Zimbabwe Guidelines for the Management of Covid-19

Abstract

In the May 2020 COVID-19 guidelines, we had stated that there were no specific therapeutic agents for COVID-19. We still do not have antivirals that can be given to prevent or treat COVID-19. However, a recent National Institutes of Health (NIH)-funded study has shown that Remdesivir has a clinical benefit i.e. reducing recovery times down to 11 days compared to 15 days. This NIH study did not show any mortality benefit. The UK based RECOVERY trial has also suggested the mortality benefit of using Dexamethasone in COVID-19 patients who need oxygen or are mechanically ventilated. However, the interim results of the WHO SOLIDARITY Trial(https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1 have shown “little or no effect on the 28 day mortality” of using remdesivir, hydroxychloroquine, lopinavi/ritonavir or interferons. Studies using repurposed medicines still continue to be conducted. It would appear that Remdesivir, being an antiviral, should be administered very early on in Covid-19 but we may not be seeing our patients during this early phase of their symptoms.Use of Dexamethasone is recommended and will be made available for the treatment of COVID-19. Remdesivir will also be added to our Specialist essential medicines list (EML -S list) and should be used in a hospital setting for those who are oxygen dependent. Dexamethasone is already available in our EML