New Delhi| Jagran Health Desk: The country has been reeling under the cascading impact of the second wave of coronavirus with daily cases crossing the mark of 3 lakh. Recently, the All India Institute of Medical Sciences (AIIMS) issued new guidelines for the treatment of coronavirus among adults for mild, moderate and severe cases. In the new clinical guidelines, AIIMS mentioned the treatment measure for coronavirus patients, here are the things you need to know:

Mild Coronavirus

What are the symptoms of mild coronavirus patients?

*The mild disease includes symptoms like dry cough, mild fever and no shortness of breath or hypoxia.

*The patient should be in-home isolation in this case.

What are the must-dos for mild disease?

* The patient must monitor temperature and oxygen saturation.
* They should follow physical distancing, indoor mask use, hand hygiene.
* Needs to stay in contact with their physician.

When does the mild symptomatic patient need to consult a doctor?

*If they are facing difficulty in breathing.
*If there is a high fever, severe cough which is lasting for more than 5 days.

What are therapies that the mild symptomatic patient can follow?

*The patients can take Tab Ivermectin (200 mcg/kg) once a day for 3 days. Those women who are lactating or are pregnant should avoid it.

*The Patients can also take TAB HCQ (400 mg BD for 1day f/b 400 mg OD for 4 days) unless contraindicated.

* In the guidelines it is also mentioned that the patient can have 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.

Moderate COVID-19 Cases

What are the symptoms of moderate coronavirus cases?

*In this, the patient will have symptoms like cough, nausea, headache, and the respiratory rate is more than 24/min, there is breathlessness and the SpO2 is 90 per cent to93 per cent on room air.

*The patient should admit to the ward in this case.

What are the must-dos for moderate coronavirus patient?

Oxygen Support

The patient needs to take oxygen support and also need to have supplemental oxygen therapy (sequential position changes every 2 hours).

Anti-inflammatory or immunomodulatory therapy

* The patient needs to have 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 the oral route if stable and/or improving.

Anticoagulation

In this case, the patient needs to have a conventional dose of 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.

Severe COVID-19

What are the symptoms of severe coronavirus patients?

In this, the patient's may face any one of these--Respiratory rate more than 30/min, breathlessness or SpO2 is greater than 90 per cent on room air.

What are the must-dos for severe coronavirus patients?

Respiratory support

*In this, the patients should consider the use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement, if work of breathing is low.

*They should be the 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 of 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.

Posted By: Deeksha Sharma