The Directorate General of Health Services (DGHS) has issued several guidelines to manage patients of Covid-19. The importance of following Covid-19 behaviour has been stressed upon by DGHS.

A lot of medicines and tests have been dropped from the treatment of asymptomatic to mildly symptomatic covid patients. In fact almost all medicines have been dropped except those for fever and cold. The importance of maintaining social distance, washing hands and wearing masks has been stressed upon.  

In the guidelines issued on May 27th, all drugs including hydroxychloroquine, ivermectin, doxycycline, zinc, multivitamins, etc have been dropped that have till now been prescribed by doctors to asymptomatic and mildly symptomatic patients. The doctors have also been asked not to prescribe unnecessary tests such as CT-scan to covid patients.

As per the guidelines, the patients with mild symptoms should self-monitor for fever, breathlessness, oxygen saturation or worsening of any symptoms. The guidelines said, “People may take antipyretic and anti-tussive for symptomatic relief, and inhalation of budesonide at a dose of 800mcg twice daily for five days for a cough. No other Covid-19 specific medication required. The patient may have to be investigated further if symptoms persist or deteriorate. Medication is not required for asymptomatic patients and those with co-morbidities who need to continue taking their prescribed medicines.”

 Remdesivir is to be used only in select moderate or severe hospitalised Covid-19 patients on supplemental oxygen within 10 days of onset of disease. It is not for mild Covid-19 patients who are at home or in Covid Care Centres. It must be advised by senior faculty members or specialists directly involved in patient’s care. If it has to be advised or ordered during odd hours, it should be done by the duty doctor after telephonic consultation with a senior faculty member/specialist/ unit in - charge.

 If the patient shows no signs of improvement in terms of oxygen requirement even after 24-48 hours of administration of steroids, tocilizumab can be prescribed. It can also be prescribed when the patient has significantly raised inflammatory markers (C-Reactive Protein≥75 mg/L) . However, it must be ensured that the patient is free of any bacterial/fungal/ tuberculous infection at the time of administration of Tocilizumab. 

Steroids are harmful in asymptomatic and mild cases of Covid-19. Steroids are indicated in only hospitalised, moderately severe and critically ill Covid-19 cases. Self-medication of steroids must be avoided. Monitoring of blood glucose is mandatory in all patients put on steroids as it may precipitate hyperglycaemia.

Nearly two-thirds of those with asymptomatic Covid-19 have abnormalities on HRCT chest imaging which are nonspecific. Most of them do not progress clinically. HRCT imaging of the chest done in the first week of Covid-19 might often underestimate the extent of lung involvement, giving a false sense of security. Correlation between extent of lung involvement by HRCT and hypoxia—when the body or a particular region is deprived of adequate oxygen supply at the tissue level—is imperfect. The guidelines said that often, young people with extensive lung involvement will not develop hypoxia but elderly individuals with minimal or less extensive lung involvement may develop hypoxia. Radiation exposure due to repeated HRCT imaging may be associated with risk of cancer later in life.

Prophylactic doses to be used in moderate cases of Covid-19 with un-fractionated heparin or low molecular weight heparin. There should be no contraindication or high risk of bleeding. Doses to be used in severe cases with un-fractionated heparin or low molecular weight heparin. Therapeutic dose to be used only if there is evidence of thromboembolism or obstruction of a blood vessel by a blood clot that has become dislodged from another area in the circulation. There should be no contraindication or high risk of bleeding.

(details sourced from ht)