New Delhi: The Union Health Ministry has advised COVID patients to go for tests for tuberculosis and other conditions if cough persists for more than two-three weeks.
The revised ‘Clinical Guidance for Management of Adult COVID-19 Patients’ issued by AIIMS, ICMR-COVID-19 National Task Force and Joint Monitoring Group (DGHS) under the Ministry of Health, on Monday underlined that There is no evidence of injectable steroids benefiting COVID patients. Oxygen supplementation or continuation is not required after discharge.
Anti-inflammatory or immunomodulatory therapy, such as steroids, can lead to a risk of secondary infections such as invasive mucormycosis when used too quickly, at high doses or for longer than necessary, he highlighted.
If cough persists for more than two-three weeks, one should opt for screening for tuberculosis and other conditions, said the revised guidelines.
The revised guidelines continue to recommend emergency use authorization (EUA) or off-label use of remdesivir in patients with “moderate to severe” disease and within 10 days of the onset of any symptoms.
It warned against the use of the drug for patients who are not on oxygen support or in a home setting.
According to the guidelines, off-label use of the drug EUA or tocilizumab may be considered for use in the presence of critical illness, preferably within 24 to 48 hours of critical illness or admission to the intensive care unit (ICU).
Tocilizumab may be considered for patients who have significantly increased markers of inflammation, and are not improving despite steroid use with no active bacterial, fungal or tubercular infections, he said.
The guidelines state that coronavirus patients have been classified into those affected by mild, moderate and severe illness.
The guidelines state that injectable methylprednisolone 0.5 to one mg/kg in two divided doses, or an equal dose of dexamethasone, may be given for a period of five to 10 days, usually in moderate cases. The same drug may be given in two divided doses of one to two mg/kg for the same duration in severe cases.
“Inhalational budesonide (given via metered dose inhaler/dry powder inhaler) may be given in mild cases at a dose of 800 mcg bd for five days if symptoms (fever and/or cough) occur within five days of illness onset. more persistently,” it was said in the guidelines.
As per the guidance note, upper respiratory tract symptoms without shortness of breath or hypoxia have been classified as mild and have been advised for home isolation and care. People with mild COVID-19 should seek medical attention if they have difficulty breathing, high fever, or a severe cough lasting more than five days.
People who have shortness of breath, in which SpO2 fluctuates between 90-93 percent, can be admitted to a ward, and will be considered as moderate cases. The guidelines state that such patients should be given oxygen support and wakefulness should be encouraged in all patients requiring supplemental oxygen therapy, with gradual position changes every two hours.
He said that respiratory rate more than 30 per minute, breathlessness or SpO2 less than 90 per cent in room air should be considered as serious illness and such patients should be admitted to ICU as they will require respiratory support.
Such patients should be put on respiratory support. Non-invasive ventilation (NIV) – helmet or face mask interface depending on availability – may be considered for people who have an increased need for oxygen when breathing is reduced.
High flow nasal cannula should be considered in patients with increased oxygen requirements. The new guidelines state that intubation should be preferred in patients with high respiratory function if NIV is not tolerated and institutional protocols should be used for ventilatory management.
People over the age of 60, or those who have heart disease, high blood pressure and coronary artery disease diabetes mellitus and other immunological conditions such as HIV, active tuberculosis, chronic lung, kidney or liver disease, cerebrovascular disease or obesity, are at risk of serious illness happens more. and mortality, the guidelines said.
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