New Delhi: India’s fresh COVID cases hit a new high once again in last 24-hours with cases rising by a record 4,14,188 infections, taking the active caseload to 36,45,164; 3,915 people died in a day. Shortage of resources to tackle a deadly second wave remains big concern. The second wave of COVID crisis has left India grappling for oxygen and medicines. With the hospital beds running out, home care for COVID patients has become more important. The alarming surge led the central government to recently release a set of instructions allowing COVID-19 patients who are being treated at home to practise “proning” if they are having breathing discomfort.
Proning is a medically accepted position to improve breathing comfort and oxygenation. It is a process of turning a patient with precise, safe motions, from their back onto their abdomen (stomach), so the individual is lying face down. The health ministry has said, “Timely proning and maintaining ventilation could save many lives..”
— Ministry of Health (@MoHFW_INDIA) April 22, 2021
As Proning technique gains recognition in this fight against COVID19, NDTV speaks with experts to know about its pros and cons:
Question: Can Proning be done by anyone?
Dr Harsh Vardhan Puri, Thoracic Surgeon, Medanta Gurugram: The science behind proning is that the ventilation mismatch is at the lowest when we are lying on our belly as a result oxygen concentration increases by 3 to 4 per cent. Proning is an old concept, when COVID was not there we were doing it in the ICUs for our serious patients. Now in COVID, we are telling anyone can do these exercises, but it is recommended for those who has an oxygen saturation below 94 per cent. So, what you need to do is that if you are in home isolation, you should be measuring your saturation four times a day and at anytime when the saturation dips below 94 per cent, you can perform proning.
It has two aspects – it needs to be done very carefully. Your belly should not be pressing the surface, it should have some gap like shown in the ministry guidelines as well. Because your diaphragm gets stressed if your tummy gets stressed and if your diaphragm gets stressed your saturation will fall further. The best tip is to make sure is simply slide in your hand and see if there is space between the tummy and the surface.
And you have to frequently change your position, after 30 to 40 minutes. You can maintain the same position for maximum one and half hour and one can do proning upto 10-12 hour per day but that depends on your ability to do so and comfort. If you are getting discomfort in one position, you can change the posture. I absolutely recommend this, if you are not getting bed and oxygen and your oxygen levels are dipping then proning is the method.
Question: What are the red flags to look out for in Proning? Should people who are severely ill and are not able to lie down on their stomach also try proning?
Dr Haresh Mehta, Cardiologist, PD Hinduja Hospital, Mumbai: No, if people are not able to perform this they should not even try. They should try and reach to the hospital as soon as possible. One should not spend enough time trying to prone oneself in order to feel better, obviously try to arrange for oxygen in the meantime and reaching the hospital should be your priority.
Secondly, proning was not designed to be performed at home by people. In pre-covid times, we performed this technique in patients who were on ventilators in ICUs or were severely ill. But now with the study in New York for this technique and how it is proving beneficial to COVID19 patients and with the discussion with Indian Council For Medical Research (ICMR), we are recommending it to people who have borderline saturation and can attempt this at home.
Proning can be done in all age-groups – from kids to teenagers and adults. As the presenT wave is more SEVERE on younger people, we are recommending proning for all the age-groups but the idea is to understand this technique and do it in consultation with your doctor so that you ensure that you are not compromising the oxygen supply to your body or worsen the oxygen saturation further.
Question: What are some of the other things apart from proning that can be done by patients at home?
Sarvesh Shashi, Founder SARVA & Divya Yoga: Three breathing exercise I swear by while I was myself suffering from COVID are – anulom vilom, a specific type of controlled breathing (pranayama) in the practice of yoga. It involves holding one nostril closed while inhaling, then holding the other nostril closed while exhaling; kapalbhati, a set of rapid breathing technique and Bhastrika Pranayama, which is also the process of rapid inhalation and exhalation. These three can very easily be done from the comfort at your home, ideally kapalbhati and Bhastrika I will tell people to avoid who don’t know how to perform it correctly but anulom vilom can be done by anyone and it has zero complications. It can be done by a small child to 100+ individual. It will do a lot of good to you and will surely increase your oxygen levels.
Question: Should people do breathing exercises at home while suffering from COVID?
Dr Harsh Vardhan Puri, Thoracic Surgeon, Medanta Gurugram: Yes, people should perform breathing exercises. The science behind this is that these exercises increase lung capacity of an individual. What I generally tell my patients is to do one simple breathing exercise – Take a deep breath and hold it for 40 seconds and then release. What it does is simple, it increases the lung overall capacity as a result your oxygen levels increase.
Question: Can proning be harmful in any way if not done properly?
Dr Harsh Vardhan Puri, Thoracic Surgeon, Medanta Gurugram: Proning should not be done by pregnant women, people who have spinal fractures or any fracture in the body, deep pain. It should be avoided immediately after eating because it can result in vomit.
And the major thing is that if for some reason the posture is not correct or pillows under your abdomen are not placed right, it will further stress your diaphragm and reduce oxygen saturation in your body instead of increasing it. I recommend people watching a guided video before performing it.
Watch: A Video By Dr Arvind Kumar, Thoracic (Chest) Surgeon, Medanta Demonstrating Do’s and Don’ts For Proning
Apart from Proning dos and don’ts, experts also answered few of the common questions regarding COVID19 treatment. Talking about how to treat patients at home if oxygen cylinders are not available, Dr Haresh Mehta, Cardiologist, PD Hinduja Hospital, Mumbai said,
There is no alternative to oxygen sadly. I would recommend patients to look for alternatives and try and reach the hospital on priority. The idea is to get admitted before it is too late and the right way to do so is that the moment you detect COVID, be in touch with your doctor or a hospital, who can guide you when you need to reach the hospital. The problem is that people realise it very late. So, if your oximeter says your oxygen levels are below 94 after a 6 minutes’ walk, then you should call your doctor.
Lastly, do people really need to wear masks at home, Dr Haresh Mehta added,
Wear a mask inside your home provided people in your family are continuously going out. If you all are staying at home, then there is no need. But make sure if you have house helps coming from outside or any other people, they wear mask all the time. Similarly, as a precautionary measure, you can also wear your mask when they are around.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.