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Get tested for TB if cough persists: Centre tells adult Covid patients

If cough persists for more than two-three weeks, one should opt for investigation for tuberculosis and other conditions, the revised guidelines stated

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Revising the clinical guidance for management of Adult Covid-19 patients, the Union health ministry has advised tests for tuberculosis, other conditions, if a Covid patient's cough persists for more than two to three weeks.

The revised 'Clinical Guidance for Management of Adult COVID-19 Patients' issued by AIIMS, ICMR-COVID-19 National Task Force and Joint Monitoring Group (DGHS) under the health ministry on Monday underlined there is no evidence of injectable steroids benefitting Covid patients not requiring oxygen supplementation or in continuation after discharge.

Anti-inflammatory or immunomodulatory therapy, such as steroids, can have the risk of secondary infection like invasive mucormycosis, when used too early, at higher dose or for longer than required, they highlighted.

If cough persists for more than two-three weeks, one should opt for investigation for tuberculosis and other conditions, the revised guidelines stated.

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 use of the drug for patients who are not on oxygen support or in home settings.

According to the guidelines, EUA or off-label use of the tocilizumab drug may be considered for use in the presence of severe disease, preferably within 24 to 48 hours of onset of severe disease or intensive care unit (ICU) admission.

Tocilizumab may be considered for patients with significantly raised inflammatory markers, and not improving despite use of steroids with there being no active bacterial, fungal or tubercular infection, they stated.

Coronavirus patients have been classified into those affected by mild, moderate and severe disease, the guidelines stated.

Injection methylprednisolone 0.5 to one mg/kg in two divided doses, or an equivalent dose of dexamethasone, can be given usually for a duration of five to 10 days in moderate cases, the guidelines stated. The same drug in two divided doses of one to two mg/kg can be given for same duration in severe cases.

"Inhalational budesonide (given via metered dose inhaler/dry powder inhaler) at a dose of 800 mcg BD for five days can be given in mild cases if symptoms (fever and/or cough) are persistent beyond five days of disease onset," it was stated in the guidelines.

According to the guidance note, 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 SpO2 fluctuating between 90-93 per cent, can get admitted to a ward, and they will be considered moderate cases. Such patients should be given oxygen support and awake proning should be encouraged in all patients requiring supplemental oxygen therapy, in sequential position changes every two hours, the guidelines stated.

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