COVID 19 Update Points learnt today on video conference with Dr. Atul Patel and Dr. Tushar Patel -( Infectious Disease Specialist) [ ] In mild or asymptomatic Covid positive patients, only treatment required is B-complex, zinc, vitamin c, and, Paracetamol SOS. [ ] In moderately symptomatic pateints where oxygen saturation is low, four things are important - • High flow oxygen via nasal prongs, mask, or masks with breathing/ non-breathing reservoir bag. • Awake proning. • Low dose steroids - Dexamethasone 6 tob8mg per day or methylprednisolone 40mg B.D. (preferably within 48 hours of admission or if o2 requirement is increasing and if inflammatory markers are increased) • Anticoagulation with LMWH - in all patients where o2 requirement is high and D-dimer is high. ** Role of HCQS is doubtful but may be given in mild to moderate cases. ** There is no role of antibiotics. ** Few patients with covid-19 experience a secondary bacterial infection. Consider empiric antibiotic therapy as per local antibiogram and guidelines in older people, immune-compromised patients, and children < 5 years of age. [ ] In severe cases, • O2 support and medications as above. • Management of septic shock with vasopressors, crystalloids, fluids. [ ] Investigational therapies (with limited available evidence) - 1. Remdesivir (under Emergency Use Authorization) may be cinsidered in patients with moderate disease (those on oxygen) with none of the following contraindications : • AST/ALT > 5 times the upper limit of normal. • Severe renal impairment (i.e. eGFR<30ml/min/m2 or need for hemodialysis) • Pregnancy or lactating females • Children (<12 years of age) • DOSE - 200 mg I.V. on day 1 followed by 100mg I.V. daily for 5 days. 2. Convalescent plasma (off label) may be considered in patients with moderate disease who are not improving on oxygen or steroids. • DOSE - Usually 200ml single dose given slowly over not less than 2 hours. 3. Tocilizumab (off label) may be considered in patients with moderate disease with progressively increasing o2 requirements, and not improving despite use of steroids. • DOSE - 8mg/kg (max. 800 mg at one time) given slowly in 100ml NS over one hour, dose can be repeated once after 12 to 24 hours if needed. 4 . Favipiravir - broad spectrum antiviral drug • Indication - mild to moderate cases and can also be used in patients with co-morbid conditions such as diabetes and heart diseases. • Contraindication - Pregnant and lactating women and in patients with severe renal and hepatic impairment. • DOSE - For adults, 1800mg orally twice daily on day 1 followed by 800mg orally twice daily, upto a maximum of 14 days.