COVID 19 India - Let's talk about the treatments

Covid 19 situation is the most talked about discussion in every household in India and worldwide. What concerns me the most are the confusion, myths and panic around the treatment and vaccination.

Whereas, it is almost extremely pivotal to be Vaccinated- It's surprising and ironic that people are running madly for treatments that are not really proven very beneficial and are only effective under certain condition and stages of the diseases, they are reluctant to be vaccinated- the only viable solution and shows way higher efficiency in controlling this pandemic.

Before we talk about the current treatments, I would like to stress on the point that do not, in any circumstances, take the treatments without doctor's consultations. She should be able to guide you after monitoring you better. Hoarding these treatments and using them in panic without proper monitoring will only cause severe damage. My aim in this blog is not to scare you but to make you aware in a simple manner on how we can better take care of ourselves and fight the pandemic. Well, needless to say but important to add here - Vaccination is the only effective way to fight it. It reduces severity of infection, if any. It reduces transmission and it is our chance to go back to normal.

Anyways, let's talk about some of these covid19 treatments now and why we should be cautious-

Overuse of STEROIDS. It has caused a massive problem and should only be used within an optimum window during the infection stage. It should not be used in very early stages as it interferes with the immune response to fight the virus and should be added to the treatment just before the cytokine storm to prevent inflammation. Also, it should be not be used if patients do not show severe symptoms of requirement of oxygen. So, please do not run to your medical store to buy steroid if you are tested positive. Stay at home, have Vitamin C and Zinc and let your body fight the virus until it can.

Michael A Matthay and B Taylor Thompson (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598750/) summarised the evidence-based role of dexamethasone in hospitalised patients with COVID-19. Their pertinent analysis is based on the background of the RECOVERY trial, which concluded that therapy with dexamethasone at a dose of 6 mg once daily for up to 10 days decreased 28-day mortality in patients with COVID-19 on "respiratory support". Patients not requiring oxygen showed no benefit but had a possibility of harm with corticosteroid therapy.

One crucial feature of corticosteroid therapy is its duration, particularly in patients with COVID-19 with sustained persistence of ground-glass opacities. Currently, an extended course of corticosteroids beyond 10 days is considered only in select cases of severe COVID-19.

Corticosteroids is seen to be a double-edged sword in the fight against COVID-19 and its essential to consider the risk-benefit ratio, use it judiciously, as a therapeutic agent for short-course (eg, up to 10 days) in a select group of patients with COVID-19 for whom survival benefit has been reported. Currently, there are no reported long-term use benefits of steroids in patients to prevent potential adverse sequelae such as pulmonary fibrosis. On the contrary, such an extended course of steroids could be detrimental. In fact, overuse of steroids is also one of the major reasons for black fungus warned by Dr Guleria, AIIMS, India. In the time, when everyone is so confused with various news articles, media, opinions, etc. it is better that one does not blindly take these drugs without doctor's consultation.

Next is the treatment with ANTIVIRAL DRUGS - they should also only be used if patients need oxygen supply and the condition is moderate to severe and shouldn't take them as a precautionary measure without consultation. In the Solidarity trial that was done in 405 hospitals in 30 countries, different drugs were assessed against standard care and it was concluded that antivirals such as remdesivir, did not have a major effect on mortality, the need to initiate artificial ventilation, or time to discharge. Compiling the trial data with randomised clinical trials with control group, it was found that at best, remdesivir would prevent only a small proportion of all deaths and it showed promising results in patients who were already in the need of the oxygen. The WHO living guidance based on a meta-analysis with data from the same four RCTs stated that remdesivir has possibly no effect on mortality and a conditional recommendation was given against the use of remdesivir in hospitalised patients with COVID-19. The EMA recommends remdesivir in adults and adolescent patients (aged 12 years or older) with COVID-19 who require supplemental oxygen.

But people have vehemently been searching for these drugs leading to hoarding, blackmailing, illegal produces, etc. and what not.

Please do not have them if your infection is not moderate to severe meaning unless you require oxygen. Listen to the warnings and guidances of WHO, EMA, ICMR, CDC, etc. and do not blindly take these drugs without doctor's consultation.

Now let's talk about my favorite topic and something on which I have spent almost a decade working on. ANTIBIOTICS- DO NOT HAVE THEM WITHOUT A BACTERIAL INFECTION. IT DOES NOT KILL VIRUSES. I can't be louder than this! Taking antibiotics without a bacterial infection kills good bacteria and make remaining surviving bacteria resistant to it overtime. Thus, when you really have a bacterial infection, no antibiotic will work on you. Covid19 is a viral infection and antibiotics do not work against it. Do not take antibiotics after vaccination to reduce fever either. It is useless because post-vaccine fever is not caused by bacteria. If possible, stay away from antibiotics as much as possible unless you have a bacterial infection (flu is not caused by bacteria so do not take it). We are not far away from another pandemic where antibiotics will become ineffective to bacterial infections due to its overuse and you may survive an organ transplant but will die due to the bacterial infection. For healthier biome, use probiotics and not antibiotics.

Another treatment is PLASMA THERAPY. Here is a link of an entire article based on it- https://www.bmj.com/content/372/bmj.n278 and I have just taken a few points here to conclude.

Mounting evidence against plasma therapy

1) In early January 2021, the investigators behind a Maharashtra state trial for plasma therapy in severely ill patients with covid-19 said they had stopped the trial prematurely after they found a higher rate of deaths and clotting in the intervention arm. It followed a randomised controlled study of over 450 moderately ill covid-19 patients, run by the ICMR, which suggested that the intervention wasn’t useful to moderately ill patients.9

2) The ICMR recommended against the use of plasma in both moderately and severely ill patients who had been unwell for more than 10 days and whose bodies already had immunoglobulin G, which is thought to appear in the body at roughly the same time as neutralising antibodies. This should have put a damper on plasma use in India, since the only patients in whom plasma seems to work are the mildly ill and roughly 98% of such patients recover on their own, says S P Kalantri, of Maharashtra’s Mahatma Gandhi Institute of Medical Sciences.

3) Plasma therapy continues to be used routinely in parts of India, but there is mounting global evidence against what was considered one of the most promising treatments in the early days of the pandemic.

4) In November 2020, a randomised study published in the New England Journal of Medicine by Argentinian researchers found that plasma therapy didn’t cut deaths in severely ill patients.11 In December 2020, a study suggested that the B.1.1.7 variant first identified in the United Kingdom had acquired mutations that help it evade human antibodies after an immunocompromised patient was treated thrice with plasma therapy for covid-19.12

5) In January 2021, the UK’s RECOVERY trial closed recruitment to its plasma arm after researchers found that there was no difference in mortality between plasma recipients and controls in the more than 10 000 people randomised to the trial."

In conclusion, WE need more updated policies around the treatment guidelines. Science changes constantly and we need to keep up with it. So, don't fret or complain if guidelines change routinely. It doesn't mean system is inefficient, it means the contrary. Welcome to the world of research. There is nothing black and white here and yes, it might be confusing because there are just too many changes but that's what happens in science. We (RE)search.

It is, however, pivotal for the government policy makers to collaborate and educate people and raise awareness. In a country like India, where powerful prescription drugs are often available over the counter, disincentivizing the use of unproved medicines is as important as recommending the use of ones that have been proved to work.

Let's be responsible and let's get vaccinated. We can fight this pandemic and we will- with vaccines!

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