COVID-19 Frequently Asked Questions
General Questions
Who is a COVID-19 suspect?
A COVID-19 suspect is: a. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset; OR b. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset; OR c. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.
Who is a contact?
A contact is anybody who has been within six feet of an infected person for at least 15 minutes (when neither are wearing masks or any other personal protective equipment). The time of association is significant here. For a symptomatic COVID positive case: Contact is one, who has been close to a COVID positive individual any time starting from 2 days before onset of the illness until the patient’s isolation OR For asymptomatic patients: Contact is one who has had a close association starting 2 days prior to specimen collection until the patient testing positive and shifting to a home or institutional quarantine. The Ministry of Health and Family Welfare (MoHFW) has defined a Coronavirus contact as a healthy person who has been close enough to a COVID positive person or a contaminated environment for an exposure, and therefore at a higher risk of contracting the disease. The ministry has further explained a contact as: 1. Someone who has shared household with a COVID positive person 2. Anybody who had a direct physical contact with a confirmed positive 3. Those who have been in direct physical contact with a patient’s infectious secretions either without recommended personal protective equipment (PPE) or with a possible breach of PPE 4. People who have been in a closed environment or had face-to-face contact with an infected person at a distance of within or less than a meter including air travel
Who is a probable COVID-19 case?
A probable COVID-19 case is a suspect case for whom either the COVID test had been inconclusive OR testing couldn’t have been performed for any reason.
Who is a confirmed COVID-19 positive?
A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms is categorised as confirmed case of the disease.
What are the common, less common, moderate, severe and emergency symptoms of COVID?
Most common symptoms of COVID-19 are:
- Fever
- Dry Cough
- Breathing difficulties
- Tiredness
And less common symptoms of corona disease are:
- Aches and Pains
- Sore Throat
- Diarrhoea
- Conjunctivitis
- Headache
- Loss of Taste or Smell
- A Rash on Skin, Or Discolouration of Fingers or Toes
Some moderate to severe COVID-19 symptoms are
- Mild to severe pneumonia, mild / moderate / severe acute respiratory distress syndrome (ARDS)
- Sepsis, septic shock
- Acute Respiratory Illness (ARI)
- Influenza-like-illnesses (ILI) -according to the WHO, the symptoms are an acute respiratory infection with fever of ≥ 38 C° and cough that has had an onset within the last 10 days.
- Severe Acute Respiratory Illness (SARI) – According to the WHO, the symptoms include an acute respiratory infection with a history of fever or measured fever of ≥ 38 C°, cough, onset within the last 10 days, and hospitalization requirement.
Emergency symptoms of COVID-19 are:
- Trouble breathing
- Constant pain or pressure in your chest
- Bluish lips or face
- Sudden confusion
What is SPO2? Why is it important to check in COVID patients?
A dip in the oxygen saturation in your blood is noticeable when you start feeling breathlessness. In cases like Coronavirus patients, it’s difficult to realize that you are getting hypoxia. Hence SPO2, or oxygen saturation in your blood, must be monitored in COVID patients.
Testing Modalities of Samples by Labs in Karnataka
As per Karnataka Government guidelines, for which cases will individual testing be conducted by labs?
As per the Government of Karnataka circular for testing labs dated July 10, 2020, samples collected from symptomatic patients or those identified as primary contacts of a confirmed COVID positive patient will fall under “Category A” and therefore samples of such persons will be sent for individual testing.
When will labs conduct pooled sample testing in Karnataka?
As per the Government of Karnataka circular for testing labs dated July 10, 2020, samples will be received from asymptomatic people and international travellers will fall under “Category B” and therefore samples of such persons will be tested as a pooled sample. A Maximum of 5 samples of category B persons can be tested via pooled method.
COVID Tests
How many types of COVID tests are there?
COVID tests can be broadly categorised as viral or serological (serum) tests. Viral tests detect presence of the SARS-CoV-2 virus whereas serological test means looking for antibodies in blood / serum/ other body fluids. Serological tests seek evidence of body’s immune reaction to the viral antigen.
What are COVID diagnostic tests?
These tests detect the presence of viral antigen in the body. Antigen based Rapid Diagnostic Tests or RDTs deliver fastest results whereas molecular tests like the RT-PCR take a little longer to confirm presence of the viral genome in our body but are more accurate with results.
Are the rapid diagnostic tests for COVID-19 sensitive enough?
Positive rapid Antigen tests are considered true positives. However, negatives require a confirmation by RT-PCR test.
What are foreign substances to our body?
A Foreign substance or an invading particle can be a disease-causing organism like virus or bacteria, also known as pathogen, or a toxin, like venom. These foreign substances in whole or parts are called antigens.
What are antibodies?
These are Y shaped proteins produced by our body’s immune system in response to a foreign substance.
How do we get antibodies in our body?
Antigens trigger the production of antibodies, also called immunoglobulins. 5 types of immunoglobulins are produced in our body with different purposes. IgM and IgG are the major players in detection of COVID infection.
Rapid Antibody Test
What is a serological test?
Our immune system releases different kinds of antibodies in response to a viral presence. IgG and IgM are primarily used as detection method in a serology test. Blood, serum, or plasma is used to look for the presence of IgM and IgG antibodies against the SARS-CoV-2.
How does the rapid antibody test work?
A person’s blood sample is used to trace evidence of a body’s immune response to the SARS-CoV-2. The test tells us if a person has had the Coronavirus infection before, by revealing if the body has produced antibodies against the virus.
Why is it called a Rapid Antibody Test?
Antibody test result is obtained much faster than the gold standard COVID confirmatory RT-PCR test. It takes 10-20 minutes approximately to read the test in comparison to 5 hours by RT-PCR.
How long does it take to develop antibodies against the COVID-19?
Like any infection, our bodies take time to build up an immune response against the novel Coronavirus. Depending on age, health, nutritional level, certain conditions that may suppress our immune system, we take time to produce antibodies against a virus. That may vary from days to weeks. Even the strength of antibodies differs from person to person.
Are rapid IgG detection tests accurate?
Rapid antibody tests are not considered confirmatory or diagnostic by WHO or ICMR as they have low accuracy in the initial stages of the infection. Accuracy is highest with Antibody tests during the 3rd week of COVID infection. Authorities have noted that some tests may detect IgM that may have been produced in response to other Coronaviruses like common colds, and mistake them for SARS-CoV-2 antibodies.
Does the Antibody test work any time during an infection?
During the early stage of an infection, this test may not give any reading, since the body takes time to produce antibodies.
Amongst the Rapid Antigen Test and Rapid Antibody Test, which test works better during the early stages of infection?
In the beginning phase of an infection, antigen test is a better option over the antibody test.
When is antibody test useful?
Antibody or serology test has shown highest sensitivity of 100%, 14 days after an RT-PCR.
What do you mean by an antibody test sensitivity?
A test that can correctly identify a SARS-CoV-2 exposure and subsequent immune reaction by producing antibodies against the infection is considered sensitive, which means a true positive rate.
What is a serological test specificity?
Specificity of a test helps rule out a non-exposure to a virus, hence no antibodies developed against that virus, which means a true negative rate.
Which kind of immunoglobulins are checked in the rapid detection tests?
- IgM antibodies (Immunoglobulin M) appears first, as the initial response to an infection.
- IgG antibodies (Immunoglobulin G or Gamma Globulin) are produced mostly a while after the body exhibits symptoms of infection. In case of SARS-CoV-2, it may take 7 to 10 days.
What does an IgM antibody test show us?
Presence of IgM in our blood means we have been infected and our body is fighting the infection, or we have recently recovered from the infection.
What can IgG antibody test tell us?
An IgG positive test means one has had a past Coronavirus infection or recovered recently and may be protected from reinfection. These types of antibodies are found usually 14 days after the patient begins to experience COVID symptoms and stays for a long time.
Does presence of IgG mean we are safe from reinfection? Once recovered, can we develop immunity to Coronavirus?
The WHO warns that there’s no concrete evidence of absolute immunity against the SARS-CoV-2. Since development natural immunity to any infection isn’t a one-time process, we should be careful and follow safety measures even after recovery from COVID-19 infection.
Is this antibody test a COVID diagnostic test?
No. while antibody test is great in revealing a past infection, it may not detect an ongoing infection at an early stage.
When should I get a serology (antibody) test done?
A serological test is most accurate in the 3rd week of the Coronavirus symptoms. The test can start detecting antibodies in the 1st week with low accuracy and increasing in sensitivity by the 2nd week. Due to the chances of false positives or false negatives, these tests are recommended after 14 days of presenting symptoms or exposure to confirmed COVID patient.
How does the IgG antibody test help in fight against COVID-19?
The IgG rapid antibody test for COVID-19, approved by the ICMR, the government of Karnataka and Government of India, may be highly effective in the following scenarios:
- Studies to assess the proportion of population exposed to coronavirus
- Surveys in high risk population like health workers, media & press, police & administration, sanitation workers, industrial workers, migrant labourers including individuals in containment zones or hotspots
- To know who has been infected from coronavirus in the past and has now recovered
- Identification of persons infected in the past, but now recovered and is a potential plasma donor
- Surveys to understand the prevalence of SARS-CoV-2 for informed policy making
- Prioritizing patients for vaccination against COVID-19, as and when COVID vaccine hits the market
Are antibody tests advised for diagnosing active COVID-19 infections?
No, antibodies tests are not the best method for diagnosing active COVID-19 infections
Rapid Antigen Test
When should you get a Rapid Antigen Test done?
You can expect the most accurate result if tested once between day 5 and day 10 of coming into contact with a COVID-19 positive patient.
How much time it takes to get results of rapid antigen test for diagnosis of COVID-19 at RxDx?
The new rapid antigen tests that have been approved for Covid-19 by ICMR, give results within 30 minutes
Why is rapid antigen test introduced in Karnataka?
To ensure early detection and isolation of possible infected patients in light of increasing number of COVID-19 cases.
How is the sample for rapid antigen test collected?
- Trained lab tech in complete personal protective equipment (PPE) collects only nasopharyngeal swab, no other source of sample is acceptable
- Tests must be conducted within an hour of sample collection
- All test results must be entered into the ICMR database
Rapid Antigen Test in Containment Zones
How does the mobile testing happen?
Mobile testing teams in containment / buffer zones have laboratory technician and an assistant to carry out the tests.
What’s the protocol regarding symptomatic or asymptomatic patients in swab collection centres?
No mixing of samples in the collection centre allowed. Symptomatic cases must be isolated at home or care centres until results are declared.
What happens when result is positive and patient is in a containment or buffer zone?
- Team calls 108
- Team does quick triage on the spot to check if home isolation is feasible or not
- Patient is shifted to CCC or hospital or recommended home isolation
What happens when antigen test result is negative, irrespective of zone?
RT-PCR is only recommended if patient is symptomatic. Fresh sample should be taken for such cases. If asymptomatic, negative antigen result is to be considered so and all precautionary measures must be taken by patient anyway.
Helpline and Karnataka government advise for COVID negative
- Call 14410 – Apthamitra free helpline number for fever, cough, breathlessness symptoms
- Don’t go out unless unavoidable
- Wear a mask outside
- Stay safe and healthy
Helpline and Karnataka government advise for COVID positive
- Call 108 for breathlessness, take the ambulance to get admitted
- If asymptomatic, stay isolated at home. Government officials will get in touch to triage and assess your medical condition.
- Seek help, call 104 and press 4, if you are in distress (very anxious, low mood, disturbed sleep and appetite).
Triaging Of Covid-19 Patients
How a COVID-19 patient is triaged by government or private hospitals in Karnataka?
The triage steps are:
- Fever is checked with a hand held thermal scanner
- Fingertip pulse oximeter is used to check SPO2 and pulse rate
- Glucometer is used to check random blood sugar
- BP apparatus is used to record blood pressure
- A patient’s comorbidities are enquired and recorded
What happens after the triage of COVID-19 patients?
- Based on the assessment, doctor certifies whether a patient is eligible for home isolation or not.
- If the patient or their family aren’t willing to opt for home isolation, or the patient is found to have moderate to severe symptoms, they are recommended appropriate COVID care facility.
Who should be hospitalized?
Prioritization of hospitalization is given to moderate to severely symptomatic COVID positive patients, serious COVID suspect cases (swab sample collected, result awaited), SARI cases.
Home Isolation
Who is considered an asymptomatic / mild patient and eligible for home isolation?
- If patient is clinically assigned so
- Age < 60 years
- No or mild fever < 38 C or < 100.4 F
- Mild cough, cold, sore throat
- A functional fingertip pulse oximeter is available at home
- Oxygen saturation reads ≥ 95%
- Random blood sugar is between 80-140 mmol
- Systolic BP is >100 mm Hg
- If patient has following conditions but those are well under control and assessed by the medical officer/doctor: hypertension, diabetes mellitus, obesity, thyroid disorder
- No history of cancer, stroke, TB; disorders like kidney (including dialysis patient), heart; HIV, immunocompromised; on steroids or immunosuppressant and certified by patient
- If pregnant, estimated date of delivery is beyond 4 weeks
What process is followed after triage to allow patient go into home isolation?
- Patient willingly signs an undertaking on self-isolation and agrees to follow guidelines on same
- Patient receives diet chart, advise, and explanation of same
- Patient receives prescription and test recommendations
- Patient and caregiver receive instructions on disinfection methods, separate washing of linens and cleaning of utensils at home
- Patient understands how to identify warning signs and symptoms and receives Do’s and Don’ts handouts
- Primary / high risk contacts of the patient are advised Hydroxy-Chloroquine Sulphate (HCQ)
- Primary / high risk contacts of the patient are advised COVID test. To be done 5 days after date of most recent exposure.
- Patient is guided on total 17 days of home isolation and release protocol
- Patient understands that any isolation protocol violation may lead to strict legal action
What should you do after providing sample for COVID testing?
You should be under strict self-quarantine at your home after providing a swab sample as you may be infectious. Until you receive your lab results, you should stay isolated to protect your community. Failure to follow this advice may invite legal action under the Epidemic Disease Act.
COVID Care Centres in Staying Facilities / Hotels
What are private medical establishment-managed COVID Care Centre (CCC)?
CCCs in the private sector are hotels or other staying facilities managed by private medical establishments registered under the Karnataka Private Medical Establishment Act (KPME) for the care of asymptomatic or mild symptomatic COVID-19 positive patients.
Why has the government approved establishment of CCC?
Karnataka government has approved setting up CCCs in hotels and staying facilities for optimum medical observation and care of asymptomatic or mild symptomatic COVID-19 positive patients so that scarce hospital beds can be made available for the moderate to severely symptomatic COVID patients.
Who can avail a CCC?
Any asymptomatic or mildly symptomatic COVID positive person who requires optimum medical supervision and care until recovery.
Who signs the consent for a private CCC institution?
The patient or patient’s relative can sign the prescribed consent form if a private institution is availed as CCC.
What are the CCC admission Eligibility criteria in Karnataka?
Any asymptomatic/symptomatic COVID positive person who meet one or more from below criteria will be admitted directly to a COVID Care Centre after triage:
- Any age but not eligible for Home Isolation or wishes to opt for a CCC
- Body temperature recorded >38C or >100.4F for over four hours
- With co-morbidities like hypertension, diabetes mellitus, obesity, thyroid disease, but well-managed and clinically under good control as assessed by a medical officer/doctor
- Without co-morbidities like heart or kidney diseases (including dialysis patients), stroke, tuberculosis, cancer, HIV, immune compromised, or steroid / immunosuppressants, etc
Any patient admitted to CCC should have vitals in the line of:
- Oxygen saturation ≥ 95%
- Respiratory rate < 24/min
- Pulse rate < 100/min
What process do you go through after admission to CCC?
All asymptomatic/mildly symptomatic COVID-19 patient needs to go through a screening for below after admission to CCC: SRF ID and personal ID Thermal scanning for temperature SpO2 and pulse rate by fingertip pulse oximeter Blood pressure via BP apparatus Random blood glucose by glucometer Enquiry of medical history, comorbidities, records verification if available Based on symptoms severity, any case not matching criteria to be shifted to Dedicated COVID Health Centres (DCHC) or Dedicated COVID Hospital (DCH)
Karnataka Government Helplines
Where can you seek help to shift to a hospital?
108 Arogya Kavacha ambulance service helps COVID patients with:
- Shifting across treatment facilities in Bangalore across CCC and hospitals (excludes shifting between 2 private facilities)
- Receives distress calls for COVID or SARI (breathlessness) and allows ambulance dispatch for shifting
How does 108 help the COVID patients?
- Any patient with breathing difficulty can call the toll-free number 108 for ambulance service
- If already a COVID positive confirmed case, the patient will be shifted to a centre or hospital as per protocol
- If patient hasn’t been tested yet, will be taken to a hospital for testing, triage, and treatment. If positive, patient will be shifted from isolation to COVID ward in the hospital, if negative, moved to non-COVID ward
- Asymptomatic COVID caller will be rerouted to BBMP’s bed allocation team for procedure.
What is this 1912 number?
It’s the 24×7 toll free call centre to raise grievances in case of admission denial by hospital or CCC faced by COVID or SARI patients.
Quarantine Guides for Apartments
If you are found to be COVID positive, how much of your area is sealed off?
The authorities seal off three floors around your apartment and any other apartment within close proximity (within 5 metres)
Why not just your apartment is sealed?
Not just patient apartment but three floors around it and any other apartment (within 5 metres) are sealed because a patient’s movement since infection (called an epidemiological movement) is the basis of marking areas as containment zones, as per SOP.
Why are some people asked to go for 28 days quarantine? Why not the usual 14 days?
14 days are mandatory for the recovery period. Another 14 days are suggested in some cases, so that patient can observe and report symptoms if any.
Is it all right if you go for a walk or jog or run inside your residential complex? What’s the right time and safety measure you can follow?
As long as you maintain social distancing and wear a mask.
Can housekeeping staff be allowed inside the complex of a COVID patient?
Any medical and support staff treating or handling COVID positive patients must follow a strict protocol.
