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Company Opene New Delhi-based All India Institute of Medical Sciences (AIIMS) has issued new guidelines for treatment of Covid-19 cases among adults. In the guidelines, AIIMS has suggested specific treatments based on the seriousness of the patient i.e. mild case, moderate case and severe case.

Here are the details:

Treatment for mild Covid-19 cases:

Identification: A patient is considered to be having mild Covid-19 is they have upper respiratory tract symptoms and/or fever WITHOUT shortness of breath or hypoxia.

Recommendation: Home isolation and care

MUST DOs:

• Physical distancing, indoor mask use, strict hand hygiene.
• Symptomatic management (hydration, anti-pyretics, antitussive, multivitamins).
• Stay in contact with treating physician.
• Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).

Seek immediate medical attention if:

• Difficulty in breathing
• High grade fever/severe cough, particularly if lasting for more than five days
• A low threshold to be kept for those with any of the high-risk features.

MAY DOs

• Therapies based on low certainty of evidence
• Tab Ivermectin (200 mcg/kg once a day for 3 days). Avoid in pregnant and lactating women.
• Tab HCQ (400 mg BD for 1day f/b 400 mg OD for 4 days) unless contraindicated.
• Inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for five days) to be given if symptoms (fever and/or cough) are persistent beyond five days of disease onset.

ALSO READ | What is the new 'triple mutant variant' of Covid-19 virus found in Bengal? How bad is it?

Treatment for moderate Covid-19 cases:

Identification: The patient's respiratory rate is more than 24/min, there is breathlessness and the SpO2 is 90% to

Recommendation: Admit in ward

Oxygen Support:

• Target SpO2: 92-96% (88-92% in patients with COPD).
• Preferred devices for oxygenation: non-rebreathing face mask.
• Awake proning encouraged in all patients requiring supplemental oxygen therapy (sequential position changes every 2 hours).

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days.
• Patients may be initiated or switched to oral route if stable and/or improving.

Anticoagulation

• Conventional dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (weight based e.g., enoxaparin 0.5mg/kg per day SC). There should be no contraindication or high risk of bleeding.

Monitoring

• Clinical Monitoring: Work of breathing, hemodynamic instability, change in oxygen requirement.
• Serial CXR; HRCT chest to be done ONLY if there is worsening.
• Lab monitoring: CRP and D-dimer 48 to 72 hourly.

Treatment for severe disease

Identification: Any one of these--Respiratory rate more than 30/min, breathlessness orSpO2

Recommendation: Admit in ICU

Respiratory support

• Consider use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is low.
• Consider use of HFNC in patients with increasing oxygen requirement.
• Intubation should be prioritised in patients with high work of breathing /if NIV is not tolerated.
• Use conventional ARDSnet protocol for ventilator management.

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

Anticoagulation

• Weight-based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight
• Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD).
• There should be no contraindication or high risk of bleeding.

Supportive measures

• Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol and local antibiogram.

Monitoring

• Serial CXR; HRCT chest to be done only if there is worsening.

What about Remdesivir and other drugs?

As per the new AIIMS guidelines, Remdesivir should be used in rare cases and its emergency use authorisation (EAU) is based on "limited available evidence and only in specific circumstances".

Remdesivir may be considered ONLY in patients with

• Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
• No renal or hepatic dysfunction (eGFR 5 times ULN (Not an absolute contradiction), AND
• Who are within 10 days of onset of symptom(s).

Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.

• Not to be used in patients who are NOT on oxygen support or in home settings

Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET

• Presence of severe disease (preferably within 24 to 48 hours of onset of severe disease/ICU admission).
• Significantly raised inflammatory markers (CRP &/or IL-6).
• Not improving despite use of steroids.
• No active bacterial/fungal/tubercular infection.

Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

Convalescent plasma (Off label) may be considered ONLY WHEN FOLLOWING CRITERIA ARE MET

• Early moderate disease (preferably within 7 days of symptom onset, no use after 7 days).
• Availability of high titre donor plasma (Signal to cut-off ratio (S/O) >3.5 or equivalent depending on the test kit being used).

ALSO READ | Covid-19 patients gasping for breath as oxygen shortage cripples hospitals

ALSO READ | Here's why doctors recommend home quarantine for mild Covid cases. How can pronal breathing help?e New Delhi-based All India Institute of Medical Sciences (AIIMS) has issued new guidelines for treatment of Covid-19 cases among adults. In the guidelines, AIIMS has suggested specific treatments based on the seriousness of the patient i.e. mild case, moderate case and severe case.

Here are the details:

Treatment for mild Covid-19 cases:

Identification: A patient is considered to be having mild Covid-19 is they have upper respiratory tract symptoms and/or fever WITHOUT shortness of breath or hypoxia.

Recommendation: Home isolation and care

MUST DOs:

• Physical distancing, indoor mask use, strict hand hygiene.
• Symptomatic management (hydration, anti-pyretics, antitussive, multivitamins).
• Stay in contact with treating physician.
• Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).

Seek immediate medical attention if:

• Difficulty in breathing
• High grade fever/severe cough, particularly if lasting for more than five days
• A low threshold to be kept for those with any of the high-risk features.

MAY DOs

• Therapies based on low certainty of evidence
• Tab Ivermectin (200 mcg/kg once a day for 3 days). Avoid in pregnant and lactating women.
• Tab HCQ (400 mg BD for 1day f/b 400 mg OD for 4 days) unless contraindicated.
• Inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for five days) to be given if symptoms (fever and/or cough) are persistent beyond five days of disease onset.

ALSO READ | What is the new 'triple mutant variant' of Covid-19 virus found in Bengal? How bad is it?

Treatment for moderate Covid-19 cases:

Identification: The patient's respiratory rate is more than 24/min, there is breathlessness and the SpO2 is 90% to

Recommendation: Admit in ward

Oxygen Support:

• Target SpO2: 92-96% (88-92% in patients with COPD).
• Preferred devices for oxygenation: non-rebreathing face mask.
• Awake proning encouraged in all patients requiring supplemental oxygen therapy (sequential position changes every 2 hours).

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days.
• Patients may be initiated or switched to oral route if stable and/or improving.

Anticoagulation

• Conventional dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (weight based e.g., enoxaparin 0.5mg/kg per day SC). There should be no contraindication or high risk of bleeding.

Monitoring

• Clinical Monitoring: Work of breathing, hemodynamic instability, change in oxygen requirement.
• Serial CXR; HRCT chest to be done ONLY if there is worsening.
• Lab monitoring: CRP and D-dimer 48 to 72 hourly.

Treatment for severe disease

Identification: Any one of these--Respiratory rate more than 30/min, breathlessness orSpO2

Recommendation: Admit in ICU

Respiratory support

• Consider use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is low.
• Consider use of HFNC in patients with increasing oxygen requirement.
• Intubation should be prioritised in patients with high work of breathing /if NIV is not tolerated.
• Use conventional ARDSnet protocol for ventilator management.

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

Anticoagulation

• Weight-based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight
• Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD).
• There should be no contraindication or high risk of bleeding.

Supportive measures

• Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol and local antibiogram.

Monitoring

• Serial CXR; HRCT chest to be done only if there is worsening.

What about Remdesivir and other drugs?

As per the new AIIMS guidelines, Remdesivir should be used in rare cases and its emergency use authorisation (EAU) is based on "limited available evidence and only in specific circumstances".

Remdesivir may be considered ONLY in patients with

• Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
• No renal or hepatic dysfunction (eGFR 5 times ULN (Not an absolute contradiction), AND
• Who are within 10 days of onset of symptom(s).

Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.

• Not to be used in patients who are NOT on oxygen support or in home settings

Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET

• Presence of severe disease (preferably within 24 to 48 hours of onset of severe disease/ICU admission).
• Significantly raised inflammatory markers (CRP &/or IL-6).
• Not improving despite use of steroids.
• No active bacterial/fungal/tubercular infection.

Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

Convalescent plasma (Off label) may be considered ONLY WHEN FOLLOWING CRITERIA ARE MET

• Early moderate disease (preferably within 7 days of symptom onset, no use after 7 days).
• Availability of high titre donor plasma (Signal to cut-off ratio (S/O) >3.5 or equivalent depending on the test kit being used).

ALSO READ | Covid-19 patients gasping for breath as oxygen shortage cripples hospitals

ALSO READ | Here's why doctors recommend home quarantine for mild Covid cases. How can pronal breathing help?

e New Delhi-based All India Institute of Medical Sciences (AIIMS) has issued new guidelines for treatment of Covid-19 cases among adults. In the guidelines, AIIMS has suggested specific treatments based on the seriousness of the patient i.e. mild case, moderate case and severe case.

Here are the details:

Treatment for mild Covid-19 cases:

Identification: A patient is considered to be having mild Covid-19 is they have upper respiratory tract symptoms and/or fever WITHOUT shortness of breath or hypoxia.

Recommendation: Home isolation and care

MUST DOs:

• Physical distancing, indoor mask use, strict hand hygiene.
• Symptomatic management (hydration, anti-pyretics, antitussive, multivitamins).
• Stay in contact with treating physician.
• Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).

Seek immediate medical attention if:

• Difficulty in breathing
• High grade fever/severe cough, particularly if lasting for more than five days
• A low threshold to be kept for those with any of the high-risk features.

MAY DOs

• Therapies based on low certainty of evidence
• Tab Ivermectin (200 mcg/kg once a day for 3 days). Avoid in pregnant and lactating women.
• Tab HCQ (400 mg BD for 1day f/b 400 mg OD for 4 days) unless contraindicated.
• Inhalational Budesonide (given via Metered dose inhaler/ Dry powder inhaler) at a dose of 800 mcg BD for five days) to be given if symptoms (fever and/or cough) are persistent beyond five days of disease onset.

ALSO READ | What is the new 'triple mutant variant' of Covid-19 virus found in Bengal? How bad is it?

Treatment for moderate Covid-19 cases:

Identification: The patient's respiratory rate is more than 24/min, there is breathlessness and the SpO2 is 90% to

Recommendation: Admit in ward

Oxygen Support:

• Target SpO2: 92-96% (88-92% in patients with COPD).
• Preferred devices for oxygenation: non-rebreathing face mask.
• Awake proning encouraged in all patients requiring supplemental oxygen therapy (sequential position changes every 2 hours).

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration of 5 to 10 days.
• Patients may be initiated or switched to oral route if stable and/or improving.

Anticoagulation

• Conventional dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (weight based e.g., enoxaparin 0.5mg/kg per day SC). There should be no contraindication or high risk of bleeding.

Monitoring

• Clinical Monitoring: Work of breathing, hemodynamic instability, change in oxygen requirement.
• Serial CXR; HRCT chest to be done ONLY if there is worsening.
• Lab monitoring: CRP and D-dimer 48 to 72 hourly.

Treatment for severe disease

Identification: Any one of these--Respiratory rate more than 30/min, breathlessness orSpO2

Recommendation: Admit in ICU

Respiratory support

• Consider use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is low.
• Consider use of HFNC in patients with increasing oxygen requirement.
• Intubation should be prioritised in patients with high work of breathing /if NIV is not tolerated.
• Use conventional ARDSnet protocol for ventilator management.

Anti-inflammatory or immunomodulatory therapy

• Injection Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

Anticoagulation

• Weight-based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight
• Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD).
• There should be no contraindication or high risk of bleeding.

Supportive measures

• Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol and local antibiogram.

Monitoring

• Serial CXR; HRCT chest to be done only if there is worsening.

What about Remdesivir and other drugs?

As per the new AIIMS guidelines, Remdesivir should be used in rare cases and its emergency use authorisation (EAU) is based on "limited available evidence and only in specific circumstances".

Remdesivir may be considered ONLY in patients with

• Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
• No renal or hepatic dysfunction (eGFR 5 times ULN (Not an absolute contradiction), AND
• Who are within 10 days of onset of symptom(s).

Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.

• Not to be used in patients who are NOT on oxygen support or in home settings

Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET

• Presence of severe disease (preferably within 24 to 48 hours of onset of severe disease/ICU admission).
• Significantly raised inflammatory markers (CRP &/or IL-6).
• Not improving despite use of steroids.
• No active bacterial/fungal/tubercular infection.

Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.

Convalescent plasma (Off label) may be considered ONLY WHEN FOLLOWING CRITERIA ARE MET

• Early moderate disease (preferably within 7 days of symptom onset, no use after 7 days).
• Availability of high titre donor plasma (Signal to cut-off ratio (S/O) >3.5 or equivalent depending on the test kit being used).

ALSO READ | Covid-19 patients gasping for breath as oxygen shortage cripples hospitals

ALSO READ | Here's why doctors recommend home quarantine for mild Covid cases. How can pronal breathing help?