CC BY-NC-ND 4.0 · Annals of the National Academy of Medical Sciences (India) 2020; 56(04): 197-207
DOI: 10.1055/s-0040-1718501
Review Article

COVID-19 Management in India: Medical Aspects, Current Concepts, and Evolving Directions

Daya K. Hazra
1  Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
Padmamalika K. Neehazra
1  Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
Suratwant Hazra
1  Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
Adarsh N. Segal
1  Department of Medicine, Boston Medical Centre, Agra, Uttar Pradesh, India
› Author Affiliations


This review deals with the emerging coronavirus disease 2019 (COVID-19) epidemic summarizing current and evolving medical management in India, and also indicating future directions in the light of possible resurgence of this disease as pandemic as well as prospective biological threats resulting from acts of bioterrorism. Clinical accounts both in published or prepublication reports from the frontline epicenters were used, incorporating the evolving flux in guidelines and current controversies, expressed not only in Print media but also video-webinars and conferences constantly in progress. Rather than presenting hard conclusions from the few randomized controlled trials, less formal clinical impressions have been incorporated in the review as it is felt that at this stage of the COVID-19 battle, such data are relevant! Periodic rewriting on this subject is in our opinion, therefore, eminently desirable (Box format used to allow this). Apart from the respiratory crisis aggravated by cytokine storms, reference is made to the cardiovascular, neurological, renal, gastrointestinal, and cutaneous features, these generalized manifestations being related to the widespread distribution of angiotensin-converting enzyme-2 receptors in the body as well as to the acute inflammatory hypercoagulopathy and disseminated intravascular coagulation typified by hyperacute levels of acute phase reactants as well as the effects of hypoxia-overt or silent!

Supplementary Material

Publication History

Publication Date:
25 October 2020 (online)

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  • References

  • 1 Chidinma Chima Melton. Management of Critically Ill COVID-19 Patients. What Are the Protocols at UCLA Health?. Vu Medi April 2020, 28–36 2020
  • 2 Cordon-Cardo C. COVID-19: What Is the Benefit of Antithrombotic Therapies & What Is the Prothrombotic Nature of the Disease? Does Hypoxia Induce Organ Damage or Is It a Multi-organ Disease?. New York, NY: Mount Sinai Vu MediVideo; 2020: 2020
  • 3 Cordon-Cardo C, Garcia-Sastre A. COVID-19: What Determines a Person’s Immune Response? When Is the Right Time to Do Antibody Testing & How Do You Determine What Degree of Antibody Response Is Protective? New York, NY: Mount Sinai Vu Medi Video; 2020
  • 4 Cordon-Cardo C, Patel G. COVID-19 Medication Responses from Mount Sinai: What Should We Know about Hydroxychloroquine, Steroids, Remdesivir and Plasma? In What Situations Is Plasma Treatment Effective? Do We Know What Doses to Give? New York, NY: Mount Sinai Vu Medi Video; 2020
  • 5 Cordon-Cardo C, et al. COVID-19: Will There Be a Second Wave of Infection and Will the Virus Virulence Change in Time? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 6 Cordon-Cardo C, et al. COVID-19 Testing Challenges: What Is the Importance of Testing for Diagnosis and Stratifying Patients by Viral Load? What Is the Possibility of a False Positive or False Negative Test? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 7 Garcia Sastre A, Narula J. COVID-19: What Are Most of the Vaccines Based On& What is the Main Focus in Neutralizing Antibodies Against the Receptor Binding Protein? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 8 Griffin D. COVID-19 Patients: Which Drug to Prescribe, When, and to Whom? What Are Some Cardiac, Cognitive & Neurological Clinical Manifestations, and Who Should Receive Anticoagulants. Vu MediVideo, April 2020 2020
  • 9 Jaffe A. What Does Elevated Troponin Mean in COVID-19? Vu MediVideo, May 2020 2020
  • 10 Jain T. et al. Potential Effects of COVID-19 on the Cardiovascular System: How to Treat ST-Elevation on EKG? Why Are STEMIs Going Down During the Pandemic? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 11 Mahmood K. et al. ARDS and COVID-19 in an LVAD Patient: Should We Look at Percent Change in LDH, Ferritin and CRP Values in A Cytokine Storm to Assess Severity? What Cardiac Manifestations Do We Need to Keep an Eye on? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 12 Mascarenhas J.. Can Pacritinib Be Used to Treat Cytokine Storm in Patients With COVID-19? What Was the Primary End Point of the Trial & Which Patients Are Eligible for the Treatment? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 13 Moll S. COVID-19 Coagulopathy: What is the PE and DVT Risk? How Should We Optimize the Anticoagulation Therapy Algorithm?(Describes Current UNC Algorithm) Vu MediVideo, May 2020 2020
  • 14 Narula J, Sharma S. STEMI Patients with COVID-19: What Cardiovascular Manifestation Are Expected in Patients? What Is the Management Protocol to Treat Them? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 15 bok15. Olin J. COVID-19: What Types of Thrombosis Are Commonly Seen? Are Anticoagulants Effective & How to Use them? New York, NY: Mount Sinai Vu MediVideo, May 2020; 2020 /bok
  • 16 Olin J. et al. COVID-19 and Stroke: Is Large-Vessel Stroke a Presenting Feature of COVID-19: in the Young? Should We Monitor These Patients with Blood Work, Antiplatelet, or Antithrombotic Therapy? Is There a High Bleeding Complication Rate? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 17 Olin J. et al. What Biomarkers Are Recommend for Looking for Pulmonary Embolism in COVID-19 Infected Patients? Are They Good for Diagnostic Purposes? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 18 Olin J. et al. COVID-19: Are You Requiring PCR Testing for All In-person Encounters and What Is the Turnaround Time? How Do You Protect Staff? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 19 Olin J. et al. Venous Thromboembolism & COVID-19: Has There Been an Increased Incidence at Mount Sinai Health System? What About Performing Mechanical Thrombectomies in Critically Ill Patients? New York, NY: Mount Sinai Vu MediVideo, May 06, 2020:53 2020
  • 20 Olin J. et al. What Is the Role of Endothelial Dysfunction in the Vascular Complications Associated with COVID-19 Patients? Why Do We See So Much Thrombosis in These Patients? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 21 Osterholm M. hVuMedi, May 2020: Possible Scenarios for the Course of the COVID-19 Pandemic: Are We Prepared for at Least Another 18 to 24 Months of Significant COVID-19 Activity? VuMediVideo, May 2020 2020
  • 22 Reddy V, Bokhari M. Electrophysiological Analysis of Two Cases of COVID-19 Patients: How do Plaquenil, Chloroquine and Azithromycin Effect the Cardiovascular System? What Causes Troponin Elevation in COVID-19 Patients with Myocardial Injury? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 23 Seitz and Schram.. Rationale for Developing Strategies for Attenuating DIC in COVID-19. Vu MediVideo, May 2020 2020
  • 24 Serrao GL2020: Refractory ARDS & COVID-19: Why Should VV ECMO Work and When Should It Be Used? Which Patients Are Good Candidates for ECMO? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 25 Serrao G.. ECMO for COVID-19: Should It Be Used to Treat ARDS & How to Deal with Recirculation Problems? Why Is It Hard to Use VV ECMO in Patients with High Cardiac Output States? Has the Use of Remdesivir in Combination with ECMO Shown to Be Successful? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 26 Serrao G. Shock in COVID-19 Era: How to Treat Different Types of Circulatory Shock? Does Placing Univentricular Support Risk Precipitate Frank Failure of the Other Ventricle? Why is IABP the Preferred Approach over ECMO? New York, NY: Mount Sinai Vu MediVideo, May 2020 2020
  • 27 Warner JP. (Codman Shoulder Society):Post-Pandemic Orthopedic Care: Challenges &Opportunities. VuMediVideo, May 2020 2020
  • 28 Herold T, Jurinovic V, Arnreich C. et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020; 146 (01) 128-136.e4
  • 29 Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F. Subacute thyroiditis after Sars-COV-2 infection. J Clin Endocrinol Metab 2020; 105 (07) 2367-2370
  • 30 Hick JL, Biddinger PD. Novel coronavirus and old lessons—preparing the health system for the pandemic. N Engl J Med 2020; 382 (20) e55
  • 31 Islam MT, Fleischer JW. Distinguishing L and H phenotypes of COVID-19 using a single x-ray image (Prepublication). Available at: Accessed May 3, 2020
  • 32 Interim Guidance for Rapid Antigen Testing for SARS-CoV-2. Available at: and July 27 2020 update and Accessed August 16, 2020
  • 33 Director General WHO. Announcing suspension of hydroxychloroquine arm of SOLIDARITY trial; 2020. Available at:’-opening-remarks-at-the-media-briefing-on-COVID-19—25-May 2020
  • 34 Hazra DK. Letter to Prof Shashank Joshi, Dean, Indian College of Physicians, April 7, 2020; 2020
  • 35 Risch HA. The key to defeating COVID 19 already exists: We need to start using it. Newsweek August 22, 2020; 2020
  • 36 Risch HA. Early treatment of symptomatic high risk COVID 19 patients that should be ramped up immediately as key to the pandemic control. Am J Epidemiol 2020; 27
  • 37 Perry Wilson F. HCQ RCTs: ethically the choice is clear Medscape. Intern Med 2020; 5
  • 38 Bergman S. Treatment of Coronavirus COVID 19: Investigational Drugs and Other Therapies, updated Aug 5, 2020, Medscape 2020
  • 39 American College of Physicians. COVID-19: An ACP Physician’s Guide + Resources. Available at:
  • 40 Beigel JH, Tomashek KM, Dodd LE. et al. ACTT-1 Study Group Members. Remdesivir for the treatment of COVID-19—preliminary report. N Engl J Med 2020; 383 (10) 994
  • 41 Cao B, Wang Y, Wen D. et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med 2020; 382 (19) 1787-1799
  • 42 Emory News Center. FDA: Human Trials can Begin for Emory COVID-19 Antiviral. Available at: News; 2020
  • 43 Zhou Q, Chen V, Shannon CP. et al. Interferon-α2b treatment for COVID-19. Front Immunol 2020; 11: 1061
  • 44 Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 2020; 178: 104787
  • 45 Alam MT. Bangladesh Medical Team Says Ivermectin with Antibiotic Doxycycline Works to Treat COVID 19 Patients. New Delhi: Press Trust of India release May 19, 2020 2020
  • 46 Casadevali A, Joyner MJ, Pirofski LA. A randomized trial of convalescent plasma for COVID-19-potentially hopeful signs. JAMA 2020; 324 (05) 455-457
  • 47 Sebba A. Tocilizumab: the first interleukin-6-receptor inhibitor. Am J Health Syst Pharm 2008; 65 (15) 1413-1418
  • 48 American College of Physicians. Coronavirus Disease 2019 (COVID-19): Information for Internists. Available at:
  • 49 Cenmino D. Corona Virus Disease 2019 (COVID-19) Treatment and management: Updated 20 August 2020. Medscape. 2020
  • 50 Karnataka Medical Association Advice. August 14, 2020. Available at:
  • 51 CDC Guidelines 2020: Guidance re housing and high risk workers; 2020. Available at: and .html/
  • 52 Hazra DK And Katoch V M. Department of Science and Technology, Govt of India: Project Submission on National Therapeutic Biomolecule Centre; 2005
  • 53 Daston L. Wikipedia and Max Planck Institute for the History of Science 2017: the History of Science and the History of Knowledge 2017;1(1):131–154; Accessed May 8, 2020