NEW DELHI: Amid the current scramble for convalescent plasma and remdesivir, the latest COVID-19 treatment protocols issued by the ICMR and AIIMS, Delhi, have for the first time set cut-off thresholds for their use after symptom onset, beyond which they have no role.
The latest guidelines released by AIIMS, ICMR-COVID-19 national task force and the joint monitoring group under the Union health ministry say that remdesivir can be used in patients with moderate to severe disease within 10 days of symptom onset while plasma can be administered in early moderate disease within seven days of symptom onset.
Convalescent plasma, as per the new protocol, is of “no use after seven days” and should be given only on availability of high titre donor plasma.
Remdesivir on the other hand 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.
These guidelines have been issued in the wake of a mammoth wave of COVID-19 infections in India that has overwhelmed the health infrastructure in many places, and acute shortage of crucial supplies such as oxygen and experimental drugs like remdesivir and tocilizumab.
The protocol has also recommended the 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.
As per 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.
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The guidelines advise physical distancing, indoor mask use, strict hand hygiene, symptomatic management such as hydration, anti-pyretics, antitussive, multivitamins, staying in contact with treating physicians, monitoring temperature and oxygen saturation for such patients.
They should seek immediate medical attention if they develop difficulty in breathing, high grade fever or severe cough, particularly if lasting for five days, the revised protocol says.
However, a low threshold has to be kept for those with any of the high-risk features such as being above 60 years of age, having cardiovascular disease, hypertension, chronic lung, kidney, liver disease or cerebrovascular disease or obesity.