Government issues updated clinical guidance for management of COVID-19 patients
The Union Health Ministry has issued an updated "Clinical Guidance for Management of Adult COVID-19 Patients" recommending emergency use authorization of Remdesivir for patients with moderate to severe diseases, requiring supplemental oxygen, within ten days of onset of symptoms. The guidelines have been issued by AIIMS, ICMR-COVID-19 National Task Force, and the Joint Monitoring Group (DGHS) under the ministry.
Tocilizumab may be considered in patients with raised inflammatory markers
The guidelines stated that Tocilizumab (a drug that modifies the immune system or its functioning) may be considered in patients with significantly raised inflammatory markers and not improving despite the use of steroids with there being no active bacterial/fungal/tubercular infection.
Off-label use of convalescent plasma only in early moderate disease
They also recommended off-label use of convalescent plasma only in the early moderate disease, preferably within seven days of symptom onset, stating "no use after seven days" and only on the availability of high titer donor plasma. Under emergency use authorization, Remdesivir may be considered for only those patients with moderate to severe diseases (requiring supplemental oxygen) within ten days of onset of symptoms.
Remdesivir shouldn't be used in patients not on oxygen support
"It is not recommended for those with severe renal impairment or hepatic dysfunction," the guidelines stated. "Not to be used in patients who are not on oxygen support or in-home settings," the ministry underlined. The guidance note comes in the wake of increasing demand for Tocilizumab, Remdesivir, and plasma, as the COVID-19 cases continue to surge.
Note specifies in what stages, doses should drugs be used
The note specifies how and in what stages and doses should the drugs be used. According to the guidance note, upper respiratory tract symptoms without shortness of breath or hypoxia have been categorized as mild disease and people have been advised home isolation and care.
Guidelines suggest several COVID-19 measures, symptomatic management and precautions
The guidelines advise physical distancing, indoor mask use, strict hand hygiene, symptomatic management (hydration, anti-pyretics, anti-tussive, multivitamins), staying in contact with treating physicians, monitoring temperature and oxygen saturation (by applying a SpO2 probe to fingers) for such patients. They should seek immediate medical attention if they develop difficulty in breathing, high-grade fever/severe cough, particularly if lasting for five days.
India hit world record with 3.14L new cases on Thursday
"A low threshold to be kept for those with any of the high-risk features such as 60 years of age, having cardiovascular disease, hypertension, chronic lung/kidney/liver disease or cerebrovascular disease, or obesity," the note stated. Meanwhile, India on Thursday reported 3,14,835 fresh coronavirus cases, the highest single-day spike since the pandemic began. No country has reported more cases in one day so far.
