In the wake of the lifting of the state of health emergency, decided following the Covid-19 pandemic, the Ministry of Health and Social Protection published, on Thursday, a new update of the Manual of procedures for standby and response. The new version includes several changes in the detection and treatment of the disease.
According to this 4th version, “expanded screening among contacts, regardless of the level of risk of contamination, is abandoned and replaced by targeted screening of close contacts at risk of complications (elderly subjects and/or with comorbidities). The ministry adds that this targeted screening “must be done by PCR or ART as soon as the index case is confirmed”.
The manual adds that “no quarantine is recommended”, while “self-monitoring and antigen testing (and/or PCR) should be carried out as soon as a clinical sign appears”. “In all cases, strict compliance with barrier measures (wearing a mask, hand hygiene and distancing) must be observed for 10 days among close contacts”, we insist.
The document adds, concerning health control at the borders, that “no requirement is currently in place either for departure or arrival for international travelers”, noting however that “special procedures will be established if the epidemiological situation requires it”.
Returning to confirmatory tests, the new manual recommends “a rapid antigen test (ART) or a sample for Rt-PCR”, which must be offered “to anyone meeting the definition of a suspected case of Covid-19” . “Any vulnerable person (elderly and/or with comorbidity) showing clinical signs suggestive of Covid-19 must be tested as soon as possible”, we insist. As a result, the scanner is no longer used to detect signs of infection.
The treatment protocol abandons the use of hydroxychloroquine
Regarding the basic treatment, the symptomatic treatment now only includes “Vitamin C 1000mg (1 tablet in the morning and 1 tablet in the afternoon, for 7 days)” and “Vitamin D” and “Paracetamol and other drugs according to the clinical picture.
As for curative treatment, in vulnerable adults (with 1 or more risk factors for complications), the manual recommends “Nirmatrelvir/Ritonavir 300/100 mg x 2/day” or Molnupiravir 800 mg x 2/day” for a duration of 5 days.
In the event of particular situations, the document evokes “antibiotic therapy in the event of signs of bronchial superinfections” and “anticoagulants at a preventive dose, if bedridden”. It also provides for corticosteroid therapy but which “should only be started in hypoxemic patients and in no case in the viral phase of the disease”. Anticytokine treatment with anti-interleukins IL1 or IL6 is also planned and must “be indicated after a multidisciplinary meeting of doctors involved in the care of Covid-19 patients in the inflammatory phase at the time of the announcement of the cytokine storm and not not responding to the therapies mentioned”.
Finally, the new manual provides for the discontinuation of Metformin in hospitalized diabetics, citing an “increased risk of lactic acidosis in the event of hypoxia”.
The treatment protocol thus abandons the use of “Hydroxychloroquine sulfate”, which was maintained in the 3rd update of the manual, published in January 2022 in the wake of the 3rd epidemic wave concomitant with the spread of the Omicron variant.