A day after the government’s task force chief expressed regret for the overuse of the steroids during the second wave, the government released revised clinical guidelines for the treatment of COVID-19 in adult patients.
Warning against the use of steroids, the revised guidelines state that the use of such drugs can increase the risk of a secondary infection like invasive mucormycosis or 'black fungus', when used too early, at a higher dose, or for longer than required.
The guidelines have been issued for three kinds of infections – "mild, moderate and severe".
What do the revised guidelines say? When should certain medicines be considered? Read on.
What are the differences between mild, moderate, and severe infection?
In a mild infection, there can be upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia. The guidelines recommend home isolation in such cases.
Those having breathlessness with a fluctuating oxygen saturation between 90-93 percent will be considered moderate cases and can get admitted. Oxygen support has been recommended for such patients.
Respiratory rate over 30 per minute, breathlessness or oxygen saturation lower than 90 percent on room air should be considered as a severe disease. Admission to the ICU has been recommended for such patients.
For which patients has Remdesivir been recommended?
Emergency use authorisation (EUA) or off-label use of Remdesivir has been recommended if patients meet the following criteria:
Ten days of onset of symptoms, in those having moderate to severe disease (requiring supplemental oxygen), but who are not on IMV or ECMO.
Consider Remdesivir for five days to treat hospitalised patients with COVID-19 (No evidence of benefit for treatment more than five days)
For which patients has Tocilizumab been recommended?
Tocilizumab has been recommended if patients meet the following criteria:
Rapidly progressing COVID-19, needing oxygen supplementation or IMV, and not responding adequately to steroids (preferably within 24-48 hours of onset of severe disease/ICU admission)
Preferably to be given with steroids
No active TB, fungal, systemic bacterial infection
Long-term follow up for secondary infections (such as reactivation of TB, Flaring of Herpes etc)
Significantly raised inflammatory markers (CRP and/or IL-6)
When should a patient be put on respiratory support?
The guidelines state that patients with severe cases should be put on respiratory support:
Non-invasive ventilation (NIV) – helmet or face mask interface depending on availability – may be considered in those with increasing oxygen requirements if work of breathing is low.
Intubation should be prioritised in patients with high work of breathing /if NIV is not tolerated.
What are the high-risk factors for a severe disease?
Patients above 60 years of age, or with comorbidities such as cardiovascular disease, hypertension, active tuberculosis, chronic lung/liver/kidney disease, cerebrovascular disease, and obesity have a high risk for severe disease and mortality.
What if the cough persists for two to three weeks?
As per the guidelines, if the cough persists for more than two-three weeks, patients should be tested for tuberculosis and other conditions.
Amid the surge in COVID-19 cases across the country, India reported 2,38,018 new infections (20,071 cases less than the previous day), 310 deaths, and 1,57,421 recoveries on Tuesday, 18 January.
The number of active cases in the country stands at 17,36,628, while the positive rate is at 14.43 percent.