India: New COVID-19 treatment guidelines include TB as comorbidity, advise against steroid use

Revised COVID treatment guidelines: The Union Health Ministry in its revised ‘Clinical Guidance for Management of Adult COVID-19 Patients’ has advised testing for TB if cough persists and also avoiding the use of the steroid. The revised clinical guidelines for coronavirus treatment come days after NITI Aayog Member (Health) and chief of the Covid Task Force Dr. V K Paul expressed concerns and regret over the "overuse and misuse" of drugs like steroids during the second wave of the COVID-19 pandemic. 

The health ministry has added active tuberculosis as a high-risk factor that can potentially cause severe disease and even mortality in COVID-19 patients. The Ministry underlined the need for COVID-19 patients to undergo tests for tuberculosis and other conditions if their cough persists for more than 2-3 weeks. 

The centre has also instructed the States to keep an eye on the decline in the number of COVID-19 tests. Additional Health Secretary, Arti Ahuja, said that it was important to effectively track the spread of the pandemic. She observed in a letter to the states that there should be increased testing in a strategic manner in line with the trend of case positivity in specific areas.

Testing remains a key component 

Ahuja highlighted that testing is a key and crucial component and the data available on the Indian Council of Medical Research (ICMR) portal shows that testing has declined in many States and Union Territories. The ICMR has advised in all its advisories including the latest on January 10 that the basic objective is early detection of cases to enable quick isolation and treatment.

She pointed that testing has so far remained a key strategy for pandemic management, as it helped in the identification of new clusters and new hotspots of COVID-19 infection. This in turn helped facilitate swift action to contain the spread such as by contact tracing, setting up of containment zones, quarantining, isolation and treatment and follow-up.

Classification of Mild, Moderate and Severe COVID-19 cases

Mild COVID-19 cases: As per the revised guidelines, the cases with respiratory tract symptoms without shortness of breath or hypoxia have been categorised as mild and have been advised home isolation and care. Those suffering from mild Covid should seek immediate medical attention though if they have difficulty in breathing or have a high-grade fever or severe cough for more than 5 days.

Moderate COVID-19 cases: The patients having breathlessness with oxygen saturation fluctuating between 90-93 percent will be considered as moderate cases of COVID-19. They can get admitted and should be given oxygen support.

Severe COVID-19 cases: The patients with a respiratory rate over 30 per minute and are having breathlessness or oxygen saturation is lower than 90 percent on room air should be considered severe covid cases. Such patients have to be admitted to the ICU and will require respiratory support. Non-invasive ventilation (NIV) such as helmet or face mask interface depending on availability can be considered for those with increasing oxygen requirements if their breathing is low.

The Ministry's guidelines further note that those in the high-risk category, above 60 years of having diabetes mellitus, hypertension, cardiovascular disease, coronary artery disease or any other immunocompromised states such as obesity, active tuberculosis, chronic lung, HIV, kidney or liver disease, cerebrovascular disease are at high risk of severe COVID disease and mortality.

COVID-19 Treatment guidelines

Avoid use of steroids

The government in its revised clinical guidelines for coronavirus treatment has stated that the doctors should avoid giving steroids to COVID-19 patients for their treatment. The Ministry said that there is no evidence of injectable steroids benefitting COVID-19 patients not requiring oxygen supplementation or in continuation after discharge.

The Ministry's revised guidelines stated that anti-inflammatory or immunomodulatory therapy, such as steroids, can increase the risk of a secondary infection like invasive mucormycosis or black fungus, when used too early, at a higher dose or for longer than required.

Remdesivir recommended for moderate to severe COVID cases

The revised guidelines for COVID-19 treatment continue to recommend emergency use authorization (EUA) of remdesivir in patients with "moderate to severe" COVID-19 infection and those who have no renal or hepatic dysfunction within 10 days of the onset of any symptom. The guidelines warn against the use of the drug on patients who are in home settings or who are not on oxygen support.

Tocilizumab recommended for severe COVID cases

The guidelines also recommend emergency use authorization of the tocilizumab drug in the presence of severe COVID-19 disease, preferably within 24 to 48 hours of the onset of severe disease or ICU admission. The drug should be considered only for patients with significantly raised inflammatory markers, which are not improving despite the use of steroids. There should though be no active bacterial, fungal or tubercular infection.

 
Source: Jagran Josh