The Health Ministry suggested that investigational therapies and drugs-Remdesivir, Convalescent Plasma Therapy, Tociluzimab and Hydroxychloroquine should only be used in a defined subgroup of Covid patients. The Ministry advised that Remdesivir may be considered in patients with moderate disease who are on oxygen and Convalescent plasma may be considered in patients with moderate disease whose oxygen requirement is progressively increasing despite use of steroids.
In the case of Convalescent Plasma Therapy, it is advised that recipients should be closely monitored for several hours post transfusion for any transfusion related adverse events and its use should be avoided in patients with IgA deficiency or immunoglobulin allergy. The Health Ministry also suggested that use of Tocilizumab may be considered in patients with moderate disease with progressively increasing oxygen requirements and in mechanically ventilated patients, not improving despite use of steroids.
On the use of Hydroxychloroquine, the Ministry said that this drug has demonstrated in vitro activity against corona virus and was shown to be clinically beneficial with significant limitations. It is advised that this drug should be used as early as possible in the disease course to achieve any meaningful effects and it should be avoided in patients with severe disease. An ECG should ideally be done before prescribing the drug. The Ministry has said that several large observational studies with severe methodologic limitations have shown no effect on mortality.
The Health Ministry has recommended real time or conventional RT-PCR test for diagnosis whereas antibody tests have not been recommended for diagnosis of Covid-19. It said, dual infections with other respiratory infections like viral, bacterial and fungal have been found in COVID-19 patients and depending on local epidemiology and clinical symptoms, tests for other potential causes like influenza, other respiratory viruses, malaria, dengue fever, typhoid fever are recommended. It has suggested collection of blood cultures, ideally prior to initiation of antimicrobial therapy for Covid-19 patients with severe disease.