If cough persists for more than two-three weeks, one should opt for investigation for tuberculosis and other conditions, said Union Health Ministry in its revised guidelines issued by AIIMS, ICMR - Covid-19 National Task Force and Joint Monitoring Group (DGHS) for management of adult Covid-19 patients on Monday January 18, 2022.
HRCT Chest has been recommended only if there is worsening of symptoms, the guideline further stated.
Doctors, meanwhile, have been advised to avoid giving steroids to Covid-19 patients. "There is no evidence for benefit for injectable steroids in those not requiring oxygen supplementation, or on continuation after discharge anti-inflammatory or immunomodulatory therapy (such as steroids) can have a risk of secondary infection such as invasive mucormycosis when used too early, at higher doses or for longer than required," the guidelines stated.
The revised guidelines said 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.
According to the revised guidance, upper respiratory tract symptoms without shortness of breath or hypoxia has been categorised as mild disease and have been advised home isolation and care.
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.
Those 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 per cent 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 warned against the use of the drug for patients who are not on oxygen support or in-home settings. The government-recommended treatments do not include medicines like ivermectin, favipiravir and Doxycycline. Antivirals like Molnupiravir and monoclonal antibodies are also not included in the guidelines.
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.
