New Delhi: In view of the dynamic COVID-19 situation in the country, the Ministry of Health and Family Welfare has issued revised clinical guidelines for the management of adult COVID-19 patients.
COVID-19 National Task Force under Ministry of Health and Family Welfare issues revised clinical guidelines for management of adult COVID-19 patients pic.twitter.com/x4R6ZntVnz
— ANI (@ANI) 17 January 2022
mild covid disease
As per the revised guidelines, COVID-19 patients experiencing moderate symptoms without shortness of breath or hypoxia should be isolated at home.
Such patients have also been advised to maintain safe physical distancing, practice good hand hygiene and wear masks indoors.
Mild COVID patients should seek medical attention only if they have shortness of breath, a high temperature, or a severe cough lasting more than 5 days.
moderate covid disease
People with moderate COVID symptoms, such as dyspnea or SP02 levels between 90 and 93%, may be admitted to a clinical ward to receive COVID therapy.
Oxygen support should be provided to such patients as per the revised recommendations.
All patients who require supplemental oxygen treatment should be urged to pronate while awake (gradual position changes every 2 hours).
Anti-inflammatory or immunomodulatory medication are two more options. There should be no contraindications or risk of excessive bleeding.
If patient’s condition worsens, clinical (breathing function, hemodynamic instability, changes in oxygen demand) and laboratory tests (CRP and D-dimer 48 to 72 hours; CBC, KFTs, LFTs 24 to 48 hours; IL- 6 levels). Exhibited.
severe covid disease
COVID-19 patients whose SP02 level is less than 90% should be admitted to the ICU.
Such patients should be put on mechanical ventilation. If respiratory function is low, NIV (helmet or face mask interface, depending on availability) should be fitted in patients with increased oxygen demand. In patients with increased oxygen demand, HFNC should be employed.
Emphasis should be placed on intubation in individuals who require great help with breathing or if NiV is not tolerated. Other treatments include anti-inflammatory medication (injection methylprednisolone 1 to 2 mg/kg IV in two divided doses or an equivalent dose of dexamethasone) for 5 to 10 days.
If patient’s condition worsens, clinical (breathing function, hemodynamic instability, change in oxygen requirement) and laboratory tests (CRP and D-dimer 24-48 hours; CBC, KFTs, LFTs 24 to 48 hours; IL- 6 levels). Exhibited.
After clinical improvement, the patient should be released as per the revised discharge norms.
Remdesivir (EUA) may be considered only in the following patients:
Moderate to severe illness (requiring supplemental oxygen)
no kidney or liver disease
those that are within 10 days of the onset of symptoms
Recommended dosage: 200 mg IV once a day on 1 f/b 100 mg IV OD for the next 4 days.
Should not be used in patients who are not on oxygen support or in-home setting
Tocilizumab (off-label) can only be considered in patients with,
Presence of critical illness (preferably within 24 to 48 hours after the onset of critical illness/ICU admission).
Significantly increased inflammatory markers (CRP and/or IL-6).
There is no improvement despite the use of steroids.
No active bacterial/fungal/tuberculosis infection.
Recommended single dose: 4 to 6 mg/kg in 100 mL NS over 1 hour (400 mg in a 60-kg adult).
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