Health ministry updates clinical management protocol for COVID-19

It included the use of Remdesivir can be done under emergency use authorisation in patients with moderate disease (those on oxygen) but not with patients with severe renal impairment, pregnancy or lactating females and children below 12 years of age

Remdesivir, Ministry of Health & Family Welfare, Plasma Therapy, Tocilizumab, Hydroxychloroquine, Emergency Use Authorization


The Ministry of Health and Family Welfare has issued an updated clinical management protocol for COVID-19. The new protocol provides for the management of COVID-19 cases based on the clinical severity of mild, moderate or severe..
It has added the loss of smell (anosmia) and loss of taste (ageusia) to the list of symptoms of COVID-19.


Under investigational therapies, it has included the use of Remdesivir can be done under Emergency Use Authorisation in patients with moderate disease (those on oxygen) but not with patients with severe renal impairment, pregnancy or lactating females and children below 12 years of age.

It stated that Tocilizumab (off label) might be considered in patients with moderate disease with progressively increasing oxygen requirements and in mechanically ventilated patients not improving despite use of steroids. Special considerations before its use include presence of raised inflammatory markers (e.g., CRP, Ferritin, IL-6) and patients should be carefully monitored post Tocilizumab for secondary infections and neutropenia.

It stated that convalescent plasma (Off Label) might be considered in patients with moderate disease who are not improving (oxygen requirement is progressively increasing) despite use of steroids. Special prerequisites while considering convalescent plasma include ABO compatibility and cross matching of the donor plasma, neutralizing titer of donor plasma should be above the specific threshold (if the latter is not available, plasma IgG titer (against S-protein RBD) above 1:640 should be used). Also, the recipient should be closely monitored for several hours post transfusion for any transfusion related adverse events and the use should be avoided in patients with IgA deficiency or immunoglobulin allergy.

Regarding Hydroxychloroquine, it has stated that the drug has demonstrated in vitro activity against SARS-CoV2 and was shown to be clinically beneficial in several small single center studies though with significant limitations. “Nonetheless, several large observational studies with severe methodologic limitations have shown no effect on mortality or other clinically meaningful outcomes. As such, the evidence base behind its use remains limited as with other drugs and should only be used after shared decision making with the patients while awaiting the results of ongoing studies. As is the case with other antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease,” it stated.