The State has brought out revised treatment guidelines for the management of COVID-19, a comprehensive document drawn from the best of evidence-based practices from across the globe and encompasses the experience of the State’s clinicians in treating those infected till date.

The new guidelines bear evidence to the new and better understanding of the disease epidemiology and transmission dynamics of COVID-19 and the newer treatment options, including the use of steroids, antivirals, and plasma therapy.

Drop in oxygen level

“We have assimilated the best from the national guidelines but have added guidance based on our clinical observations too. One is the note about the atypical manifestations of COVID-19 that clinicians should watch out for. The highlight, however, is the algorithmic approach to treating patients with exertional desaturation (drop in oxygen level), a phenomenon which is well recognised but has not been addressed in other guidelines,” a senior clinician said.

“Post-discharge follow-up of patients is also very important. Exertional dyspnea or breathlessness was one of the sequelae of COVID-19 that some of the healthcare workers who had recovered from the disease experienced. Recognizing exertional dyspnea and addressing it at the right time is very important as interstitial pneumonia in some cases can progress to irreversible pulmonary fibrosis,” he added. The new guidelines thus talk about an exertional desaturation test or the 40 steps test for those patients with normal oxygen saturation (> 94%) at rest in room air and who are clinically stable.

If the oxygen levels drop after the walk test, these patients may be started on low-dose steroids after consulting the pulmonary specialist or physician.

Pregnant women, children

The other additions in the guidelines include the CT-guided approach to diagnosing a person who tests negative in PCR test but has clinical symptoms of COVID-19, critical care guidelines for adults and paediatric cases, and treatment of pregnant women in serious condition to whom antiviral Remdesivir cannot be administered.

While antivirals like Remdesivir and Favipiravir are new additions, clinicians in the State still swear by hydroxychloroquine (HCQ), the early administration of which in mild/asymptomatic patients has been found to be beneficial.

“AIIMS has removed HCQ from its protocol but we have not seen any adverse effects in our patients treated on HCQ. Convalescent plasma therapy which used to be indicated as the last resort has been pushed ahead in the course of treatment in the new guidelines. Early administration of antivirals and steroids might be the key to preventing overreaction of the immune system or the cytokine storm syndrome,” doctors at Government Medical College Hospital, Thiruvananthapuram, said.

A uniform pattern

Doctors said a crucial factor for the successful clinical management of COVID-19 patients in the State had been the highly centralised and uniform treatment pattern followed by all COVID-19 hospitals here. The State Medical Board (SMB) reviews all serious cases in ICUs in various hospitals daily and all critical decisions are taken by the institutional medical boards in consultation with the SMB.