Covid care: FAQs about getting oxygen support at home - The Daily Guardian
Connect with us

Medically Speaking

Covid care: FAQs about getting oxygen support at home

When is oxygen support required for Covid patients at home? How to choose between oxygen concentrators and cylinders? What if these are not available? These FAQs answer some common queries which are on everyone’s minds right now.

Dr Sapna Zarwal



With oxygen deprivation and lung infections becoming common problems faced by patients during the second wave of Covid-19, many patients have been recommended to use oxygen concentrators and cylinders at home to maintain oxygen levels and avoid fatalities. However, with oxygen therapy, one needs to be doubly careful and be aware of the risks and dangers as well. Here are the answers to some common queries that will help you make the right decision regarding oxygen support.


Oxygenation should be preferred when blood oxygen levels (SpO2) readings drop below 94%. Ideal oxygen levels should be between 95% and 99%. While no oxygen therapy can instantly boost oxygen levels or restore them to normal, Covid-positive patients should aim to achieve a saturation of up to 92%. Experts also advise that achieving 100% saturation shouldn’t be done when the body is sick. More so, this may exhaust your resources quicker, whether it is a concentrator or cylinder that you use.


An oxygen concentrator is an electronically operated device that separates oxygen from room air. It provides a high concentration of oxygen directly to you through a nasal cannula. These devices work on the principle of ‘rapid pressure swing absorption’ which is where the nitrogen is removed from the air using zeolite minerals which absorb the nitrogen, leaving other gases to pass through and capturing oxygen as the primary gas. The collected oxygen is 92-95% pure.


The difference is that a concentrator purifies the air and makes it available for patients who have low oxygen levels in their blood. It just needs to be pulled into a power source. Cylinders accomplish the same, but the oxygen is already compressed within the tank. That supply is gradually reduced until the tank runs out and needs to be refilled or replaced.


Normal air will have 21% oxygen. If 1 litre oxygen is provided to the patient through the concentrator, the oxygen percentage (or fraction of inspired air) in the lungs rises to 24%, with 2 litres it rises to 28% and with 10 litres it rises to 60%. Depending on the need, the litres of oxygen per minute must be regulated. There is a need for monitoring this from time to time to ensure that the flow of oxygen is proper and that the patient is not over oxygenated. Seek your doctor’s advice to decide how many litres per minute of oxygen is required for your patient. Keep a pulse oximetre handy to check oxygen levels from time to time. Oxygen concentrators can supply between 0.1 litres per minute (LPM) to 5 to 10 LPM.


Only mild to moderately ill patients, who have an oxygen saturation level between 90% and 94%, should depend on an oxygen concentrator and can use it at home. We must understand that hoarding such life-saving equipment will only worsen the country’s problem. Anyone with oxygen saturation depleting below 80-85% may need a higher flow of oxygen and will have to switch to a cylinder or liquid medical oxygen supply and may eventually need hospitalization.


There are two types of oxygen concentrators— continuous flow and pulse dose. Continuous flow oxygen will provide the same flow of oxygen every minute unless it is turned off, irrespective of whether the patient is breathing it in or not, while pulse dose oxygen concentrator detects breathing patterns and dispenses oxygen when it detects inhalation. The oxygen dispensed per minute will vary in the second case.


Oxygen delivery can be increased by using prone positioning. Physical position affects the distribution and volume of air in the lungs and can have direct effects on the expansion or collapse of the delicate alveoli that permit the exchange of oxygen and carbon dioxide in the blood. It involves turning a patient with precise, safe motions, from their back onto their abdomen so that the individual is lying face down, to improve breathing and oxygen flow in the body. Having said that, getting the right advice on how proning can be complemented with oxygen supply is significant. Talk to your doctor today to understand when to opt for oxygen support at home, if your patient is eligible for oxygen support at home, and how it can be best utilized.

The author is Consultant, General Physician, Fortis Hospital, Mulund.

The Daily Guardian is now on Telegram. Click here to join our channel (@thedailyguardian) and stay updated with the latest headlines.

For the latest news Download The Daily Guardian App.

Medically Speaking


Dr Radhika Sheth



We all have currently adapted well to the new normal and working from home. While work from home comes with its own benefits, lack of physical activity and stress can lead to an imbalance of PCOD. PCOD is a common disorder in women of reproductive age group and affects 5% to 10% of women. It is associated with hormone imbalance and problems in metabolism. Though PCOD may cause irregular periods, there is a likelihood that women with PCOS may face fertility or related issues as well. However, the ongoing pandemic, increased stress and lack of physical activity are likely to cause a spike in PCOD conditions. 

How can PCOD condition worsen during the pandemic? 

Lack of physical mobility has led to a spike in complaints of the irregular menstrual cycle during the pandemic. While the exact causes of PCOD are unknown but certain factors that may play a role include excess insulin, low-grade inflammation, heredity and excess androgen. While working from home, PCOS is also adversely affected by diet, lifestyle and exposure to certain environmental toxins. Insulin Resistance: Insulin is a hormone produced in the pancreas. Insulin is needed to convert glucose to energy and to control cell growth. It has a key role to play in the metabolism of carbohydrates, lipids and proteins.

Low-grade Inflammation: In some women, eating certain foods, or exposure to certain environmental factors may trigger an inflammatory response. When an inflammatory response is triggered, WBC secrete mediators that may lead to insulin resistance and atherosclerosis.

All these factors contribute to spike in PCOD: irregular /absent menstrual periods, heavy menstrual bleeding, excessive facial and body hair, weight gain and obesity, patches of thick, darkened skin (acanthosis nigricans), particularly on the neck, groin, or underneath the breasts, oily skin and/or acne, insulin resistance and type II diabetes, and infertility due to irregular or absent ovulation

Treatments for PCOD

Daily exercise – Regular exercise has many benefits in treating PCOD. Exercise helps by burning calories, lowering cholesterol levels and building muscle mass, which decreases insulin resistance. 

Eating a healthy diet – The ideal diet consist of different kinds of foods from various food groups- good carbohydrates, such as vegetables and fruits; lean meats, such as poultry; fish; and high fibre grains. It is advisable to eat foods that are low in sugar and fat and with a low glycemic index. Low GI foods cause the body to release insulin slowly, making it easier for the body to use food as energy rather than store it as fat. Foods rich in fibre also help control blood sugar levels. Carbohydrates are broken down into sugar, hence they are best eaten in limited amounts. It is better to avoid refined carbs, especially those found in processed foods, especially white flour, rice, potatoes, and sugar. Sugary drinks, including soda and sweetened juices, should be avoided.

Increase your exposure to sunlight by at least sitting and working under the sun for some time. 

Weight Loss– this may help to control some of the symptoms of PCOS and help to increase fertility.

The writer is a Consultant Fertility Specialist, Cloudnine Group of Hospitals, Mumbai.

Continue Reading

Medically Speaking

Flickering screens may help children with reading, writing difficulties



A new study has found a link between visual white noise and cognitive abilities such as memory, reading and non-word decoding in children with reading and writing difficulties.

The study “Sensory white noise improves reading skills and memory recall in children with reading disability” was published in the scientific journal ‘Brain and Behavior’. Previous studies have shown that children with attention difficulties and/or ADHD solve cognitive tasks better when they are exposed to auditory white noise.

However, this is the first time that such a link has been demonstrated between visual white noise and cognitive abilities such as memory, reading and non-word decoding in children with reading and writing difficulties.

“The white noise to which we exposed the children, also called visual pixel noise, can be compared with giving children glasses. The effect on reading and memory was immediate,” explained Goran Soderlund, Senior Lecturer in Education at the University of Gothenburg and Professor of Special Education at the Western Norway University of Applied Sciences.

The study was conducted on around 80 students in the Smaland region of southern Sweden. The children who took part were selected following a word recognition test and were split into three groups: good readers, children with some reading difficulties and children with major reading difficulties (i.e. having phonological impairments).

In the study, the children were asked to read 12 words while being exposed to four different levels of visual white noise, from zero to high. The test involved assessing how many of the words the children could read correctly and how many words they were able to recall afterwards.

The results showed that the group with major reading difficulties, particularly phonological difficulties, performed significantly better when exposed to visual pixel noise. They read more words correctly and also recalled more words in moderate noise conditions. The white noise had no effect or negative effects on the good readers and those with only minor reading problems.

“This is the first evidence of visual white noise having effects on higher-level cognition, in this case, both reading and memory,” said Goran Soderlund.

The children were exposed to different levels of white noise, with the results showing that the amount of noise is critical for reading and memory.

“You can compare it with being shortsighted and needing glasses. We saw that when we exposed the children to a medium level of white noise, their reading improved. However, their reading skills were less good when there was no noise or a high level of noise,” added Goran.

“These results show that children with reading and writing difficulties can be helped with an incredibly simple intervention. By adjusting screens in school or at home, we hope to be able to resolve their problems at a stroke. This is the first study of its kind, and replications are needed,” Goran further said.

Goran Soderlund now wants to further investigate the effects of white noise. He hopes that new studies can answer the question of whether practising with white noise for a prolonged period can lead to lasting improvements.

“It’s worth exploring, as we just don’t know. This first study of ours is basic research. But our results show that the children improved immediately, so it’s important to continue with new studies to establish whether this simple measure, which everyone can do on their own laptop, will actually provide enduring help for these children,” Goran said.


Continue Reading

Medically Speaking




During a recent study, researchers at the University of Maryland School of Medicine (UMSOM) developed two rapid diagnostic tests for Covid-19 that are nearly as accurate as the gold-standard test currently used in laboratories.

Unlike the gold standard test, which extracts RNA and uses it to amplify the DNA of the virus, these new tests can detect the presence of the virus in as little as five minutes using different methods. The findings were published in the journal Nature Protocols. One test is a Covid-19 molecular diagnostic test, called Antisense, which uses electrochemical sensing to detect the presence of the virus. The other uses a simple assay of gold nanoparticles to detect a colour change when the virus is present. Both tests were developed by Dipanjan Pan, PhD, Professor of Diagnostic Radiology and Nuclear Medicine and Pediatrics at UMSOM, and his research team. Dr Pan has a joint appointment at the University of Maryland Baltimore County (UMBC).

“These tests detect the presence of the virus within 5 to 10 minutes and rely on simple processes that can be performed with little lab training,” said Dr Pan. They do not require the extraction of the virus’s RNA – which is both complicated and time-consuming.

They also are more reliable than the rapid antigen tests currently on the market, which detect the virus only in those with significantly high viral levels. “These two newer tests are extremely sensitive and can detect the presence of the virus, even in those with low levels of the virus,”

Last month, the US Food and Drug Administration (FDA) registered the laboratory of Dr Pan as an approved laboratory development site for the Antisense test. The move paves the way for Dr Pan’s laboratory to begin conducting the test at the university, in research settings, as it undergoes further development.

In February, RNA Disease Diagnostics, Inc. (RNADD) received an exclusive global license from UMB and UMBC to commercialize the test. Dr Pan serves as an unpaid scientific advisor to the company.

This test detects the virus in a swab sample using an innovative technology called electrochemical sensing. It uses a unique dual-pronged molecular detection approach that integrates electrochemical sensing to rapidly detect the SARS-CoV-2 virus.

“The final prototype is like a glucometer, which patients with diabetes use at home to measure their blood glucose levels,” said Dr Pan, “and is just as easy for people to do themselves.” Dr Pan and his colleagues, in collaboration with RNA Disease Diagnostics, are launching a study of NBA basketball players in New York City to compare the Antisense test to rapid Covid tests that the NBA is using to monitor Covid infections in its players.

“We would like to see whether our test can yield more reliable results compared to the existing platforms,” he said. “Current antigen-based rapid Covid tests miss infections about 20% of the time and also have high rates of false-positive results. Our Antisense test appears to be about 98% reliable, which is similar to the PCR test.”

Similar to the Antisense test, the second rapid test also does not require the use of any advanced laboratory techniques, such as those commonly used to extract RNA, for analysis. It uses a simple assay containing plasmonic gold nanoparticles to detect a colour change when the virus is present. In April, Dr Pan and his colleagues published a stepwise protocol in the journal Nature Protocols, explaining how the nano-amplified colourimetric test works and how it can be used.


Continue Reading

Medically Speaking


Various reports indicate that this mutant has been responsible for several complications cropping up among patients even after recovery. Here is what you need to know about the variant.

Dr Chandrashekhar T



The Delta Covid-19 variant is the new villain that has taken centre stage. It is believed to be 60% more transmissible than the B.1.1.7 variant (or alpha variant) and may be associated with an increased disease severity such as hospitalisation risk. Several reports from across the country indicate that this mutant has been responsible for several complications cropping up among patients even after recovery. Here is what you know about the variant.


Variants are mutations of the Coronavirus. Scientists say viruses constantly mutate naturally as they replicate and circulate in their hosts. Sometimes these mutants disappear; other times they persist. The Delta variant known as B.1.617.2, is gaining ground around the world and is said to have contributed to the country’s recent surge. Sometimes we can see a mutation in the mutated variant this is called a double mutation.

According to WHO and CDC, the viruses which are prevalent in the United States, Europe, South America, and another part of Africa as well as in the Asian region are of different mutants. The variant prevalent in the US is called Alfa, Beta and Theta were prevalent in South America and Africa. Theta and Gamma were prevalent in European countries. Delta was prevalent in India and Asia by large, which has now spread to other nations too. Kappa variant was prevalent in Australia. Now, people should know that the Delta wave hasn’t come in the second wave only. It was there in the first wave as well. However, Coronavirus is an RNA virus and is in constant mutation with increasing transmissibility and virulence.


To begin with, it is important to know what variants of concern (VOC) are. A variant for which there is evidence of an increase in transmissibility, more severe disease, significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures are termed as VOC.

The Delta variant was under investigation/Variant of Interest (VOI) even in the first wave, as it was termed as the variant of concern by the WHO. Therefore, WHO, ICMR, and other government agencies in India are closely watching its mutations. Therefore, the Delta virus falls under the category of a variant of concern as it is more transmittable, more virulent, and causes many complications.

HOW DOES THE DELTA VIRUS IMPACT HUMAN HEALTH? Now, we all know that Covid-19 can cause multiple problems in the body. First, is the clotting problem causing a brain Stroke or a Heart Attack or a particular vessel getting blocked causing gangrene of the limbs, legs, or hands or blood clots causing Pulmonary Embolism or even Gangrene in the intestine. 

Apart from blood clots in the arteries of limbs, heart, and brain, Covid-19 patients are coming with intestinal clots that are causing gangrene of the GI. Similarly, clotting can cause Pancreatitis as well.

The other problem is the inflammation problem called that Systemic Inflammatory Response Syndrome. This causes symptoms including fever or Hypothermia, Tachycardia, Tachypnoea, and a change in blood leucocyte count. Cytokine Release Syndrome (CRS) is another issue. CRS occurs when the immune system responds too aggressively to an infection. It causes a variety of symptoms, including fever, headaches, and nausea.


Yes, the vaccines available to us in our country – Covishield, Covaxin, and Sputnik put up a good defence against this variant and hold a very good efficacy rate. So, you might wonder if vaccines work then what is the problem. The problem is that not everybody has been vaccinated. And the variant is at its peak when the rate of vaccinations nationally has slowed down. Having said that the vaccination program will soon ramp up. Apart from this, staying at home and following all necessary Covid-19 safety protocols – social distancing, wearing a mask, and hand hygiene are essential.

The writer is Chief Intensivist, Fortis Hiranandani Hospital, Vashi.

Continue Reading

Medically Speaking

Difficult conversation about death with children: The dos and don’ts



‘A child asked her grandmother when her mother would return. The grieving grandmother told her that her mother had gone to heaven and became a star. She will watch her from there.’ All of us at some point in our childhood would have been told a story such as this. The intention of the grandmother is none else than to comfort the child. Won’t it be easier to look up at the sky and remember her mother? or believe she is safe with God.

But what really happens when you use euphemisms like ‘gone to a better place’ or ‘gone to heaven’. Usage of such terms can be very confusing for children and sometimes scary too! They may struggle to understand how heaven might be better than being with them, why did their loved one leave, how do you become a star?

As such children may experience intense feelings of anxiety, sadness, guilt, anger etc. on losing a loved one. They themselves may be struggling with their feelings and more often than not they look to the other caregivers for guidance and support. In these moments, not openly sharing about the loss or telling them how they should be strong and try to move on can prove to be very damaging for the child. Unaddressed feelings of grief can lead to development of anxiety, depression and even cause post-traumatic disorder in children.

How we talk about death and conversations around it, can therefore go a long way in determining how our children cope with their grief. The words you choose will have to depend on the emotional maturity and development of your child. But there are some basic guidelines that medical experts outline which should be applied when having a conversation with a child about loss.

To begin with, there is no right time to inform a child about the loss. Children should be informed sooner than later lest they find out on their own which can throw them into an emotional spiral. The person who talks to the child about the loss should be someone who they are close to, like the primary caregiver or if the person is grieving and not in a position to talk, then the next person the child is attached to. Talking about loss can be a difficult conversation and requires all the love and attention of the person breaking the news.

When talking about loss, first assess their understanding of loss. Different age groups perceive death and loss, differently. For a toddler it may be a temporary loss with the expectation of seeing the caregiver after sometime. For a younger child, death may mean something more permanent and can therefore generate a strong sense of loss and sadness.

Avoid using euphemisims like ‘passed away’ or ‘gone to sleep’ when talking about loss. Children tend to focus on words literally and using unreal words and telling stories about what happened to their loved one, can leave them wondering, confused and anxious. They might also feel that death is not permanent and their loved one may come back. It is therefore important to use real words like ‘death’, and ‘dying’ and state exactly what happened in order to prepare them for real life situation and help them cope better with their feelings.

Talk to your child in age-appropriate language while talking about the loss. As per medical experts, younger children within the age range of 2-5 years, can be explained about death in simple words. For instance, you can let them know that when a person dies, their body stops working- that means the heart does not beat and they do not breathe. For older children in the age range of 6-9 years, a caregiver can add more information and explain with what they might relate. For instance ‘every organism has a life cycle. Humans also have a life cycle. You are born, you die and in between you live.’

Children may get curious and ask questions repeatedly. Respond to the questions honestly, openly and with patience. Share with them, what you think is relevant for their age and do not overwhelm the child with facts and description. It can make the loss scary, and result in feelings of anxiety.

Children may struggle with their emotions as you talk about the loss. Encourage them to express their feelings and let them know it’s ok for them to cry. Avoid telling them how they should or should not feel. There are no rules to grieving. Acknowledging their feelings and letting them express is the first step to healing.

Some children may also carry the guilt, if they believed they were in any way responsible for the death of their loved one. For instance, if they said something hurtful to their grandmother after which she died. Let them know it’s not their fault.

More importantly, as you have this most difficult conversation, mindfully listen to your child’s responses and reactions and be available to support them. Be open about your feelings and reassure the child that you are taking care of yourself and that you are going to be with them and keep them safe.

As adults, when we lose a loved one, we struggle with our emotions. For a child it’s even harder as they are still in the process of developing their emotional and cognitive skills and are therefore not as equipped to navigate through the torrent of emotions they may experience on losing a loved one. Having an open conversation about the loss can support your child to cope better with the loss and prevent it from turning into a traumatic experience.

Continue Reading

Medically Speaking




Preclinical trials of a new radiopharmaceutical to treat ovarian cancer have produced successful results, dramatically limiting tumour growth and decreasing tumour mass. Designed specifically for ovarian cancers that are resistant to traditional therapies, the new radiopharmaceutical can be produced in 25 minutes at a low cost, which leads to better efficiency compared with alternative methods.

This research was presented at the Society of Nuclear Medicine and Molecular Imaging 2021 Annual Meeting. According to the American Cancer Society, more than 20,000 women are diagnosed with ovarian cancer each year and nearly 14,000 will die from the disease. Ovarian cancer patients have a five-year survival rate of 49.1 per cent. It is the fifth leading cause of cancer-related death among women.

In the study, researchers utilized a new generator system to develop the targeted alpha-therapy Pb-214-TCMC-trastuzumab to treat HER2-positive ovarian cancer. Ovarian cancer cells and mice bearing ovarian cancer tumours were split into three groups: those treated with Pb-214-TCMC-trastuzumab, those treated with Pb-214-TCMC-IgG and an untreated control group. All groups were imaged over time to determine the effectiveness of the treatment. Compared to the Pb-214-TCMC-IgG and control groups, the tumour signal for mice and cells treated with Pb-214-TCMC-trastuzumab decreased dramatically over the course of the study, signalling the efficacy of the therapy. There were no adverse side effects from the treatment as determined by the weight loss of all animals surviving.

“The short 27-minute half-life of Pb-214 is ideal for fractioned alpha particle therapeutic applications,” stated Mike Zamiara, study author and president of Niowave Inc. in East Lansing, Michigan. “The generator system can provide Pb-214 every hour, potentially providing a new source of alpha-particle therapy to patients at a lower cost. In the future, the generator system will be available for many therapeutic products in a turn-key system under development, providing reliable doses for improved patient care.”

Continue Reading