There is an urgent need to establish clinical and management guidelines at the national level so that more efficacious and less harmful medicines are used for COVID-19 treatment. Guidelines should explicitly mention at what stage of the infection a specific drug should be given and it should be made clear all that medications should be ‘ONLY’ under medical supervision, say public health experts.
None of the currently used medicines should be bought over the counter and consumed as they can cause irreversible harm to the person. “Gains of evidence-based medicine are being compromised by irrational use of drugs for COVID-19 under the pretext that something ‘has to be done’ – This is a dangerous argument as it is pushing many drugs licensed for other purposes into the COVID management cauldron without adequate rigorous trials,” warns Public Health Foundation of India (PHFI)’s Indian Institute of Public Health-Hyderabad Director Dr. G.V.S. Murthy.
This includes use of many anti-cancer, anti-protozoal, anti-biotic and anti-viral medications with no clinical trials to prove efficacy and safety of medications. Many of these may be no better than a placebo. Large clinical trials of more than 1,000 patients are going on with drugs like Remdesivir, Lopinavir/ Ritonavir, Tocilizumab or convalescent plasma used alone. Big trials with combination drugs like hydroxychloroquine + famotidine/lopinavir/azithromycin/ favipiravir, Remdesivir + Interferron, Favipiravar etc., plus stem cell therapy and colchicine are also being trialled, he says.
The World Health Organisation (WHO) ‘living guideline’ gives a strong recommendation for systemic steroids like dexamethasone for patients with severe and critical COVID-19 though not for non-severe COVID-19, based on eight randomised controlled trials (more than 7,000 patients). Corticosteroids are cheap, readily available and included in the WHO’s list of essential medicines.
“WHO says systemic steroids may reduce the need for invasive mechanical ventilation. The ‘Recovery’ trial using Dexamethasone showed it decreased 28-day mortality in patients requiring oxygen or invasive ventilation,” explained Dr. Murthy.
COVID-19 deaths can also be reduced if accessible ventilation facilities supported by good maintenance care are provided for patients with moderate to severe symptoms. Since only 15 to 20% of such patients need these facilities, proper mapping and improved access to them should be ensured. For those with mild COVID-19, adequate hydration, fever management, improved nutrition and stress-free rest will go a long way to improve outcomes, he explains.