Coronavirus treatment: The dos and don'ts for mild, moderate, severe cases

The health ministry has released revised clinical guidelines for the management of adult Covid patients. Here's what you must know

In view of escalating coronavirus cases, rise in positivity rate, and the risk Omicron spread, which has wreaked havoc in Europe the US, the Covid National Task Force under the Ministry of Health and Family Welfare has released revised clinical guidance for the management of adult Covid patients.

Here's what you must know

1. Avoid taking steroids

They 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.

2. When to get tested for TB, other diseases

If cough persists for more than two-three weeks, get tested for tuberculosis and other conditions.

3. Use of remdesivir for patients with "moderate to severe" disease

The revised guidelines continue to recommend emergency use authorisation (EUA) or off-label use of remdesivir in patients with "moderate to severe" disease and those with no renal or hepatic dysfunction within 10 days of the onset of any symptom.

They warn against the use of the drug for patients who are not on oxygen support or are in in-home settings.

4. Use of tocilizumab drug for severe cases

EUA or off-label use of the tocilizumab drug may also be considered for use in the presence of severe disease, preferably within 24 to 48 hours of the onset of severe disease or intensive care unit (ICU) admission.

Tocilizumab may be considered for patients with significantly raised inflammatory markers, and cases of no improvement despite the use of steroids with there being no active bacterial, fungal or tubercular infection.

Classification of Covid cases (as per symptoms)

Mild: Upper respiratory tract symptoms without shortness of breath or hypoxia has been categorised as mild disease. Patients with mild disease are advised home isolation and care. Those suffering from mild Covid should seek medical attention if they have difficulty in breathing, high-grade fever, or severe cough lasting for more than five days.

Dos for mild cases

— home isolation with physical distancing

— indoor mask use

— strict hand hygiene

— symptomatic management (hydration, antipyretics, antitussive).

— stay in contact with treating physician

— monitor temperature and oxygen saturation

Moderate case: Those experiencing breathlessness with a fluctuating oxygen saturation between 90-93 per cent can get admitted, and they will be considered moderate cases. Such patients should be given oxygen support.

Dos for moderate cases

Seek immediate medical attention if

— difficulty in breathing or

— oxygen saturation drops below 93,

— or high grade fever/severe cough, particularly if lasting for more 5 days

— moderate patients will have to be admitted in ward.

Severe case: Respiratory rate over 30 per minute, breathlessness, or oxygen saturation lower than 90 per cent in room air should be considered a severe disease and such patients have to be admitted to an ICU as they will need 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 in those with increasing oxygen requirements if breathing is low.

Who is at high risk for severe disease and mortality?

According to the guidelines, those aged above 60 years, or those having cardiovascular disease, hypertension and coronary artery disease, diabetes mellitus and other immunocompromised states, such as HIV, active tuberculosis, chronic lung, kidney or liver disease, cerebrovascular disease or obesity are at high risk for severe disease and mortality.