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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 84-89

COVID-19-affected family treated at home through integrative approach: Upbringing the concept of ayurvedic family physician for COVID cluster management


Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow University, Lucknow, Uttar Pradesh, India

Date of Submission26-Jul-2021
Date of Acceptance02-Sep-2021
Date of Web Publication14-Dec-2021

Correspondence Address:
Dr. Sanjeev Rastogi
Department of Kaya Chikitsa, State Ayurvedic College and Hospital, Lucknow University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_60_21

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  Abstract 


The second wave of COVID-19 pandemic in India had been highly devastating to the family and community clusters. It has simultaneously affected many within a close community including the family and has posed unique issues related to health care. A pan India disruption in hospital-based health-care delivery during the second wave has increased the trouble manifolds in cases where many members of the family were simultaneously affected. Family physicians through online consultations have played crucially to navigate the family from this grim situation. During prevailing uncertainty of availability of dependable hospital-based care, most people remained bound to home care following the advice of their respective physicians. Ayurveda family physicians also have played decisively in this phase. This is observed that the families treated in an integrative mode utilizing the standard home care recommendations along with standard Ayurveda care as per the Ayurveda physicians' recommendations, got benefitted most. As is shown in the case under study, all patients in the family cluster suffering from SARS-CoV-2 infection, recovered completely in a short span and, despite brief episodes of lowered oxygen in between, did not require any hospitalization. This observation highlights the importance of Ayurveda family practice during the current pandemic and warrants more serious studies to define the role and impact of Ayurveda family practice during the pandemic.

Keywords: Ayurveda, COVID-19, family cluster, family physician


How to cite this article:
Rastogi S. COVID-19-affected family treated at home through integrative approach: Upbringing the concept of ayurvedic family physician for COVID cluster management. J Ayurveda Case Rep 2021;4:84-9

How to cite this URL:
Rastogi S. COVID-19-affected family treated at home through integrative approach: Upbringing the concept of ayurvedic family physician for COVID cluster management. J Ayurveda Case Rep [serial online] 2021 [cited 2022 Jan 27];4:84-9. Available from: http://www.ayucare.org/text.asp?2021/4/3/84/332437




  Introduction Top


SARS-CoV-2 has strong transmissibility within family settings.[1] Delayed and denied diagnosis, common utility spaces, inadequate isolation, and close interpersonal contacts are the reasons for easy lateral transmissibility of SARS-CoV-2 within the family. SARS-CoV-2 pandemic affecting the family clusters has posed novel issues and problems related to the health-care burden in a family setting. Simultaneous effective care to each affected member of the family and at the same time preventing others in the family from catching the infection arrives as a mammoth task to one who has taken the responsibility of care of the family. Analysis of the family cluster cases suggests that COVID-19 had no age or sex predominance and hence affects everyone in the family. Although secondarily infected members in a family tend to develop milder illness, there can be contrary outcomes with gross morbidity and mortalities within a family.[2] Large families, including three generations in a single dwelling, allow an easy lateral and vertical transmission of the disease in particular to the terminal generations, both the elderly and infants. A comprehensive family care is required in such cases where each one in the cluster living close to the index case in the family needs monitoring, screening, and action as per the actual need. Besides active treatment to those who are symptomatic, a longer duration of quarantine for asymptomatic and symptomatic family members has been recommended to break any possibility of family transmission.[3] We, however, know that in reality, in country like India having an average household of 4.6 persons[4] and average living space of 494 Sq.ft in rural and 504 Sq.ft in urban areas giving an average of 100 ft area per person,[5] such quarantine is nearly impossible. As a consequence, family clusters getting affecting during epidemic are inevitable.

During the second wave of COVID-19 pandemic, India faced an unprecedented increase of caseload eventually leading to near collapse of its already overburdened health-care system.[6] Active COVID-19 cases outnumbered the available beds in the hospitals, and an acute shortage of beds equipped with the ventilator facilities created a chaos in the country. Shortage of oxygen and lifesaving drugs in hospitals and markets made the situation further grave. Many of them were forced to remain at home despite their falling oxygen levels warranting hospitalization.[7] The saddest part of the situation is that many causalities in the second wave have actually been caused due to the unavailability of medical aid in time which could have been saved otherwise.

The burden over a family in a situation where many of its members have contracted the disease and where there are uncertainties related to access and availability of medical care is unprecedented. No one can feel the state of agony and helplessness, which might have been faced by each individual member of the family, especially those who are in charge of the family care.

The situation was responded differently by different people depending upon their level of access and affordability to the premium resources as per the situation. Failing to get adequate support from modern health-care facilities at the time when it was urgently needed, many have been forced to be diverted to unsupervised alternative health care or even unsupervised home care. The outcomes of this approach were as expected, and in the second wave, the country has seen more deaths in home care comparing to the hospital care.

There was also a small fraction of people or families who were able to fetch the expert opinion from Ayurveda during this phase of extreme crisis. These were the people who either had been connected to some ayurvedic physicians for some other reason or have searched extensively through authentic databases of published medical literature to find if anyone within their reach has treated similar cases with the help of Ayurveda. Teleconsultation means have come as a boon during the pandemic, where it was nearly impossible to get physically connected with a physician.[8] Teleconsultation not only has provided means of connection to the people living in the same locality where the health-care provider is placed, but also it has provided a connectivity to the people from faraway places even from outside the continent.

This was observed that in this difficult time, those who had a good support system, had a good connectivity with their trusted family physician, and had faith in Ayurveda could sail through smoothly despite facing critical periods of lowered oxygen levels, which in normal course would have warranted an urgent hospital admission. This was important to note that trust of the parents on a health-care system and a physician played crucially to determine the net outcome for other members of the family too.

COVID-19 outbreak has posed many challenges to general practitioners and family physicians. Less research has been done on how actually COVID-19 has affected family practice and how it could be utilized for an optimal family care during the pandemic.[9] In Ayurveda, such studies have never been attempted so far.

We present here a family cluster comprising four members inclusive of parents and their two adult children. Three among four in this family came positive for COVID-19 in a successive manner. Since the start of the symptoms, the family remained in contact with their ayurvedic physician and followed all the instructions carefully besides following the standard treatment guidelines for home care as issued by the authorities. It was observed that despite some transient oxygen crisis during the course of illness for two among three, it was managed well and all of them recovered completely without any residual features. This is also noteworthy that two among three who suffered from the disease, were belonging to high-risk groups owing to their age (63 years and 59 years, respectively) and comorbidities (hypertension and chronic obstructive pulmonary disease [COPD]). This family cluster management for SARS-CoV-2 in an integrative mode in home setting with favorable outcomes demonstrates the utility of Ayurveda interventions in family cluster management. It also shows that initiating Ayurveda interventions in early phases of the disease possibly plays a crucial role in determining the net outcome.[10] Psychological support in the form of having connectivity with a trusted physician throughout the course of the illness also played decisively in determining the net outcome.


  Family Cluster Description Top


It was a nuclear family having a middle socioeconomic status comprising father (AB 63 years), mother (KB 59 years), son (UB 31 years), and daughter (AUB 29 years) native of Lucknow. Father was a computer professional working in a private organization and mother was a homemaker. Son was a computer professional in job and daughter was also working. Entire family had a good educational background. The family was in touch with the concerned Ayurveda physician for the past many years for their routine health care. Entire family had a trust upon Ayurveda system of medicine and often used it as a first-line therapy for their routine health-related issues. This is how when the symptoms suspected for SARS-CoV-2 infection broke out in the family, they immediately sought advice from Ayurveda and followed it wholeheartedly.


  Course of Illness and Intervention Description For Each Individual Member of the Family Top


Father

The father was aged 63 years with no comorbidity of concern who received his first dose of Covaxin on April 4, 2021. From the next evening, he felt body pain, joint pain, and restlessness. He also had fever which was measured to be 102°F. On April 6, he noticed a loss of smell and taste. The fever continued for which he took paracetamol on as and when needed basis. On the next day (April 7), body pain was reduced, but he developed mild cold and cough. He lost appetite and did not feel any hunger throughout the day. He started taking zinc and Vitamin C tablets on his own. From April 10, he again developed features such as body ache, fever, and severe weakness. On April 13, he tested positive for COVID-19 through reverse transcription–polymerase chain reaction (RT-PCR). He started following the conventional protocol comprising zinc, Vitamin C, doxycycline, azithromycin, and paracetamol immediately in recommended doses and duration. He also took the advice from his ayurvedic family physician and was advised to have tablet Ashwagandha (500 mg) and tablet Guduchi (500 mg) twice in a day. After starting all medicines, he felt chest pain, dry nose, and throat with mucus and blood clots. Increased dryness in the throat and nose was noticed. This was soon relieved by applying Ghee constantly in both nostrils. On April 23, he noticed the comeback of taste and smell. He started feeling hungry and energetic. Temperature was recorded between 99°F and 100°F. All medicines were continued till he had symptoms. He was retested for RT-PCR this time (April 28), but the report came positive again. Now, he was feeling little energetic and was able to do his own activities of daily living with ease. On May 13, his repeat RT-PCR test came negative. He had improved appetite and normal taste and smell sensations. There was occasional feeling of weakness, chest pain, and headache. Sometimes, there were mild coughing and dryness in the nose. His SpO2 during the course of illness remained between 96%–99%. During the whole course of therapy, he followed the dietary recommendations of his ayurvedic physician comprising freshly cooked, light, and easily digestible food and also took steam inhalation and hot gargle in an off-and-on basis.

Mother

The mother was aged 59 years having COPD diagnosed in 2015 and on regular medication for this since then. She experiences mild cough and occasional breathlessness throughout the year. She also received the first dose of Covaxin on April 4, 2021. She, however, did not develop any symptom. On RT-PCR testing, she was found positive on April 13. Standard medication as per the current protocol was started along with Ayurveda recommendations for tablet Ashwagandha (500 mg) and tablet Guduchi (500 mg) twice in a day. She developed fever (99°F–101°F) and mild cough in the meantime. Her SpO2 remained in between 95% and 98%. On April 18, she developed coughing, breathlessness, vomiting, and loose motions. She was added with a probiotic and Proton Pump Inhibitor (PPI) and was additionally added with Chausath prahari pippali (500 mg) twice in a day and Shringarabhra rasa (125 mg) twice in a day. During coughing and breathlessness episodes, her SpO2 level was reported to be between 93% and 95%. In the next three days, vomiting, loose motions, coughing, and breathlessness were completely relieved. These medicines (except PPI and probiotic), however, have been continued for the next 20 days. On May 13, she was tested again and found negative for RT-PCR. In post COVID phase, she had mild fatigue and occasional coughing. She continued to take hot water and steam and resumed her household chorus gradually.

Son

The son was aged 31 years, otherwise in perfect health, who started with high-grade fever (101°F–104°F) on April 22, 2021. There was no loss of taste, smell, or appetite initially. After taking paracetamol for 1 day, he started on standard medication from the next day along with tablet Ashwagandha (500 mg) and tablet Guduchi (500 mg) twice in a day. On April 25, he was found RT-PCR positive. Subsequently, he developed extreme weakness and constant chest pain and severe breathlessness. SpO2 level was dropped to 88% at around 3 pm with fever of 102°F. He was given some postural advice (pronated lying) to ease the breathing. At 3.45 pm, his SpO2 level was improved to 91%. Chausath prahari pippali (500 mg) thrice in a day and Shringarabhra rasa (125 mg) thrice in a day were immediately added to his treatment since he started breathlessness. There was a gradual decrease in fever and breathlessness. Due to his cough and breathlessness, he was unable to take steam, so was given nebulization with Budecort (recommended by a modern physician practicing nearby) at around 5 pm. SpO2 at the end of day was observed to be 95%. On subsequent days, his chest discomfort, cough, and breathlessness reduced although he continued to have fever. He continued to have the same Ayurveda medication along with nebulization (now without Budecort) two times in a day. SpO2 level was maintained between 94% and 96%. From April 27, there was no chest pain or breathlessness. SpO2 was reported to be between 94% and 97%, and there was fever between 99°F and 101°F. Nebulization was stopped from April 30 as he started taking steam since then. On May 13, he came negative for RT-PCR. He did not report any post COVID symptoms except occasional cough. He did not lose his taste or smell sensation throughout the course of the illness.

Daughter

The daughter was aged 29 years, otherwise perfectly healthy, who was the only caretaker in the home when all others have contracted the disease. She was completely involved in the treatment process of the remaining three members of the family and also was involved in household chorus. She was recommended to have tablet Ashwagandha (500 mg) once a day and tablet Guduchi (500 mg) once a day for the prophylaxis since the observation of the index case in the family. She did not develop any symptoms during this 1 month and was tested for RT-PCR thrice between some intervals. Her reports were negative throughout. The summary of major events in the course of illness for whole family is summarized in [Table 1].
Table 1: Demography of family under treatment

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  Discussion Top


The second wave of the COVID-19 pandemic in India had been different to the first wave in many ways and means. It has shown a greater positivity rate and also a bigger case fatality rate comparing to the preceding wave. The largest difference observed during the second wave was the affliction of family and community clusters by the disease. The second wave was also found to be more lethal comparing the earlier one in terms of its invasiveness and rapidity of devastations it has created. Sudden upsurge of cases with increased number of cases requiring intensive medical care could not be met adequately with existing health-care infrastructure in India. Poor infrastructural settings in the hospital and shortage of intensive care unit bed equipped with ventilator facilities have created havoc and forced many to remain at home despite urgency of health care needed by them. Unfortunately, many of such victims died unattended at home for want of adequate medical care. It was a time of horror to an average Indian family knowing that how hard it would be to find any support from anywhere if such crisis occurs in the family. Greater rate of infectivity with increased occurrence of cluster infections added with uncertainty of getting medical attention at the time of need together has created a panic state in the average Indian society.

Having the support of a family physician available to listen and to suggest initial remedies, teleconsultation facilities with the help of phones in order to minimize the physical exposure and support of Ayurveda together have played dependably in this state of chaos. The collapse of hospital-based health-care system during the second wave has brought the concept of family practice again at the center stage. In countries like India, where family practice still plays a significant role in primary health care, patients usually count on their family physicians for information, advice, reassurance, forward referral, and all the other critical components of primary care. This trust upon family physicians has resurfaced more than ever during the COVID crisis. Family physicians also play the role of a gatekeeper to screen and filter the patient load for the forward referral. This is crucial as it not only offers the immediate on the spot care to those who are fit for it but also assures appropriate care to rest others by giving them a genuine referral. If adopted intelligently, this segment of family physicians might have significantly reduced the hospital load during the pandemic.[11]

This family cluster study during the COVID-19 pandemic gave us two clear inferences to note. One is that, there is an urgent need to revive the family care approach in parallel to the hospital-based care as both of these cater to the different level of needs and are still complementary to each other. Family physician not only can help reducing the burden of hospital care by offering a genuine filter for appropriate referral but can also become a major source of post hospital care for those who received hospital care for urgency of their clinical conditions. The second and equally important inference is to see the role of Ayurveda family physicians fitting into the conventional health-care delivery. Despite the conceptual differences between their fundamental understandings about health and disease, ayurvedic physicians have proven themselves complementary to net health care by offering the dependable remedies to patients and eventually reducing the burden upon the health-care system. This contribution of ayurvedic family physicians was much pronounced during the current pandemic.[12],[13],[14],[15]


  Conclusion Top


Family practice had been playing a crucial role in net health care until the past few decades. With technical advances in health care, involvement of multispecialty in treating a single patient, increasing affordability, increasing awareness about specialty care, and insurance coverage of health-care expenditures has gradually substituted the family practice from more advanced hospital-based care. During the second wave of the pandemic, after near collapse of hospital-based health care, there was a sudden upsurge of demand of family consultation. In suburbs and rural settings where hospital-based health care was neither available nor affordable, family practitioners enjoyed their positions as usual during the pandemic also. One significant change which was observed during the pandemic was a rise in demand of personalized Ayurveda consultations. Online consultation facilities utilizing various telecommunication means have helped people getting connected with their physicians. There are many advantages associated with family practice comparing to the hospital-based practice. Where the latter offers more sophisticated standard care, the former has the edge in providing personalized care within one's affordability. Besides advantage of Ayurveda, it was observed that getting acquainted with an Ayurveda family physician helped decisively during the current pandemic in keeping the whole family cluster under constant watch and supported through standard Ayurveda care both for prophylaxis and treatment. The case under study clearly shows that such support may help passing the critical phase more smoothly without getting into the panic and without any need of hospitalization. We presume that revival of family practice in tune to the specific need arriving during the pandemic may prove to be a game-changer for India in the current time. The addition of ayurvedic family practice into it is definitely going to add dividends in net outcome, as is shown by the case under the study.

Caregiver's perspectives

Three members in my family found COVID positive. All of them showed different symptoms and their healing time period also varied. My father aged 63 years, my mother aged 59 years who also had COPD since 2015, and my brother aged 31 years all found positive in different time periods. As soon as the reports came, they were given standard allopathic medication for the prescribed time along with the recommended ayurvedic medicines. During the entire tenure of 15–20 days, each of the patients had critical conditions for 4–5 days which were varied in nature. Some of the features during critical period comprised extreme weakness, high fever (103°F–105°F), reduced level of SpO2 (86%–88%), extreme breathlessness, chest pain, and dehydration. During these conditions, they diverted toward ayurvedic medicines and simple first aid remedies to control the situation. Reduced level of SpO2 (86%–88%) was effectively handled by patient lying pronated for 20 min which raised oxygen level from 88% to 91%. Chausath prahari pippali and Shringarabhra rasa gave relief in breathlessness within 30 min. Chest pain was effectively handled by hot water bag fomentation upon the chest. None of the patients were hospitalized at any stage during the treatment. After 1 month, reports came negative for all. They do have weakness still, but gradually, they are recovering fine. There are no other symptoms persisting.

It was also observed that the caretaker (age – 29 years, female) was completely involved in the process of providing food and medical care to the rest three members of the family. She was taking Ayurveda medicines prophylactically from the 1st day the disease broke out in the family. She did not have any symptoms during the whole course of management. She was tested thrice for RT-PCR between some intervals and her reports were negative throughout [Table 1].


  Acknowledgment Top


The authors are highly thankful to the family under treatment for showing their trust and solidarity with Ayurveda during critical time of COVID-19.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lin GT, Zhang YH, Xiao MF, Wei Y, Chen JN, Lin DJ, et al. Epidemiological investigation of a COVID-19 family cluster outbreak transmitted by a 3-month-old infant. Health Inf Sci Syst 2021;9:6.  Back to cited text no. 1
    
2.
Diao KY, Zhang XC, Huang S, Wang HL, Gang YD, Deng YP, et al. Features of family clusters of COVID-19 patients: A retrospective study. Travel Med Infect Dis 2021;39:101950.  Back to cited text no. 2
    
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United Nations Department of Economic and Social Affairs, Hosehold Size and Composition-2019, India. Available from: https://population.un.org/Household/index.html#/countries/840/. [Last accessed on 2021 May 29].  Back to cited text no. 4
    
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