No Ivermectin, Zinc in COVID Treatment – What’s Govt’s Latest SOP?

The latest SOPs also clearly list who should be using Remdesivir, Tocilizumab, and steroids.

The Union Health Ministry and Family Welfare's directorate general of health services (DGHS) has issued revised guidelines to stop the use of Ivermectin and Doxycycline, along with Zinc and multivitamin tablets in COVID-19 treatment.

The new guidelines have dropped all medicines, except those to treat symptoms, for mild cases. The latest SOPs also list clearly who should be using Remdesivir and Tocilizumab, along with who exactly must take steroids.

I have tested positive for COVID-19 but I am asymptomatic. What medication should I take?

• No medication required for COVID-19 infection – including Hydroxychloroquine, Ivermectin, Zinc, or Doxycycline
• Asymptomatic patients can continue medications for other co-morbid conditions, if any
• Avoid visiting hospitals, tele-consultation is enough
• Practice COVID-appropriate behaviour – isolation, wearing mask, strict hand hygiene
• Advised to eat healthy balanced diet with proper hydration
• Can take the six-minute walk test 3-4 times a day
• No further test/investigation is required at this stage

What are considered mild COVID-19 symptoms?

• Has one/some of the following symptoms: Fever, cough, sore throat, weakness, diarrhoea, gastro-intestinal problems, nausea
• But does not have: Shortness of breath or difficulty in breathing
• Respiratory rate < 24/minute
• SpO2: ≥ 94% on room air

What is the treatment protocol for mildly symptomatic patients?

• Medicines to be given only to relieve symptoms
• Self-monitoring for fever, breathlessness, SpO2or worsening of any symptoms
• Inhalational Budesonide (given via Metered dose inhaler with space device) at a dose of 800 mcg BD for 5 days) for cough
• No other COVID-19 specific medication required
• COVID-appropriate behavior to be followed.

I have mild symptoms. Should I take a CT scan? Other tests?

• Patient may have to be investigated further only if symptoms persist or deteriorate.
• They can be monitored in home isolation or a COVID care centre

In which situations is it okay to get a CT scan done?

• In suspected and confirmed cases of moderate COVID-19 when the patient continues to deteriorate clinically even after initiation of appropriate therapy, especially if there is a high risk of invasive fungal infection.
• Depending on clinical assessment, your physician may consider a CT scan.

Should I get a CT scan done to find out if I have COVID-19?

No, that is not recommended. Diagnosis of COVID-19 should only be done through approved laboratory tests.

I have asymptomatic/mild COVID-19, should I get a CT scan done?

• No, it is not recommended in asymptomatic and mild cases. CT scans done in the first week of illness might underestimate the extent of lung involvement and give a false sense of security. Almost two-thirds of asymptomatic people have abnormalities on CT scans that are non-specific and most of them do not progress clinically.
• A CT scan is not required to initiate treatment in COVID-19 patients with hypoxia and an abnormal chest radiograph.
• It is not required to assess response to treatment either.

I have tested positive for COVID-19. Should I take Ivermectin and Zinc tablets?

This is not recommended, according to latest health ministry guidelines.

The revised guidelines have also dropped drugs such as hydroxychloroquine, ivermectin, doxycycline, zinc and multivitamins, that were earlier prescribed by doctors to treat asymptomatic or mildly symptomatic COVID-19 patients.

Who should take Remdesivir?

• Remdesivir is a reserved drug approved by DCG (I) under Emergency Use Authorisation only based on limited scientific evidence globally. It is to be used only in select moderate/severe hospitalised COVID-19 patients on supplemental oxygen within 10 days of onset of disease.
• It is not indicated in mild COVID-19 patients who are in home care/COVID care centres.
• Physicians are advised to exercise extreme caution in using Remdesivir as this is only an experimental drug with potential to harm.

Who can be prescribed Tocilizumab?

Tocilizumab is an immunosuppressant drug and it has been approved by DCG (I) for use as an off-label drug only in severe and critically ill patients of COVID-19, who meet the following conditions:

• If the patient shows no signs of improvement in terms of oxygen requirement even after 24-48 hours of administration of steroids, and
• Has significantly raised inflammatory markers (C-Reactive Protein≥75 mg/L)

However, it must be ensured that the patient is free of any bacterial/fungal/ tuberculous infection at the time of administration of Tocilizumab.

Are steroids safe to take for COVID-19 patients?

• Steroids are harmful in asymptomatic and mild cases of COVID-19
• Steroids are indicated in only hospitalised moderately severe and critically ill COVID-19 cases
• Self-medication of steroids must be strictly avoided
• Monitoring of blood glucose is mandatory in all patients put on steroids as it may precipitate hyperglycaemia
• In any case, COVID-19 infection and its treatment are likely to precipitate diabetes in previously normal individuals or worsen diabetes in known cases
• It must be also remembered that steroids may prolong viral shedding, and hence caution is required.