The Covid Management Guidelines India Group is a collection of senior expert clinicians, academics and methodologists in reputed institutions nationally, led by the Christian Medical College Vellore in partnership with the Clinical Infectious Diseases Society of India (CIDS). We are supported by methodologists at the Prof BV Moses Centre for Evidence Informed Healthcare and the Cochrane Infectious Diseases Group.
We are using a rigorous evidence-based approach to make guidelines to support clinicians managing patients with COVID-19 in secondary and tertiary care settings in India. Prioritised management interventions are each subjected to systematic evidence review, followed by application of GRADE methodology by experts in the field to appraise the evidence and interpret the intervention’s place in an Indian context. As each recommendation or clinical practice guideline is ready, it will appear on this website in a modular fashion, enabling immediate use by clinicians.
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| Intervention | Mild | Moderate | Severe | Critical | Certainty of evidence | Date of Recommendation | |
|---|---|---|---|---|---|---|---|
| • Symptomatic (any acute COVID-19 related symptoms) • AND respiratory rate <24/min • WITHOUT pneumonia or hypoxia | • Pneumonia (clinical or radiological) OR hypoxia (SpO2 <94% in adults with no underlying lung disease) • AND respiratory rate ≤30/min • AND SpO2 ≥90% on room air | Pneumonia with ANY ONE of the following: • RR >30/min • severe respiratory distress • SpO2 <90% on room air • NO invasive or non-invasive respiratory support needed | • Requirement for high-level respiratory support: NIV or HFNO or IMV • OR ARDS (PaO2/FiO2 ratio of <300) • OR sepsis • OR shock | ||||
| Antiviral | Azithromycin | Not recommended | Not recommended | Not recommended | Not recommended | HIGH | 27/09/2021 |
| Ivermectin | Not recommended | Not recommended | Not recommended | Not recommended | HIGH | 06/10/2022 | |
| Hydroxychloroquine / Chloroquine | Not recommended | Not recommended | Not recommended | Not recommended | MODERATE | 04//02/2022 | |
| Favipiravir | Not recommended | Not recommended | Not recommended | Not recommended | VERY LOW | 14/02/2023 | |
| Remdesivir | Not recommended | Recommended % | Recommended % | Recommended % | MODERATE | 16/06/2022 | |
| Interferons | Not recommended | Not recommended | Not recommended | Not recommended | MODERATE | 27/10/2021 | |
| Molnupiravir | Recommended * | Recommended * | Not recommended | Not recommended | VERY LOW | 04/04/2024 | |
| Anti- inflammatories | Tocilizumab / Sarilumab | Not recommended | Not recommended | Recommended * | Recommended * | MODERATE | 24/05/2021 |
| Baricitinib | Not recommended | Recommended π | Recommended π | Recommended π | MODERATE | 17/09/2021 | |
| Inhaled corticosteroids | Recommended $ | Not recommended | Not recommended | Not recommended | LOW | 21/06/2021 | |
| Systemic corticosteroids | Not recommended | Not recommended | Recommended @ | Recommended @ | VERY LOW | 15/07/2021 | |
| Colchicine | Not recommended | Not recommended | Not recommended | Not recommended | LOW | 03/09/2021 | |
| Itolizumab | Not recommended | Not recommended | Not recommended | Not recommended | VERY LOW | 22/11/2021 | |
| Thromboprophylaxis | Therapeutic dose Vs Nontherapeutic dose of thromboprophylaxis | Recommended α | Recommended β | Recommended β | Recommended α | MODERATE | 08/08/2022 |
| Antibody | Convalescent Plasma | Not recommended | Not recommended | Not recommended | Not recommended | HIGH | 27/10/2021 |
| Casirivimab-Imdevimab | Recommended £ | Recommended £ | Not recommended | Not recommended | HIGH | 11/08/2021 | |
| Respiratory Therapies | NIV Vs HFNO | Recommended | Recommended | Recommended | Recommended | VERY LOW | 27/07/2021 |
| Oxygen Saturation Targets | Recommended Ω | Recommended Ω | Recommended Ω | Recommended Ω | VERY LOW | 12/02/2022 | |
| Other Supportive Management | Prone Positioning | Not recommended | Recommended | Recommended | Recommended | VERY LOW | 05/11/2021 |
| * :- Only in patients with mild to moderate covid-19 with risk factors for developing severe disease. # :- Tocilizumab 8mg/kg, maximum 800mg as a single dose $ :- for symptomatic relief. @ :- 6 mg of Dexamethasone or equivalent per day IV or Oral till normalization of Oxygen saturation or max 10 days. % :- Remdesivir 200 mg IV OD on the first day followed by 100 mg IV OD from Day 2-5, to be given with in 5 days of symptom onset α :-Enoxaparin 40 mg SC OD β :- Enoxaparin 40 mg OD to 1 mg/Kg BD SC π :- 4 mg once daily for 14 days or until discharge £ :- Only for patients with non-omicron variant with a risk factor for severe illness, and no detectable covid-19 antibodies present in their body. Casirivimab 600 mg + Imdevimab 600 mg as a single infusion within 10 days of symptom onset. Ω :- Target SPO2 at 94-98%. Strong against recommendation Conditional against recommendation Conditional for recommendation Strong for recommendation | |||||||