Thread by @spkalantri

I couldn't believe my eyes. So I asked my colleague to read to me the recent Covid19 guidelines by DGHS @MoHFW_INDIA. I couldn't believe my ears too.

The 9-page-PDF guides how to treat, investigate and monitor patients with Covid19 infection.

What is the first surprise? 1/N

Surprise 1.

Asymptomatic patients: "No investigation at this stage. And “No medications are required.”

No blood tests or fancy drugs for early Covid! 2/N

Surprise 2.

Mildly ill patients: May need investigations if symptoms persist or they deteriorate.

Paracetamol and cough syrup. Budesonide.

No other medicine required- So, no HCQ, Favipiravir, Ivermectin, Azithromycin, Doxycycline, Zinc and Vitamins. No plasma, either. 3/N

Surprise 3.

Moderately ill: Oxygen, control of co-morbidities, steroids, anticoagulants. Period. No coronil nor 2- DG.

4/N

Surprise 4.

Severely ill: oxygen, steroid, anticoagulants and clear indications for Tocilizumab. Clear criteria for prescribing.

Need for recruiting the hospital infection control committee. 5/N

Surprise 5.

Diagnostic tests specifically mentioned. No Ferritin and LDH after day 1.

Clear indications for a chest x-ray.

Irrational and rampant use of HRCT Chest heavily criticised.

7/N

“Exercise extreme caution when ordering an HRCT.”

Full page on HRCT. When HRCT is needed; 4 bullet points on why routine HRCT shouldn’t be done and 4 bullet points on when HRCT should not be ordered!

8/N

Surprise 6.

Full page on Remdesivir and Tocilizumab.

Advised to exercise extreme caution when ordering Remdesivir—“as this is only an experimental drug and has a potential to harm.”

Romance with remdesivir is over. This is unbelievable!

10/N

Surprise 7.

Full page on steroid and anti-coagulants.

Sensible, straightforward advice on steroid: Dexa— 6 mg a day, for 10- days, no taper, only in hypoxic patients.

Anticoagulants- prophylactic dose. Only in moderate or severely ill patients.

11/N

Surprise 8.

Full page on diagnosis, treatment and monitoring of Covid associated mucormycosis. The dose and duration of amphotericin B clearly spelt out. Clear guideline on when to switch to oral antifungal drugs.

12/N

Today David Sackett, the father of EBM, would have been so happy!
Very impressive and the authors deserve high praise for sticking to EBM in the national guideline- conscientious, explicit & judicious use of current best evidence in making decisions for treating Covid19.
13/13