Delhi: As COVID-19 cases continue to surge in India, the Ministry of Health and Family Welfare has revised the guidelines for the clinical treatment of ‘Mild’, ‘Moderate’ and ‘Severe’ Covid-19 patients. The guidelines issued by AIIMS, ICMR – Covid-19 National Task Force, and Joint Monitoring Group (DGHS) under Union Health Ministry for management of adult Covid-19 patients, said that people above 60 years of age, those suffering from cardiovascular disease, hypertension, CAD, diabetes mellitus, and other immunocompromised states like HIV, patients of active tuberculosis, chronic lung, kidney or liver disease, persons with cerebrovascular disease and those suffering from obesity have a higher risk of severe infection or mortality.Also Read - Fourth Dose Of COVID Vaccine Provides Limited Defense Against Omicron: Israel Study
The latest guidelines do not include the use of Antivirals like Molnupiravir and monoclonal antibodies in patients to treat the COVID-19 infection. Medicines like ivermectin, favipiravir, and Doxycycline are also not recommended in the guidelines. Antibiotics, and vitamins also don’t have any place in India’s latest Covid management guidelines. Also Read - Karnataka COVID Third Wave May Peak Next Week. What State Minister R Ashoka Said on Weekend Curfew, Full Lockdown
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According to the new guidelines, patients with upper respiratory tract symptoms or fever without shortness of breath come under the ‘mild’ category of the infection. For such patients, the guidelines recommend home isolation. These patients must follow physical distancing from others, use a mask even in indoor settings, and monitor temperature and oxygen saturation regularity. If patients with mild infection face difficulty in breathing or the SpO2 goes below 93 percent, high-grade fever, severe cough, particularly lasting for more than five days, they should seek medical help. Inhalational Budesonide (given via Metered dos inhaler/ dry powder inhaler) at a dose of 800 mcg BD for 5 days) to be given if symptoms (fever or cough) are persistent beyond five days of disease onset.
As per the guidelines, Inhalational Budesonide (given via Metered dos inhaler/ dry powder inhaler) at a dose of 800 mcg BD for 5 days can be given to the patent if symptoms (fever or cough) are persistent beyond five days of disease onset.
As per the guidelines, if the respiratory rate of the patient is less than or equal to 24 per minute and they are breathlessness, and their SpO2 is between 90% to 93%, these patients fall under the moderate category of the disease. Patients with moderate symptoms are recommended hospitalisation. Awake proning is encouraged in all patients requiring supplemental oxygen therapy.
Methylprednisolone 0.5 to 1 mg/kg in two divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days is recommended for such patients. The guidelines said there is no evidence for benefits for injectable steroids in those NOT requiring oxygen supplementation, or on continuation after discharge. It also noted that anti-inflammatory or immunomodulatory therapy (such as steroids) can have a risk of secondary infection such as invasive mucormycosis when used too early, at a higher dose, or for longer than required. Other treatments include anti inflammatory or immunomodulatory therapy. There should be no contraindication or high risk bleeding in such patients
Patients having a respiratory rate of less than 30 per minute, breathlessness, and oxygen level less than 90% on room air fall under the severe category, and are recommended to be admitted in ICU wards. As per the guidelines, such patients should be put on respiratory support. NIV (Helmet or face mask interface depending on availability) should be used in patients with increasing oxygen requirements if work of breathing is Low. The use of HFNC is also advised in patients with increasing oxygen requirements. In case the patient is intolerant to NIV, intubation should be prioritized or them.
Other treatments for such patients also include anti-inflammatory therapy (Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone) usually for the duration of 5 to 10 days.
The guidelines noted that steroids can have a risk of secondary infection such as black fungus when used too early, at a higher dose, or for longer than the required period, and issued advisory in controlled use of such drugs.
Remdesivir should only be considered in patients with 10 days of onset of symptoms, and those having moderate to severe diseases (requiring supplemental oxygen), but who are not in IMV or ECMO. The drug should be considered for five days to treat hospitalised patients with Covid-19 (No evidence of benefit for treatment more than five days). The drug should not be used in patients who are not on oxygen support or in the home setting.
Recommended dose: 200 mg IV on day 1 followed by 100 mg IV OD for the next four days.
As per the new guidelines, Tocilizumab may be considered only in patients whose infection is rapidly progressing and they are needing oxygen supplementation or IMV and not responding adequately to steroids (preferably within 24-48 hours of the onset of severe disease/ICU admission).
Tocilizumab should preferably to be given with steroids, to patients with no active tuberculosis, fungal, systemic bacterial infection. The
Recommended single dose: 4 to 6 mg/kg ( 400 mg in 60 kg adult) in 100 ml NS over one hour