As Omicron continues to drive Covid cases in India, the Ministry of health and welfare has issued a slew of new guidelines for the clinical management of Covid treatment in the country.
Mild Disease
As per the new guidelines, Covid-19 patients undergoing mild symptoms without shortness of breath and hypoxia are required to observe home isolation. Such patients have also been advised to maintain physical distance, hand hygiene, and use of masks indoors. Those suffering from mild Covid should seek medical attention only if they are having difficulty in breathing, high fever, or severe cough lasting for more than 5 days.
Moderate Disease
People suffering from moderate Covid symptoms, those undergoing breathlessness or with SP02 levels fluctuating between 90-93 per cent, can get admitted to the clinical ward to avail of Covid treatment. According to the new guidelines, such patients should be given oxygen support. Awake proning should be encouraged in all patients requiring supplemental oxygen therapy (sequential position changes every 2 hours). Other treatments include anti-inflammatory or immunomodulatory therapy. There should be no contraindication or high risk of bleeding.
Clinical (Work of breathing, Hemodynamic instability, Change in oxygen requirement ) and lab (CRP and D-dimer 48 to 72 hourly; CBC, KFT, LFT 24 to 48 hourly; IL-6 levels) to be done if the patient’s condition worsens.
Severe Disease
Covid-19 patients with SP02 levels lower than 90% should be admitted to the ICU. 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. HFNC should be used in patients with increasing oxygen requirements. Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated
Other treatments include anti-inflammatory therapy(Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone) usually for duration of 5 to 10 days.
Clinical (Work of breathing, Hemodynamic instability, Change in oxygen requirement ) and lab (CRP and D-dimer 24-48 hourly; CBC, KFT, LFT 24 to 48 hourly; IL-6 levels) to be done if the patient’s condition worsens.
After clinical improvement, a patient should be discharged as per revised discharge criteria.
Remdesivir (EUA) may be considered only in patients with:
Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN)
No renal or hepatic dysfunction
Who are within 10 days of onset of symptoms
Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.
Not to be used in patients who are not on oxygen support or in-home settings
Tocilizumab (Off-label) may be considered in the below cases:
Presence of severe disease (preferably within 24 to 48 hours of the onset of severe disease/ICU admission).
Significantly raised inflammatory markers (CRP &/or IL-6).
Not improving despite the use of steroids.
No active bacterial/fungal/tubercular infection.
Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.
Notably, Molnupiravir has not been included in the new guidelines as a drug to be used for Covid treatment. Other drugs prescribed in the new treatment norms include Tab Ivermectin (200 mcg/kg once a day for 3 days) and Tab HCQ (400 mg BD for 1 day f/b 400 mg OD for 4 days) etc.
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