The government in its new Covid guidelines said that doctors should avoid giving steroids to COVID-19 patients and advise tuberculosis tests if their cough persists.
About the Covid Guidelines:
The revised guidelines clearly states that drugs like 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.
About the Doses:
Spelling out the doses for the drugs if necessary for three kinds of infections – “mild, moderate and severe”, the guidelines said that if cough persists for more than two-three weeks, patients should be tested for tuberculosis and other conditions.
While speaking to a news conference last week, NITI Aayog Member (Health) and chief of the Covid Task Force Dr V K Paul had expressed concerns over the “overuse and misuse” of drugs like steroids.
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. Besides, it also says that those people who are having 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.
Respiratory rate over 30 per minute, breathlessness or oxygen saturation lower than 90 percent on room air should be considered a severe disease and such patients have to be admitted to an ICU as they will need respiratory support, the note said.
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 work of breathing is low.
The revised guidelines continue to recommend emergency use authorization (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. It further warns the people against the use of the drug for patients who are not on oxygen support or in-home settings.
Use of the tocilizumab drug:
According to the guidelines, 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. They said, “Tocilizumab may be considered for patients with significantly raised inflammatory markers, and not improving despite the use of steroids with there being no active bacterial, fungal or tubercular infection.”
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, the guidelines further reads.
