Health Ministry releases clinical guidelines explaining the management of Covid-19 in adult patients

The Union health ministry on Wednesday issued an advisory prescribing the treatment protocol for coronavirus disease (Covid-19) in adults, categorising them under three sections – mild disease, moderate disease and severe disease.

Explaining the clinical guidance under moderate and severe category, the health ministry has specified the stage at which a patient can be discharged. The guidance has been issued by the members of AIIMS, ICMR Covid-19 National Task Force, Joint Monitoring Group, health ministry and Centre.

Mild disease

A mild form of Covid-19 is characterised with upper respiratory tract symptoms, with a fever or lack of it without shortness of breath or hypoxia, the advisory said.

In home isolation and care, a mild case of Covid-19 patient should follow physical distancing, indoor mask use and strict hand hygiene. For symptomatic management, a patient can focus on recovering with hydration, anti-pyretics, anti-tussive, multivitamins.

Moderate disease

A patient with a moderate form of Covid-19 infection will show any one of symptoms like respiratory rate more than 24 per min, breathlessness, SpO2: 90% to < 93% on room air.

Such a case may require the patient to be admitted to a hospital ward with oxygen support targetting SP02 between 92-96% and 88-92% in patients with COPD).

The guidance says preferred devices for oxygenation in such a case will be a non-rebreathing face mask. Additionally, awake pruning is encouraged in all patients requiring supplemental oxygen therapy with sequential position changes every 2 hours, the guidance says.

Severe disease

A patient with a severe form of Covid-19 will show signs of respiratory rate less than 30 per minute or breathlessness or Sp02 < 90% on room air. Due to this severe impact, the patient will need admission to the Intensive Care Unit with respiratory support.

In such a treatment protocol, the use of Non-Invasive Ventilation (NIV) like a helmet or face mask interface depending on availability is suggested in patients with increasing oxygen requirement, if work of breathing is low. Additionally, intubation in patients with high work of breathing should be prioritized, if NIV is not tolerated, the guidance advisory said.

In this case of Covid-19 infection, a patient should be introduced to anti-inflammatory or immunomodulatory therapy.

The guide also states that remdesivir may be considered only in patients with moderate to severe disease, requiring supplemental oxygen.