Tocilizumab should be given for treating patients suffering from moderate to severe Covid-19 infection who have persistent reduction in their oxygen levels (a condition called hypoxia) that continues to get worse. The hypoxia may continue to get worsened even after 24 to 48 hours of treatment with corticosteroids and supportive care.

No, Tocilizumab is not recommended for all Covid-19 patients. This is because Tocilizumab has its own potential health hazards. Tocilizumab can lead to persistent serious infection and prolonged multiplication and shedding of the virus causing infection, so, it must be given only if the benefits outweigh the risks involved.

The potential side effects of Tocilizumab include anaphylaxis (serious allergic reaction) with infusion, transaminitis (very high levels of liver enzymes due to which they start moving into the bloodstream), leukopenia (a condition where a person has reduced white blood cells and hence increased risk for infections) and neutropenia (a condition where a person has abnormally low number of cells called neutrophils, that fight infections in our body). Some other side effects are risk of serious bacterial infections, viral infections and reactivation of tuberculosis (TB) virus.

Tocilizumab should not be given to patients who have or ever had abnormal levels of liver enzymes (transaminitis), platelet counts (<50000), or if they have TB, or any active bacterial or viral infection. The use of Tocilizumab is contraindicated in pregnancy and breastfeeding mothers too, owing to its risk of developing serious complications.

Your doctor will decide the next course of action if there is no improvement seen even after giving Tocilizumab. Tocilizumab will prevent inflammation of the lungs but will not cure the damage already done due to the existing disease. Recovery of the lungs takes time to improve. Persistent breathlessness after Tocilizumab administration requires further evaluation of patients for other lung-related issues (pulmonary intravascular coagulopathy) or heart-related problems (cardiac dysfunctions). Any other bacterial infections that might have occurred should also be treated separately.