India's Covid Pandemic Management

Coronavirus constitutes a large group of viruses that affect both animals and humans. In some rare cases, the coronavirus can transmit from animals to people such as the SARS and MERS virus did.

The COVID-19 outbreak took place in the Chinese town of Wuhan. Presently, it has spread to 215 countries. Out of these countries, India was pretty severely affected. Hence, the COVID management in India had to be rigorous.

The COVID-19 management protocol of India states what should be done by healthcare workers when they come across an infected person. Discussed in this article are some of the key details about virus management in India.

COVID Treatment Guidelines in India

According to the Ministry of Health and Family Welfare, Government of India, these are the guidelines for the treatment of COVID-19.

1. If the Person Has Mild Disease

In case the person has a mild disease, he/she should be treated at home according to the rules given below. The symptoms and other formalities are listed as follows:

Symptoms

• Upper respiratory tract symptom
• This may be WITH or WITHOUT shortness of breath or hypoxia

Must-Do

• Maintain physical distancing, use masks indoors and maintain proper hygiene of hands.
• Symptomatic management such as:
  • Antipyretics
  • Antitussive
  • Hydration
  • Multi-vitamins
• Remain in contact with the doctor treating you.
• Monitor temperature and oxygen saturation by applying a SpO₂ probe to the fingers.
• Seek immediate medical attention if:
  • There is a problem with breathing
  • High fever or critical cough lasting for more than 5 days
  • Keep a lower threshold for those with any of the high-risk features such as:
    • Age > 60 years
    • Cardiovascular disease
    • Cerebrovascular disease
    • Chronic lung/kidney/liver disease
    • Diabetes mellitus
    • Any other immunocompromised states
    • Hypertension and Coronary Artery Disease
    • Obesity
2. If the Person Has Moderate Disease

If the person has a moderate disease, he/she should be admitted to a hospital ward and taken care of there.

Symptoms

• Respiratory rate greater than or equal to 24 per minute, along with breathlessness
• SpO₂ 90% to less than equal to 93% on room air.

Must-Do

• Anti-inflammatory therapy
  • Injection 0.5 to 1 mg/kg Methylprednisolone in 2 divided doses
  • Or an equivalent dose of dexamethasone for 5 to 10 days.
  • If improving, patients may be transferred to the oral route.
• Provide Oxygen Support
  • Target SpO₂ to 92-96% (88-92% in patients with COPD, that is, chronic obstructive pulmonary disease).
  • Use a non-rebreathing face mask.
  • Experts recommend awake proning for those patients requiring supplemental oxygen therapy with position changes every 2 hours.
• Monitoring
  • Clinical Monitoring: Change in oxygen requirement, hemodynamic instability, work of breathing
  • Serial CXR
  • Do HRCT chest only if the condition worsens.
  • Lab monitoring: D-dimer and CRP 48 to 72 hourly; CBC, LFT, KFT 24 to 48 hourly
  • Do IL-6 levels if the patient is deteriorating.
• Anticoagulation
  • The usual dose of Low Molecular Weight Heparin (weight-based e.g., enoxaparin 0.5mg/kg per day SC) or prophylactic unfractionated heparin.
  • There shouldn’t be any high risk of bleeding or contraindication.
3. If the Person Has Severe Disease

If the person has severe disease, he/she should be admitted to the ICU (Intensive Care Unit).

Symptoms

• Respiratory rate greater than 30 per min and breathlessness
• SpO₂ less than 90% on room air

Must-Do

• Respiratory support
  • For patients with increasing oxygen requirements, use NIV (helmet or face mask interface) if the work of breathing is low.
  • Consider the use of HFNC in patients with increasing oxygen needs.
  • Give intubation to patients with high work of breathing NIV is not tolerated.
  • Use regular ARDSnet protocol for ventilatory management.
• Anti-inflammatory therapy
  • Injection Methylprednisolone 1 to 2mg/kg IV in 2 divided doses or an equivalent dose of dexamethasone for 5 to 10 days.
• Supportive measures
  • Maintain euvolemia, if available, use dynamic measures for assessing fluid responsiveness.
  • If there is sepsis/septic shock, manage as per existing protocol and local antibiogram.
• Anticoagulation
  • Weight-based intermediate-dose Low Molecular Weight Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD) or prophylactic unfractionated heparin.
  • There shouldn’t be any high risk of bleeding or contraindication.
• Monitoring
• Serial CXR
• HRCT chest to be done only if there is worsening.
• Lab monitoring: D-dimer and CRP 24-48 hourly
• LFT, CBC, KFT daily
• Do IL-6 if deteriorating. This is subject to availability.

Besides the above clinical treatment methods, authorities have implemented various other measures to contain the spread of this highly contagious disease.

Also read:

Country-wide Directives for COVID-19 Management

The Indian Government first issued a circular concerning the outbreak of COVID-19 and necessary measures to contain it in March 2020. The latest advisory from the Ministry of Health & Family Welfare dated 27^th December 2021 comprises extension of the following containment measures.

• Mandatorily covering one’s face in public places, transport vehicles, and workplaces.
• Maintaining a physical distance of at least 6 feet among customers in shops, workers, and individuals in public places.
• Practising work from home (WFH) as far as possible.
• Following modified business or working hours in commercial and industrial organisations, shops, workplaces, and markets, to contain the disease’s spread.
• Sanitising entire workplace frequently, especially areas that commonly come into human contact, such as door handles.
• Ensuring provisions for sanitisers, hand wash, and thermal screening in common areas, and entry and exit points.

Additionally, the authorities undertook the following steps to bring down COVID-19 cases:

1. Tracking all RT-PCR tests and subsequent COVID-positive individuals real-time via contact number.
2. Following MoHFW and ICMR guidelines while conducting tests and ensuring all co-morbid individuals are tested.
3. Tracing all international passengers via the “AIR SUVIDHA” website that DSOs and SSOs have access to.
4. Reducing mob capacity in large gatherings, such as that in workplaces, transport vehicles, rallies, funerals, marriages, and other social events.
5. Implementing night curfew, and updating status of “Buffer Zones” and “Containment Zones” real-time based on new COVID-positive cases.
6. Accelerating complete vaccination among the remaining population and enhancing doorstep vaccination campaign.
7. The increasing availability of medical equipments, such as oxygen, ambulances, necessary drugs by utilising the Centre’s ECRP-II funds, and enhancing bed capacity.
8. Enforcing home isolation and curtailing circulation of misinformation.

Hence, it can be seen that the COVID management in India has been both clear and rigorous. The rules were laid out so that health care professionals knew what the course of treatment ought to be.

Having a thorough knowledge of the same can help individuals prepare better for the IAS exam and other competitive tests. Referring to expert-formulated study materials can also help further one’s progress.