Don’t prescribe steroids for mild cases: Centre in new COVID advisory

Days after raising flags over the “misuse” of COVID-19 medicines, the government in its revised clinical guidance for COVID treatment has instructed doctors to avoid prescribing steroids to patients.

The revised guidelines, framed by the Indian Council of Medical Research (ICMR) and All Indian Institute of Medical Sciences (AIIMS) say that the risk of secondary infections like mucormycosis or black fungus is high when injectable steroids of a higher dose than required are used at an early stage of the disease.

The revised guidance says that there is no evidence to show that injectable steroids benefit patients who do not require oxygen support.

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Doctors have been asked to instruct patients to get themselves tested for tuberculosis or other respiratory diseases if cough persists for more than two to three weeks instead of prescribing them steroids.

The earlier treatment protocol for COVID recommended two doses of steroids like injectable methylprednisolone or dexamethasone daily for five to 10 days for moderate and severe cases.

The revised guidance has categorised the symptoms into mild, moderate and severe sections. Upper respiratory tract symptoms without shortness of breath has been categorised as mild disease for which patients have been recommended home isolation.

The guidance advises those with mild symptoms but suffering from breathing difficulties, high-grade fever, or severe cough that has lasted for more than five days to seek medical help.

It recommends hospital admission for moderate cases – of people who experience breathlessness with oxygen saturation level between 90 and 93. Such patients have also been recommended oxygen support.

Patients recording oxygen saturation level lower than 90 per cent and having a respiratory rate of over 30 minutes will be considered severe cases. The guidance recommends ICU admission of these patients and use of non-invasive ventilation helmet or face mask interface in case the breathing is low.

The revised protocol does not mention any new drugs, and continues to recommend the use of antiviral drug remdesivir for moderate to severe cases. The guidance has tweaked the usage of Tocilizumab, stating that the drug should be given with steroids and preferably within 24-48 hours of the onset of severe disease or ICU admission with raised inflammatory markers CRP and/or IL-6.

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Stating that the “overuse and misuse” of steroids was leading to severe conditions like mucormycosis, NITI Ayog member (health) Dr VK Paul last week recommended the general public to also follow “rational treatments” like AYUSH listed under the government’s treatment protocol.

“For fever, paracetamol is given, and for cough, Ayush syrup can be used. This is what we have prescribed in the home care module too. If cough continues for more than three days, there is an inhaler called Budesonide. These are the only three things that need to be done…other than that do gargle, take rest not overdo, it has a cost,” he said while addressing the media.