Busting the myths on Covid-19 medication
As the country reels under the second wave of coronavirus disease (Covid-19) pandemic, there is a lot of discussion around the drugs and treatments that work and those that don't against the virus. Speaking to Hindustan Times, Dr Lancelot Pinto, a pulmonologist and epidemiologist at Hinduja Hospital in Mumbai, cleared the air on Covid-19 medication.
The virus, which has killed 226,188 people and infected more than 20 million people in the country, continues to ravage the lives of millions, resulting in the collapse of the healthcare system. As thousands of Covid-19 patients gasp for breath due to shortage of oxygen cylinders, many others run from pillar to post for antiviral medications such as remdesivir or favipiravir.
Here is what Dr Pinto, one of India's leading experts on Covid-19 treatment protocols, has to say about various Covid-19 medications:
Paracetamol- Patients should use paracetamol for fever and body ache but not round-the-clock as fever is a monitoring parameter of a person's heath. Doctors recommend patients do not consume more than 2-3 gm per day.
Antivirals- The antivirals that have been tried for Covid-19 are lopinavir-ritonavir, remdesivir and favipiravir. Till date, the only antiviral drug that may have a role in the treatment of Covid-19 is remdesivir. None of the other drugs has been proven to be useful. A small clinical trial which tested favipiravir found the drug to not be effective for the primary end-point for which the trial was designed. Despite this, it has been widely sold and used across the country, exposing patients to all the adverse effects, while potentially offering no benefit at all. To the best of my knowledge, no other major nation across the world is presently using the drug. Interferons, which have antiviral effects, have been tried for Covid-19 too. SOLIDARITY, a large WHO-funded trial did not find interferon to be useful. The RECOVERY trial found that when used with corticosteroids, interferon may have a beneficial role.
Antibiotics- Antibiotics are antibacterial. They have no role in the treatment of the manifestations of Sars-CoV-2 infection (a viral infection). However, if there is a suspicion of a superadded secondary bacterial infection (uncommon in non-hospital settings, and in the first 2 weeks of the disease), they can be used. The routine use of drugs such as azithromycin and doxycycline should be strongly discouraged.
Ivermectin- Ivermectin is an anti-parasitic drug that was found to neutralise Sars-CoV-2 in the lab. This leads to hope that it may have a role in humans. However, no trial has found such an effect. A recently published systematic review suggested that it may have a role, but most of the included studies were not of a high research standard. Its routine use should also be discouraged.
Remdesivir- Remdesivir does not save lives. Multiple studies have onsistently proven this. It may horten the duration of ymptoms in individuals who ave disease that is severe enough for them to warrant hospitalisation, and if they have signs of lung involvement. It may be more effective when given early in the viremic phase (in the first week of illness) than in the late immune phase. However, hospitalising individuals who are not sick enough to be hospitalised otherwise only to receive remdesivir should be discouraged, as it is not necessary, and will worsen the availability of hospital beds for those who truly need them.
Plasma- PLACID (ICMR Indian trial), RECOVERY and Platina were large trials that conclusively proved that convalescent plasma was not effective. However, small trials have suggested that when used very early in the disease among high-risk individuals, with high titers of antibodies in the infused plasma, it may have a protective role. The widespread pleas for plasma when the patient is moderately or severely ill are unlikely to help the patient in any way
Steroids- The RECOVERY trial proved that steroids, when used in patients with low oxygen levels, saved lives. However, their use in individuals with low oxygen levels is key. Early use of steroids, when oxygen levels are normal, can cause clinical worsening and be counterproductive. They should not be used routinely to bring down fever unless there is a concomitant evidence of clinical worsening or drop in oxygen levels. They are the only drugs which save lives, but when used with abundant caution.