The Union health ministry on Thursday issued a revised ‘Clinical Guidance for Management of Adult COVID-19 Patients’ recommending the EUA/off-label use of Tocilizumab drug in case of severe diseases, preferably within 24 to 48 hours of the onset of the disease or ICU admission. The guidelines issued by AIIMS, ICMR-COVID-19 National Task Force and the Joint Monitoring Group (DGHS) under the ministry stated that Tocilizumab (a drug that modifies the immune system or its functioning) may be considered in patients with significantly raised inflammatory markers and not improving despite use of steroids with there being no active bacterial/fungal/tubercular infection.
They also recommended off-label use of convalescent plasma only in the early moderate disease, preferably within seven days of symptom onset, stating that “no use after seven days” and only on availability of high titre donor plasma. Under emergency use authorization (EUA), Remdesivir may be considered for only those patients with moderate to severe diseases (requiring supplemental oxygen) within 10 days of onset of symptoms.
It is not recommended for those with severe renal impairment or hepatic dysfunction, the guidelines stated. “Not to be used in patients who are not on oxygen support or in home settings,” the ministry underlined.
The guidance note comes in the wake of increasing demand for Tocilizumab, Remdesivir and plasma, as the COVID-19 cases continue to surge. The note specifies how and in what stages and doses should the drugs be used. According to the guidance note, upper respiratory tract symptoms (or fever) without shortness of breath or hypoxia has been categorised as mild disease’ and people have been advised home isolation and care.
The guidelines advise physical distancing, indoor mask use, strict hand hygiene. symptomatic management (hydration, anti-pyretics, antitussive, multivitamins), staying in contact with treating physician, monitoring temperature and oxygen saturation (by applying a SpO2 probe to fingers) for such patients. They should seek immediate medical attention if they develop difficulty in breathing, high grade fever/severe cough, particularly if lasting for five days.
A low threshold to be kept for those with any of the high-risk features such as 60 years of age, having cardiovascular disease, hypertension, chronic lung/kidney/liver disease or cerebrovascular disease or obesity, the note stated.