reduction of the viral load are worth trying and will do no harm, although he does not believe using clearly defined medical phrases such as “viral load reduction” is necessarily helpful given the lack of clinical evidence as to the efficacy of such steps.
My advice: Watch Ramanathan’s video. It might make those with Covid-19 feel a little better a little faster. And it definitely won’t make you any worse.
Watch Dr Sandya Ramanathan's Covid-19 video on irishtimes.com/video