New Delhi, India – At the end of last month, the Indian government made far-reaching changes to the hospital’s COVID-19 treatment plan, which caused a lot of controversy and confusion after the drugs that people almost memorized were eliminated.
Over the past few months, I have read my family’s prescriptions repeatedly, remembering who should prescribe what medicine, and urging the local pharmacy to send it as soon as possible. Like thousands of others, I have read hundreds of social media requests for these drugs.
So why should the government abandon them? When I searched on Google, I still remember Ivermectin, a drug that is now being eliminated and under strict scrutiny, was prescribed by my dermatologist for the first time in July last year.
“Just one tonight,” the doctor said. Someone told me that this is an antiparasitic medicine used to deworm and scabies.
But I hardly knew that in two months, I would be prescribed Ivermectin as part of my COVID treatment.
During the telephone consultation, the doctor prescribed doxycycline (an antibacterial drug) for five days and ivermectin for one day.
Later that day, when government health workers forced to come to our door, my COVID-19 negative husband gave me a packet of hydroxychloroquine and was told to take the medicine for 7 days.
We both skipped.
It was a popular drug at the time, and its demand surged after former U.S. President Donald Trump threatened to stop medical supplies if India reduced exports to the United States.
This is still the first wave. Although the tragedies of Indian immigrants returning home are endless, people have lost their livelihoods, and the blockade has triggered a large-scale economic slowdown, but the mortality rate is very low, and there is no shortage of hospitals and oxygen.
In the second wave, we thought it would be weaker in most cases, but it has not yet raged us.
In April, the second wave attacked our home. My whole family—my husband, my mother, and my in-laws—have been infected with COVID-19, even though some people have been vaccinated. When hospital beds, oxygen and medicine were in short supply, we were caught in a violent outbreak.
My COVID-positive father-in-law took Ivermectin for about a week. He also took the antiviral drug favipiravir, commonly called fabiflu.
When he arrived at the hospital on May 2 with pulmonary pneumonia, he had been injected with Ivermectin, Doxycycline, Azithromycin and Favipiravir. In the hospital, they further performed remdesivir and plasma therapy-twice.
We prepared a hospital bed and an oxygen generator for him through the telephone line. When my mother was admitted to the hospital on May 11, we did the same for her.
The only difference is that when she was hospitalized with pulmonary pneumonia, the plasma therapy was removed from the government’s health agreement against the coronavirus.
But this is April 2021. The country’s top scientific institution, the Indian Council of Medical Research (ICMR), has been marked as “improper use of plasma therapy” as early as November 2020.
In a press release on November 17, 2020, ICMR stated that “PLACID, the world’s largest plasma test, does not show that CPT is beneficial for patients.”
On June 10 this year, Samiran Panda, the head of ICMR’s Epidemiology and Infectious Diseases Department, confirmed to me that plasma therapy has been marked by ICMR as having no benefit.
Regarding other drugs such as ivermectin, he said that all the evidence is based on observational studies, which suggests that it may be helpful, but “there are no double-blind placebo-controlled randomized clinical trials to prove its efficacy.”
“There is not strong enough evidence for the use of doxycycline, favipiravir and hydroxychloroquine,” he said.
Until May 27, many of these drugs are part of the Ministry of Health’s clinical guidelines for COVID-19. But they have not been approved by the World Health Organization or the U.S. Food and Drug Administration (FDA).
However, many doctors believe that plasma therapy does save lives.
Dr. Manoj Luthra, Director of Cardiac Surgery at Jaypee Hospital in Noida, a suburb of New Delhi, told me, “Although plasma therapy may have been cancelled by the government, doctors have sufficient anecdotal evidence to prove its effectiveness as a COVID-19 treatment”.
“Some of us also wrote to the government on this,” he said, and shared an article titled “New Evidence Proving the Efficacy of Ivermectin in the Prevention and Treatment of COVID-19”, which was published American Journal of Therapeutics.
But in April, people were generally worried about other drugs, such as the widespread use of steroids to treat the coronavirus. Both my mother and my father-in-law have been taking steroids for more than a month.
In May, we learned that the government’s new guidelines would recommend that hospitals use steroids for no more than 10 days or until the hospital stay, whichever is earlier.
Steroids are essential to reduce lung inflammation in COVID-19 patients, and if given at the right time and duration, they are considered to save lives. But they can also reduce immunity and increase blood sugar levels.
Bishnu Panigrahi, head of Fortis Medical’s Strategic Group, one of India’s largest private hospital groups, said, “As far as steroids are concerned, they have been abused.”
He said that steroids were “used very early in the treatment process, with higher doses and longer durations, leading to secondary infections.”
“Black fungus is a consequence of improper use of steroids,” he said.
Black FungusOr mucormycosis, a rare but life-threatening infection with a mortality rate of 50%. It affects the sinuses, brain, and lungs, and can be fatal to patients with severely weakened immune systems.
In India, the incidence of this disease has risen by 150%, and 31,216 infections and 2,109 deaths have been reported in the second wave of infections so far.
Black fungus is now listed as an epidemic disease by the Indian government under the Epidemiology Law.
As concerns about overuse of prescription drugs intensified, the government made a radical revision to the health agreement late last month.
On May 27, the Directorate-General of Health Services (DGHS) under the Ministry of Health effectively cancelled all drugs routinely prescribed by doctors, including ivermectin, azithromycin, doxycycline, zinc, fapilavir and plasma therapy.
DGHS only recommends antipyretics (drugs used to prevent or reduce fever) and antitussives (used to relieve or suppress cough) for mild patients, and does not recommend any drugs or examinations for asymptomatic patients.
It is recommended to use steroids and anticoagulants in moderate cases, and to increase immediate oxygen therapy, intubation, ventilation and immunomodulators in severe cases.
Medical institutions have retained remdesivir (used in moderate to severe cases) and tocilizumab (an off-label immunosuppressant used in severe to critically ill patients).
DGHS’s new guidelines have been welcomed by many people, including Soumya Swaminathan, WHO’s chief scientist, who tweeted: “Evidence-based guidelines from @mohfw DGHS-simple, reasonable and clear guidance for doctors.”
Swaminathan stated that the guidelines “can be updated as new evidence becomes available”.
However, the guidelines issued by the Ministry of Health and ICMR continue to recommend ivermectin and hydroxychloroquine for mild to moderate cases. They have not been updated or changed before the publication of this report.
Currently, COVID-19 guidelines are issued by DGHS, the Federal Ministry of Health, ICMR, and the State Medical Council. And they are not always the same.
Therefore, although almost all commonly used drugs for COVID-19 have been eliminated so far, Redcivir is a broad-spectrum antiviral drug used for the treatment of hepatitis C, but it is still retained by DGHS in its health protocol . The drug has also been approved by the FDA and used to treat coronavirus in several other countries.
But like everything else, there is no broad consensus on this.
Panigrahi of Fortis Hospitals said, “Although the literature does not show any significant reduction in mortality, the use of remdesivir is still rampant. This is the result of large pharmaceutical companies promoting this drug.”
However, DS Rana, medical director of Sir Henggaram Hospital in New Delhi, one of the capital’s largest COVID facilities, said it is an effective antiviral drug.
“Good trials have shown that if this drug is used in the early stages of the virus, it can have a positive impact on the early recovery of COVID in terms of hospitalization. DGHS recommends using it wisely,” he said.
Although no treatment mechanism is perfect in the current situation, and trial and error is part of the fight against unknown viruses, the evidence must be reviewed repeatedly to modify treatment decisions to reduce the long-term effects of experimental drugs.
The government itself admits that the third wave of the virus is “inevitable.”
Experts say that precedents and examples in the United States and Europe show that vaccination of at least 30-40% of the population by the end of the year can effectively contain the virus.
So far, less than 5% of India’s 950 million adult population have been vaccinated.
The country’s current total number of COVID-19 cases is close to 30 million, and as of Thursday, 381,903 people have died. During the second wave of COVID, nearly 200,000 people died.
Therefore, despite the sharp decline in the number of daily cases in the past two weeks, there are growing concerns about reinfection, rehospitalization, and secondary infections.
Indians hope that the new centralized vaccination policy announced by the government on June 7 will further ease the number of cases.
According to the new policy effective from June 21, the federal government will directly purchase 75% of the manufactured vaccine dose and vaccinate it free of charge. The remaining 25% of injections will be performed in private hospitals.
Although global trends indicate that transmission and mortality rates decrease with increasing vaccination, the Indian government must simplify its clinical treatment plan for COVID-19 and align it with global trends.
As for my family, my mother is still recovering from the secondary infection, while my father-in-law continues to have post-COVID complications.