New COVID-19 Guidelines: Home Isolation, Managing Fever And Use Of Remdesivir

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New COVID-19 Guidelines: The Health Ministry has stated new guidelines for home isolation for mild and asymptomatic Corona positive cases.

It also includes protocols on managing children suffering from COVID-19.

Recommendations on home isolation treatments

The patients must communicate with the physician treating them and report to them if there is any deterioration in the condition. They must also continue medication for other co-morbid illness after consulting the doctor. Patients are advised to take steam inhalation twice a day and also perform warm water gargles.

Controlling fever

According to the new COVID-19 guidelines, if the fever is not controlled with the maximum dose of paracetamol, the doctor may prescribe other drugs such as Naproxen. Ivermectin tablets can also be taken for 3 to 5 days. Inhalational Budesonide can be given if the fever or cough persists beyond 5 days of the onset of the disease. The physician can prescribe low-dose oral steroids if fever persists beyond 7 days.

Taking Remdesivir

The guidelines state that one must not attempt to procure or administer Remdesivir at home. Such decisions can only be taken by a medical professional and administered only in a hospital setting. In case of a drop in the level of Oxygen or shortness of breath, the patients should get themselves admitted in a hospital and seek immediate consultation.

Managing children with COVID-19

The new COVID-19 guidelines state separate measures for children with no symptoms, those with mild symptoms and the ones with severe symptoms. Asymptomatic children do not require any treatment but it should be seen if they are developing any symptoms. Subsequently, treatment should be carried out based on the severity of the illness. Children who display mild symptoms such as runny rose, sore throat, cough, etc., can easily be treated at home with home isolation and symptomatic treatment.

The symptomatic treatment includes taking paracetamol after every 4-6 hours. for cough, throat soothing agents such as warm saline gargles can be helpful. To maintain hydration, oral fluids can be taken. Antibiotics are not indicated for treating children with mild illness.

Categorising moderate disease in children

A child suffering from moderate COVID-19 (Oxygen saturations above 90%) if they have the following respiratory rate based on their age:

Less than 2 months old: respiratory rate>60/min

Between 2-12 months: respiratory rate>50/min

Between 1-5 years: respiratory rate>40/min

Over 5 years: respiratory rate>30/min

The protocol states that children with moderate COVID-19 disease may be suffering from pneumonia which may not be clinically apparent. Routine lab tests are not required unless indicated by associated co-morbid conditions.

Recommended treatment

The protocol states that children with moderate COVID-19 disease should be admitted in a dedicated COVID health centre or secondary-level healthcare facility. They should then be monitored for clinical progress. Fluid and electrolyte balance should be maintained in children. Oral feeds must be encouraged and intravenous fluid therapy should be initiated if oral intake is poor.

Medicines to be taken

Paracetamol (10-15 mg/kg/dose) for fever. It can be repeated every after every 4-6 hours. Amoxycillin can be taken for bacterial infection. Oxygen supplementation is needed for oxygen saturation below 94%. Corticosteroids can be administered in case of a rapidly progressive disease. However, steroids is not needed in all children with mild illness, particularly during the first few days.

Severe illness in children

Children with Oxygen saturation below 90% are said to have severe degree of COVID-19 infection. They may have severe pneumonia, ARDS (acute respiratory distress syndrome), septic shock, MODS (multi-organ dysfunction syndrome), or pneumonia with cyanosis (bluish discolouration caused due to deoxygenation). Symptoms like grunting, severe retraction of chest, lethargy and seizure may be present in such children.

New COVID-19 guidelines state the following treatment for children with severe infection

Children with severe COVID-19 infection should be assessed for blood clot in a deep vein or thrombosis, haemophagocytic lymphohistiocytosis (HLH), which is a severe systemic inflammatory syndrome; and organ failure. Three specific investigations must be carried out: complete blood counts, liver and renal function tests, and chest X-ray. The protocol recommends Intravenous fluid therapy and corticosteroids- dexamethasone at 0.15mg/kg per dose (maximum 6 mg two times in a day is preferred). There is lack of safety and efficacy data in children below 19 years of age for anti-viral agents like Remdesivir. Further, the protocol states that children do not need the anti-malaria drug hydroxychloroquine, anti-viral favipiravir, ivermectin, and anti-HIV drugs lopinavir/ritonavir for treatment.