India, June 7: The Union health ministry’s directorate general of health services (DGHS) has revised the Covid treatment guidelines dropping all medicines, except antipyretic and antitussive, for asymptomatic and mild cases.
This decision comes at a time when India is witnessing a significant dip in its Covid-19 tally. The revised guidelines, issued on May 27 have dropped all drugs including hydroxychloroquine, ivermectin, doxycycline, zinc, multivitamins, etc prescribed by the doctors to asymptomatic or mildly symptomatic Covid-19 patients retaining only antipyretic for fever and antitussive for cold symptoms.
The guidelines have also discouraged medical practitioners to prescribe unnecessary tests to the affected victims such as CT scans.
Stressing on the importance of abiding by Covid-19 appropriate behaviour such as mask, strict hand hygiene, and physical distancing, the guidelines advised people who experience Covid symptoms to seek teleconsultations and to consume a healthy balanced diet with proper hydration.
The patients and their families were also asked to stay connected and engage in positive talks through phone, video calls, etc.
In cases concerning the asymptomatic cases, the guidelines said that no medication is required except for those with comorbidities who need to continue taking their prescribed medicines.
While in mild cases, the guidelines recommended self-monitoring for fever, breathlessness, oxygen saturation (SpO2), or worsening of any symptoms.
It also suggested that people may take antipyretic and anti-tussive for symptomatic relief, and inhalation of budesonide (given via metered-dose inhaler with space device) at a dose of 800 mcg twice a day for 5 days for a cough for treatment of COVID related symptoms.
‘No other Covid-19 specific medication is required. The patient may have to be investigated further if symptoms persist or deteriorate,’ the guideline said.
Following are the guidelines for use of Remdesivir
- Remdesivir is a reserved drug approved by DCG (I) under Emergency Use Authorization only based on limited scientific evidence globally. It is to be used only in select moderate/ severe hospitalized COVID-19 patients on supplemental oxygen within 10 days of onset of disease.
- It is not indicated in mild COVID-19 patients who are in-home care/ COVID Care Centers.
- Physicians are advised to exercise extreme caution in using redeliver as this is only an experimental drug with the potential to harm.
What is Mucormycosis?
Mucormycosis is a fungal disease which occurs in patients with the underlying conditions and predisposing factor such as diabetes mellitus, rampant misuse/overuse of steroids, malignancies, organ transplantation, etc. The mode of infection is through inhalation of fungal spores from the air. It is not contagious.
Reasons for the increase in Mucormycosis in COVID-19 patients
- Uncontrolled hyperglycemia due to any reason
- Misuse, overuse, and irrational use of steroids.
- Prolonged ICU stay, unhygienic humidifiers and irrational use of broad-spectrum antibiotics may also be associated with mucormycosis
- Pre-existing co-morbidities such as haematological malignancies, use of immunosuppressants, solid organ transplants, etc.
Steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19
- Steroids are indicated in only hospitalized moderately severe and critically ill COVID-19 cases.
- Steroids should be used at the Right Time, in the Right dose and for the Right duration
- Self-medication of steroids must be avoided.
- Dexamethasone 6mg IV once daily or peroral for initially for 10 days or till the time of discharge whichever is earlier, based on clinical judgment daily.
- An equivalent glucocorticoid dose may be substituted (if dexamethasone is unavailable) by methylprednisolone 32 mg orally or 40 mg I/V or 50mg hydrocortisone intravenously every 8 hours or Prednisone 40 mg (per oral).
Earlier, the much-debated drug Ivermectin was also dropped off the list as a Covid prescribed medicine. In March too, the WHO noted that “the current evidence on the use of Ivermectin to treat COVID-19 patients are inconclusive”. Ivermectin, it said, was a broad spectrum anti-parasitic agent included in the WHO essential medicines list for several parasitic diseases.
The WHO had already advised against the use of Ivermectin, an anti-parasite drug usually prescribed to treat certain parasitic roundworm infections, as a prophylaxis treatment for COVID.
The May 27 order had also restricted Remdesivir to select moderate/severe hospitalized patients who are on supplemental oxygen within 10 days of the infection. Another drug in high demand, Tocilizumab is an immunosuppressant medicine that the DGHS said should be used only in severe and critically ill patients.
The second wave has also led to a spurt in cases of black fungus, which experts believe is due to the indiscriminate use of steroids to treat coronavirus.
Meanwhile, India added 1.14 lakh new coronavirus cases over the last 24 hours while deaths from COVID-19 rose by 2,667. The country’s overall caseload currently stands at 2.88 crore and total fatalities are 3.46 lakh.