Amid a recent spike in the number of novel coronavirus cases in the country, the Health Ministry on Thursday released a revised set of clinical guidance for the management of adult COVID-19 patients. Based on the symptoms, the Ministry has also updated treatment protocols for the patients having mild, moderate or severe symptoms.
The clinical guidance proposed Remdesivir to be prescribed only to patients with moderate and severe disease requiring supplemental oxygen within 10 days of onset of symptoms. According to the new set of issued guidelines the Remdesivir should not be used by patients who are NOT on oxygen support or is being treated in home settings.
The document further recommended the use of the Tocilizumab drug on patients with severe disease (preferably within 24 to 48 hours of the onset of ICU admission) or patients not showing any sign of improvement despite the use of steroids.
The guidance note also suggested, Convalescent plasma (Off Label) may be considered in patients with early moderate disease, preferably within seven days of symptom onset.
Special prerequisites while considering convalescent plasma include, “Availability of high titre donor plasma (Signal to the cut-off ratio (S/O) >3.5 or equivalent depending on the test kit being used).”
As per the guidance note, Upper respiratory tract symptoms or fever without shortness of breath or hypoxia to be classified as ‘Mild Disease’. Patients with mild disease are advised to monitor their temperature and oxygen saturation regularly and should also follow regular COVID-19 precautions like- home isolation, strict hand hygiene, physical distancing and indoor mask use. The patients with mild disease should seek immediate medical attention if they face breathing difficulty or high-grade fever/severe cough, particularly if lasting for more than 5 days.
According to the document, the defining clinical assessment parameters are Respiratory Rate of more than or equal to 24 and oxygen saturation (SpO2) of less than or equal to 93% on room air. Close monitoring of patients with moderate COVID-19 is required. Patients with moderate COVID-19 is to be isolated to contain virus transmission, they are also advised to get themselves hospitalized.
Preferred devices for oxygenation: the non-rebreathing face mask.
The guidance note prescribed, Methylprednisolone infection (1 to 2mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone) for the treatment of patients with severe disease. For the respiratory support, use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement should be considered, if the work of breathing is LOW. The guidance note also suggested the use of HFNC in patients with increasing oxygen requirement. The guidance note advised patients with severe disease requires urgent ICU admission.