If you are COVID-19 positive patient, Start counting your breaths! This is a scary statement. However, counting breaths really mean counting breaths in one minute to assess Coronavirus severity. Let me explain it.

People are asked not to visit hospitals and most guidelines also recommend strict self-isolation and home-quarantine. Although this is a great step to reduce the number of positive patients, self-isolation and home-quarantine have its own drawbacks too.

Most positive people are not aware when they have to visit a hospital. So, while at the home-quarantine, you can check these signs to assess the severity of your disease. Counting breaths is one of the signs of assessing Coronavirus severity!

Single-Breath Count in one minute: This is a very simple method that is used by doctors to evaluate for impending respiratory failure and fatigue. This test is performed by asking the patient to take a deep breath and start counting in a normal voice. A single breath count of 20 or more was found to correlate with a functional vital capacity of 20 ml/kg in a study [Ref]. A single breath count of 13 or more has a negative predictive value of 88.5% in patients with GBS (Guillain Barre syndrome) for requiring mechanical ventilation. A single breath count of 5 per minute or less has a sensitivity and specificity of 90.6 % and 95.2 % respectively for predicting the need for mechanical ventilation [Ref].



Recommendations:

If you are COVID-19 positive and in home-quarantine, you should check your single breath-count. If it is less than 20 in a minute, you need medical help OR

If your single-breath count drops to half from the baseline, you should visit your hospital.

If you have a pre-existing lung disease, you should use your inhaler and recheck your single breath count.

It is also important to perform a single breath count while you are not exercising, exerting, smoking, or panicking!

Count your Breathing Rate to assess Coronavirus severity: Another simple and important sign of respiratory failure or severity of COVID-19 infection is the respiratory rate. You should lie down in a semi-recumbent position and turn your stop-watch on. Start counting your breaths for one minute. With each breath, you would notice your chest rising. Count “one” with each chest movement. If your breathing rate is more than 24 in one minute, you should visit your hospital If you are asthmatic or have a pre-existing lung disease, ensure your disease is controlled and count your breaths after using your medicines. In children, the respiratory rate suggestive of pneumonia is > 60 for infants of one month or less, > 50 for children 1 month to one year, and > 40 for those older than one year of age. Most guidelines associate a breathing rate of 30 or more with the severity of pneumonia and COVID-19 associated pneumonia [Ref]. Other guidelines have used a breathing rate of more than 20 along with other factors in their management algorithm of pneumonia [Ref].



Recommendations:

If you are COVID-19 suspected or positive and in self-isolation/ home-quarantine, count your respiratory rate. If it exceeds 24 or more in a resting state, you need to be concerned and visit your hospital.

Observe for Accessory Muscles of respiration:

Normally, when we breathe, we use our diaphragm. The diaphragm is the muscle that divides the lungs and the abdomen.

However, in severe pneumonia and impending respiratory failure, we use the accessory muscles of respiration as well.

Observe for two important sign that are suggestive of severe respiratory insufficiency: Abdominal paradox: this is the inward movements of the abdomen while breathing in. Intercostal and suprasternal recession : You can observe these signs by exposing the chest and neck and looking at it (in a mirror or may be observed by someone else). If there is an inward movement of the neck and chest muscles, this is suggestive of impending respiratory failure.



Recommendations:

If you are COVID-19 positive and develop difficulty in breathing, look at your chest movements. If you find the abdominal paradox and the indrawing of intercostal muscles, you need to visit your hospital.

If you have a pre-existing lung disease, try not to miss your medicines. Always control your pre-existing disease prior to checking for the abdominal paradox and intercostal recession.

Other important signs suggesting Coronavirus severity:

Other important signs that you can observe at home while in home-quarantine are cyanosis, nasal flaring, and shallow breathing.

Cyanosis is the bluish coloration of the lips, tongue, or digits.

Nasal flaring is the outward movement of the nostrils with each breath.

Shallow breathing can be difficult to observe at home. It can be detected by looking at the chest while breathing. Shallow, rapid breathing with minimal diaphragmatic breathing is suggestive of severe COVID-19 associated pneumonia.

Recommendations:

If you are COVID-19 suspected or positive and in home-quarantine and you develop cyanosis, shallow breathing, or flaring of the nostrils you should visit your hospital.

NOTE:

These are my self-made guidelines and may not be 100% authentic. However, this is an effort to disseminate some important clinical signs of respiratory failure that a person can monitor himself while in home-quarantine.

The idea about writing this post came to my mind when I saw an unfortunate COVID-19 positive patient who was found dead in his room in Islamabad (I don’t know how true is the story)

These are some of the important clinical clues that may be suggestive of severe COVID-19 associated pneumonia and respiratory failure.

You should check for these signs at your home. If you find any one or more of these signs, you should visit your hospital immediately as you may be requiring oxygen and other medical care.

Take care of yourself and your loved ones. Don’t let yourself or your loved-one die alone in a room simply because of ignorance.