When COVID-19 first started, not much was known about it. We were left scrambling in the dark tugging at straw strings and trying out different treatments and management methods based on past knowledge and anecdotal evidences.
Some of them gained the reputation of 'miracle COVID drugs' despite subsequent studies pointing out that these 'repurposed drugs' don't work.
In spite of push back from the medical fraternity and experts, these treatments—most notable Remdesivir, convalescent plasma therapy, Ivermectin, Hydroxychloroquine, Doxycycline—continued to be listed in the Health Ministry's COVID management guidelines. That is, until now.
Revised COVID-19 management guidelines issued by the the Ministry’s Directorate General of Health Services (DGHS), on 27 May, has dropped all these medicines that have been so far touted as COVID treatments.
The revised guidelines for mild and moderate cases no longer recommends the use of Ivermectin, Plasma therapy.
(Photo: https://www.dghs.gov.in/)
The only medicine that has been retained in the guidelines is Inhaled Budesonide, Paracetamol, and antitussives (over-the-counter common cold medicines)
(Photo: https://www.dghs.gov.in/)
Treatments for mild to moderate cases that have been dropped include multivitamins, Zinc supplements and steam inhalation.
These new guidelines have been welcomes by health experts. Dr Soumya Swaminathan, Chief scientist at the World Health Organisation (WHO), for instance, hailed it as being 'simple and rational'.
What the Revised Guidelines Say
Let's look at some of the most noteworthy updates made to the guidelines.
For Asymptomatic Patients
No investigation or medication is required at this stage.
In Mild Cases
The guidelines have dropped Ivermectin, Hydroxychloroquine, Doxycycline and multivitamins, but continues to recommend inhaled Budesonide as a treatment option (only at this stage).
It also recommend patients may take Anti-Pyretic and Anti-tussive for symptomatic relief.
“No other Covid specific treatment is required.”The Directorate General of Health Services (DGHS)
In Moderate Cases
Oxygen therapy and steroids are recommended only for patients whose saturation levels drop below 92 and only when certain criteria for prescription are met.
In Severe cases
Oxygen therapy, steroids, anti-coagulants are recommended at this stage.
HRCT scans have been strongly discouraged, and to be done with extreme caution "only if there is worsening of symptoms."
Guidelines for Specific Treatments
Apart from the general recommendations, the guidelines, unlike the previous single page guidelines, also give details of when, and under what circumstances specific treatments are to be used.
Remdesivir
"Physicians are advised to exercise extreme caution in using Remdesivir as this is only an experimental drug with potential to harm," reads the guidelines.
Tocilizumab
To be used only only in severe and critically ill patients who show no signs of improvement in terms of oxygen requirement even after 24-48 hours of administration of steroids and have significantly raised inflammatory markers.
Steroids
"Steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19," states the recommendation.
Steroids are only advised for hospitalised moderately severe and critically ill patients under a doctor's supervision and a recommended dosage.
The updated guidelines also include recommendations for the management of mucormycosis— a fungul infection that has been on the rise in India at an alarming rate in tandem with the second wave of COVID-19.
According to the guidelines, the causes for mucormycosis include, "underlying conditions and predisposing factor such as diabetes mellitus,rampant misuse/overuse of steroids, malignancies, organ transplantation etc."
Liposomal Amphotericin B in doses specific to the stage of the infection has been recommended as the treatment of choice.
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