Third wave of Covid-19: Mumbai, Delhi see decline in daily cases

Covid cases across the country crossed 258,000 on Monday, even as the two big metros - Mumbai and Delhi - reported a dip in reported cases. The national daily positivity rate increased to more than 19 per cent, signaling the need to step up testing.

As the third wave persists, the health ministry has issued new clinical guidelines for adult Covid patients. The government may also consider starting vaccination for those in the 12-14 age group from March, PTI has reported.  

Mumbai reported 5,956 cases - 24 per cent lower than Sunday. Delhi had over 12,000 cases - a decline of 31 per cent, compared to Sunday. While on a day-to-day basis, there was a slight drop in countrywide cases, compared with 271,000 infections reported on Sunday, this could also be because of low levels of testing during the weekend. The fewer reported cases could also be due to a large number of people opting for home antigen tests, instead of the reverse transcription-polymerase chain reaction (or RT-PCR) test. 

The health ministry on Monday also issued new clinical guidelines for adult Covid patients. For severe cases described as having peripheral capillary oxygen saturation (or SpO2) below 90 per cent in room air and respiration at less than 30 per cent, admission to an intensive care unit or high-dependency unit is to be followed. 

While most protocols remain the same as in the previous waves, the government, while suggesting the use of Remdesivir and Tocilizumab in severe patients under very specific circumstances, has not included Molnupiravir in its advisory. 

“Consider Remdesivir for five days to treat hospitalised patients,” the guidelines stated, stressing there was no evidence of benefit beyond that period. The drug is not to be used on patients who are not on oxygen support or in a home setting. 

If a cough persists for more than two or three weeks, the health ministry has suggested that the patient be investigated for tuberculosis and other conditions. 

The guidelines have been framed by the Indian Council of Medical Research and the All India Institute of Medical Sciences' joint monitoring group and the national task force. 

In the current wave being spurred by the highly transmissible Omicron variant of the novel coronavirus, the government has said that patients with upper respiratory tract symptoms, with or without fever and with no shortness of breath, are mild cases. 

For those with moderate disease, the government has said there is no evidence of benefit for injectable steroids in those not requiring oxygen supplementation, or on continuation after discharge.

Learning from past experience, the guidelines also state that anti-inflammatory or immunomodulatory therapy, such as steroids, can have a risk of secondary infection, such as invasive mucormycosis, when used too early at a higher dose or for a longer-than-required period. 

Meanwhile, a PTI report said India may begin inoculating children in the 12-14 age group against Covid in March as the 15-18 population is likely to get fully vaccinated by then, said N K Arora, chairman of the Covid-19 working group of the National Technical Advisory Group on Immunisation in India. 

"Adolescents in this age group have been actively participating in the inoculation process, and going by this pace of vaccination, the rest of the beneficiaries in the 15-18 age group are likely to be covered with the first dose by January-end and subsequently their second dose is expected to be done by February-end," said Arora.