DNA Explainer: What is 'Line of Treatment' for COVID? Why plasma therapy is now out of it?

 In a major development, the Indian Council of Medical Research (ICMR) has clinically dropped convalescent 'plasma therapy' treatment for patients suffering from COVID-19 from its newly revised guidelines.

The decision of removing this treatment from the 'Line of treatment' arrived after medical experts and scientists raised concerns against this practice. ICMR had permitted off-label use of convalescent plasma to treat COVID-19 patients in its revised guidelines on April 22, but now they have pulled it back.

COVID-19 is an infectious disease caused by SARS-CoV-2, the novel coronavirus. The novel coronavirus was discovered after an outbreak in Wuhan, China, in December 2019.

A whole lot of vaccines are now available to protect against the novel coronavirus and researchers are also working on creating more potential treatments.

However, there is a lot of confusion regarding the line of treatment to be followed in treating COVID-19 patients.

'Line of Treatment'

In October 2020, Remdesivir became the first drug approved by the Food and Drug Administration (FDA) to treat COVID-19.

This intravenous (IV) infusion therapy is used to treat people above the age of 12 years who have been hospitalised with the condition. To date, it is still the only COVID-19 treatment that's been approved by the FDA.

If your symptoms are more severe, your doctor's supportive treatments may be given at a hospital with the help of a 'set' of antibiotics and antiviral drugs. This 'prefix' set of medicines like - Ivermectin, Doxycyclocin, and FabiFlu falls under the 'Line of Treatment'.

This type of treatment may involve fluids to reduce the risk of dehydration, medication to reduce fever, and supplemental oxygen in more severe cases.

Meanwhile, Remdesivir usage has been permitted off-label in treating moderate to severe cases requiring supplemental oxygen.

In addition, Tocilizumab may also be considered in severe cases, according to the new guidelines.

People who have a hard time breathing due to COVID-19 may need nebulizers, oxygen beds, or even ventilators.

ICMR revised guidelines

In the treatment of COVID-19 infections, doctors have time and again warned against the misuse of steroids.

Steroids are to treat inflammatory conditions which may be seen in a serious COVID-19 case when the virus is replicating. But its early and wrong use leads to more complications than benefits as steroids also repress the immune system.

They are useful only in moderate to severe illnesses when oxygen saturation is falling. The steroid therapy is recommended only for a duration of five to 10 days, not more than that.

Now it has also emerged that the cases of back fungus or mucormycosis in COVID-19 patients are increasing because of steroid misuse.

Use of oxygen for treatment

Patients infected with SARS-CoV-2 can develop severe pneumonia and respiratory failure, which often require treatment in intensive care units (ICU).

Oxygen therapy and supportive care are still the main forms of therapy for SARS-CoV-2 pneumonia until suitable anti-infective therapies become available.

Some COVID-19 patients need oxygen support when shortness of breath progresses to a more acute condition.

Most patients with COVID-19 have a respiratory tract infection, and in the most severe cases, their symptoms can include shortness of breath.

A small proportion of such cases can progress to a more severe and systemic disease characterized by Acute Respiratory Distress Syndrome (ARDS).