Srinagar The Doctors Association Kashmir (DAK) on Tuesday issued an advisory on treatment protocol for hospitalized Covid-19 patients. “Lack of definitive treatment guidelines is leading to chaotic medication in Covid-19 patients,” said DAK President and influenza expert Dr Nisar ul Hassan.
“There is an urgent need of an explicit, comprehensive and continuously updated treatment protocol to prevent unnecessary prescription of medicines and ensure that Covid treatment is uniform,” he said.
Dr Hassan said Covid-19 is a biphasic illness. The first week of Covid is viral replication phase. The second week is driven by body’s hyperinflammatory response what is widely referred to as cytokine storm.
“Based on this understanding, antiviral therapies are effective early in the course of the disease, while anti-inflammatory therapies are beneficial in the later stages of Covid-19,” he said.
“Remdesivir, an antiviral drug is currently the only drug that is approved by US FDA for the treatment of Covid-19. It is recommended for use in hospitalized patients who require supplemental oxygen,” Dr Hassan said.
“However, it is not routinely recommended for patients who require mechanical ventilation due to lack of data showing benefit at this advanced stage of the disease,” he said.
The DAK President said steroids are recommended for Covid-19 patients in second phase of illness to counter the body’s hyperimmune response. They are life-saving in severe cases who have respiratory distress or need oxygen or ventilation.
“Steroids are to be avoided during the first phase of Covid-19 when viral replication is happening,” he said.
“Adding Tocilizumab, an antinflammatory drug to steroid therapy improves survival among patients who are exhibiting rapid respiratory decompensation due to Covid-19,” Dr Nisar said
Quoting Recovery trial, he said the combination of steroid and tocilizumab has been found to reduce the mortality by about one-third for patients requiring simple oxygen and nearly one-half for those requiring mechanical ventilation.
Dr Nisar said evidence has shown that Covid-19 infections can lead to increased risk of blood clots which can lead to organ damage and death.
“In absence of contraindication, all acutely hospitalized patients with Covid-19 should receive heparin to prevent clotting,” he said.
“Empirical antibiotic therapy is not recommended in Covid-19 patients. Antibiotics should only be prescribed in cases of proven or strongly suspected secondary bacterial infection,” he added.
