The ICMR recently discontinued plasma therapy for treating patients of Covid-19. Meanwhile, Dr D.S. Rana, chairman of a reputed private hospital in Delhi, told The Sunday Guardian that remdesivir injections were not successful for treating Covid patients and should be discontinued too.

Now, in an exclusive interview with The Sunday Guardian, Dr Naveet Wig, chairperson of the AIIMS Covid Task Force and HoD of Medicine, has said that both plasma therapy and remdesivir are effective when used on Covid patients.

“Plasma therapy has been found to be useful in specific conditions. In the first seven days since any patient is infected with Covid, if the patient is diabetic, if they are old and the body is less able to fight against this virus, and if they test negative for antibodies, then, if given good plasma, it will be effective. That plasma is an anti-viral medicine,” said Wig.

“Some science studies and the US FDA have said that within seven days, if we use plasma therapy for patients of Covid-19, it can be effective in the first three days. The strain neutralises with this therapy,” he further said. 

However, plasma therapy cannot be given to patients who have been infected for more than seven days because they already have antibodies, he added. Patients who are on ventilator support will also not be affected by plasma therapy, he said.

Regarding remdesivir, Wig said, “We do not administer remdesivir injections for every patient. Remdesivir is also an anti-viral drug, given to patients who are hospitalized, on low-flow oxygen and within the first ten days.”

He added that whether it is for patients with mild symptoms or for patients using a ventilator, it is for the doctor to decide. “The guidelines are only for guidance. The doctor who is treating the Covid patient knows better about what treatment is best for that patient.”

“We should treat illness like a disease. Science should be treated in the manner of science. Medicine is an art, and that art is available only with a doctor. Not available with a scientist,” said Wig.

Over 2.57 crore people in India have been infected with Covid-19 so far, with over 2.76 lakh fresh cases being registered in 24 hours, as per data on Thursday. The country also recorded 3,874 deaths, pushing the overall toll to 287,122.

The Health Ministry said on Thursday that seven states have more than 25 percent case positivity, while 22 states have more than 15 percent case positivity. However, it also said that the number of districts reporting a decline in case positivity have increased from 210 in April 29-May 5 to 303 in May 13-19.

Most notably, Delhi reported 3,231 new Covid-19 cases in 24 hours, the lowest number of fresh cases since 1 April this year. The positivity rate has also come down to 5.5 percent over the 24-hour period amid the Covid-induced lockdown in the national capital, which has been imposed since 19 April. This is the lowest positivity rate since 6 April, when 4.93 percent was recorded.

The recovery rate is as high as 95.5 percent in Delhi, the highest since 7 April when Delhi had 95.57 percent recoveries. In 24 hours, 7,831 people were discharged, taking the total number of recoveries to 13,47,157.

Delhi also recorded the lowest number of active cases with 40,214 since 12 April when 38,095 cases were registered.

In Mumbai, cases have decreased by 25 percent in the last ten days, and deaths have also reduced by 23 percent. On 10 May, there were 1,794 cases and 74 deaths in the commercial capital, but on Thursday, there were 1,433 cases and 59 deaths.

However, despite the decline in Covid cases in India’s worst-affected cities, the number of people hospitalised or dying due to Covid is still worryingly high.

Max Hospitals, Delhi’s biggest private hospital chain, has seen more than 30,000 patients being admitted during the second wave or since April first week. Dr Sandeep Budhiraja, Group Medical Director of Max Healthcare, told a news channel that they had a monthly mortality rate of 6 percent during the first wave, which has increased to 7.6 percent this time. “In the 45 age group, mortality rate has increased from 7-9 per cent to 9-11 per cent this time,” he stated.

Officials of Lok Nayak Jai Prakash Hospital, Delhi’s biggest Covid-dedicated hospital, run by the Delhi government, say that late hospitalisations have contributed to the numbers.

Meanwhile, Maharashtra Health Minister Rajesh Tope told the Centre that mucormycosis or black fungus, which has claimed 90 lives in the state so far, is a matter of “prime concern for the state” at present.

Tope made the statement after a meeting where Prime Minister Narendra Modi virtually interacted with district magistrates and field officials on the Covid-19. According to PTI, 17 district collectors from Maharashtra attended the meeting.

The Delhi and Punjab governments have started acting on a war-footing following concerns that a third Covid-19 wave might be round the corner once the current second wave recedes in the country.

A three-member panel created by the Department of Science and Technology has told the Central government that the impact of the second wave in India will start to decrease in July this year, while a third wave will start within the next six to eight months. Acting on this, Delhi CM Arvind Kejriwal held a high-level meeting on Wednesday with officials to review the current Covid situation in Delhi, and to deliberate on the measures to be taken to prevent the third wave of the pandemic.

A report from Chandigarh said amid projections and concerns of a possible third Covid wave and its impact on children, Punjab Chief Minister Captain Amarinder Singh on Thursday ordered the Health Department to go into mission mode with preparation, which will include specialised training of all doctors in the Health Department by the end of June, while directing house-to-house surveillance to control the current spread of the disease in the rural areas.

In Dehi, Kejriwal prioritized the increase in the number of beds, along with an increased oxygen allocation and the creation of a special task force to protect children from the third Covid wave. He also directed officials to work on advance preparation for sufficient oxygen tankers and ensure proper functioning of oxygen plants for an optimum supply of oxygen to hospitals.

Kejriwal tweeted, “If the third wave of Corona emerges, we have to be prepared in advance to fight it; took some important decisions today in a meeting with the officials. 1. To create a special task force to protect children from the third wave 2. Adequate beds, oxygen, and better management of essential medicines.”

The third wave may require Delhi to be prepared with 40,000 oxygen beds, and the Delhi government is making preparations to install 10,000 ICU beds. Along with beds and oxygen management, management of medicines was also discussed. A committee comprising officials will be formed to overlook the availability of medicines, oxygen, and beds. A special task force comprising pediatricians, experts, and senior IAS officers will also be constituted as a part of Delhi government’s efforts to protect children from Covid’s third wave.

Deputy Chief Minister Manish Sisodia and Health Minister Satyendar Jain were also present in the meeting along with officials of the Delhi government. In a bid to take precaution against a possible third wave, the National Commission for Protection of Child Rights has written to Union Health Secretary, Rajesh Bhushan, requesting him to issue necessary directions for emergency transport services/ambulance suitable for children and neonatals, in view of the high risk for infants and children in the possible upcoming wave.

Chairperson of the National Commission for Protection of Child Rights, Priyanka Kanoongo, in a letter to Rajesh Bhushan wrote that the ongoing Covid-19 pandemic is impacting several children and adolescents as India grapples with escalating virus cases in the second wave of this pandemic situation. She said that doctors have confirmed that even newborns and infants are testing Covid-19 positive, though their condition remains under control and rarely turns fatal. Further, a third wave is projected to hit the country and according to experts it may affect children in large numbers.

There are guidelines on the management of newborns in a maternity ward and in the Neonatal Intensive Care Unit (NICU), but there is an urgent need to reorganize a Neonatal/children Emergency Transport Service (NETS) to prepare specifically for neonatal and children for third wave of Covid-19, she urged.

Meanwhile, chairperson of the Covid Task Force for AIIMS, Dr Naveet Wig, on Thursday said that the Covid-19 crisis is “a dynamic situation” and to prevent a third wave of the pandemic, there is a need to keep changing strategies. Wig told The Sunday Guardian, “The Covid crisis is like a Test match, it is not a one-day match. We have to keep changing our strategies all the time. It is such a dynamic situation that no one formula will take care of this.”

“Public support is important. People have to understand this disease, how it happens. Until and unless people participate, we will not be able to prevent it,” Wig said. “Covid appropriate behaviour is a must. We lacked Covid appropriate behaviour after the first wave. That behavioural change led to the second wave. We have to wear the mask all the time, whether we are vaccinated or not,” he added. “We do not have to let the third wave come in the way the second wave came in. We need to keep the positivity rate in districts less than 5 per cent and less than 1 per cent in the village,” Dr Wig said.

Meanwhile, amid concerns of a possible third wave of Covid and its impact on children, Punjab Chief Minister Captain Amarinder Singh directed the state expert group head Dr K.K. Talwar to look into all aspects of medical education, and to get training modules prepared for the Health Department. He underlined the need to ensure that all medical officers in the state are trained to deal with Covid, especially in children.

Expressing concern over the spread of Covid in rural areas, the Chief Minister directed that teams of Health and other departments immediately start house-to-house surveillance in every village. The teams should be equipped to give basic medicines without delay, and RAT testing of symptomatic persons must be done at the earliest, he said. He also directed that some CHCs in each district be prepared as L2 facilities, with oxygen concentrators and doctors with proper treatment protocols.

The model village of Hiware Bazar in Ahmednagar district of Maharashtra is showing the way on how to combat the Covid-19 pandemic. From 1-20 May, there has not been a single case of Covid-19 in Hiware Bazar, located in the Nagar tehsil.

Over the last three decades, the village that has a population of 1,600 -1,700, has seen a transformation from being a drought-prone village to a model village, known for rainwater harvesting, water conservation, and management programmes.

“We have successfully managed to break the chain during the second wave,” Popatrao Pawar, the Up-Sarpanch of Hiware Bazar, told The Sunday Guardian. 

Between March-April 2021, 52 cases were reported in the village out of which five were on ventilator, but now over the past fortnight, there have been zero cases. So far, only two deaths from Covid-19 have been reported in the village. A lot of efforts has gone into breaking the chain. Social distancing is compulsory in the village and wearing masks is also compulsory. Even villagers are allowed to buy grocery once a week. 

Ashok Rao, whose family of six people contracted Covid, told The Sunday Guardian that when they got Covid, all of them quarantined at a village school. Within 15 days, the test reports came negative. He said: “Corona is curable and there is no need to create a panic.”

Mahadev, who used to work in the army, took voluntarily retirement from the army and is now working in the general administration department at the Mantralay in Mumbai. When he came to the village, his antigen test done and he was found Covid positive. He immediately quarantined at an isolation center made by the village panchayat outside the village. In this way, he saved his family from contracting Covid. At Hiware Bazar, rapid antigen test has been made compulsory for outsiders who enter the village and, in this way, the spread of Covid-19 is being checked.

A recipient of Padmshee award, Popatrao Pawar, up-sarpanch of the village said: “However, we are not going to lower our guard. We have made it compulsory in the village that once you come outside your home, wearing N-95 mask is mandatory.”

The gram panchayat provides the N95 masks and sanitisers to every household. In this 2,000 population village, house sanitisers have been kept outside houses.

Four vehicles have been arranged by the gram panchayat for ferrying serious Covid-19 patients to Ahmadnagar so that they don’t have to rely on government ambulance. The village has made its own isolation center where symptomatic patients are treated. Critically ill patients are shifted to the Ahamadnagar civic hospital. Since the last 20 days, not a single Covid case has been reported in the village. 

Villagers step outside their houses wearing masks; social distancing is being followed in the village. Every house hola in the village has a cow; they sell the additional milk at a near-by milk factory. Milk collection center has been set up inside the village which opens three hours in the morning and three hours in the night. The milk collection center has fixed timings among each household so that villagers do not come together at a center.

The gram panchayat holds regular meetings with villagers, informing him about the Covid trend. Hiware Bazar held a vaccination drive on Thursday where 70 peoples got the vaccine from 82-year-old ladies to 35-years-old frontline workers. The gram panchayat is making a list of people who will take the vaccine first. The lists include senior citizens and frontline workers. Till  now, 250 villagers got vaccines over a period of three months. Those who are coming to take vaccine, have to first go for antigen test. If the rapid test results is negative, then they l proceed for vaccine.

When 52 people got Covid, the gram panchayat made his own SOPs and Covid 19 rules and regulations. The SOPs specify that no social function can take place for another month; no gathering will be allowed. Mask wearing is compulsory and social distancing is compulsory even if one is meeting one’s neighbours. Ahmednagar’s Collector Rajendra Bhosale and Zilla Parishad CEO Rajendra Kshirsagar have appreciated the efforts of Hiware Bazar and Pawar.

On the ongoing agricultural activities, Pawar said that nearly 300 to 400 people come and work in the fields. “We have made arrangements for their stay near the villages,” he said, adding that in agricultural fields also, Covid-appropriate behaviour has to be maintained. Last month, 52 villagers where found positive, but due to the gram panchayat and Popatrao Pawar’s efforts, now the village is Covid free.

Amid declining active coronavirus cases across the county, Prime Minister Narendra Modi on Thursday cautioned the states against laxity in Covid-appropriate behaviour and said that the past experience has taught us that the virus remains a challenge even on a minor scale.

“Though the active Covid cases in the country have started decreasing, the experiences over the years and a half taught us that as long as the infection exists on a minor scale, the challenge remains,” he said while interacting with the district magistrates (DMs) and field officials of 10 States regarding the Covid-19 situation on the ground.

The Prime Minister noted that past epidemics and the current pandemic taught us that constant change and innovation in the strategies are very important, and said, “These viruses specialise in mutations, formatting, so our methods and strategies should also be dynamic.”

He said the country needs new strategies and solutions in the midst of new challenges posed by coronavirus and the experiences and feedback of field officials help in making practical and effective policies.

Interacting with the district magistrates (DMs) and field officials of 10 states, the Prime Minister said the country needs new strategies and solutions in the midst of new challenges posed by Covid-19. “Coronavirus has made your work more demanding and challenging. In the midst of new challenges, we need new strategies and solutions. It becomes important to use local experiences and we need to work together as a country. Your work in the field, your experiences, and your feedbacks help in making practical and effective policies. The vaccination drive is also being taken forward by incorporating suggestions from states and many stakeholders at every level,” he said.

On vaccine wastage, the Prime Minister said, “Wastage of a single vaccine means not being able to give the necessary protection to one life. It is therefore important to prevent vaccine waste.”

Even as the Union Health Ministry on Thursday in a letter to the states and Union Territories asked to make “Mucormycosis” or “black fungus” a notifiable disease under the Epidemic Diseases Act (EDA) 1897, Delhi Chief Minister Arvind Kejriwal said that there are about 200 cases of “black fungus” in the national capital. He added that the Delhi government has decided to set up centres to treat the condition in three state-run hospitals. Meanwhile, the Gujarat government has declared Mucormycosis an epidemic.

Mucormycosis, or black fungus usually infects people whose immune system has been compromised, causing blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood.

Doctors believe that the use of steroids to treat severe Covid-19 could be causing the rash of cases because those drugs reduce immunity and push up sugar levels.

In the letter, the Union Health Ministry has stated, “The treatment of this fungal infection requires multidisciplinary approach consisting of Eye Surgeons, ENT specialists, General Surgeon, Neurosurgeon, Dental Maxillofacial surgeon etc. and institution of Amphotericin B as an antifungal medicine. You are requested to make mucormycosis a notifiable disease under Epidemic Diseases Act 1897.” Under this, all government and private health facilities, medical colleges will follow guidelines for screening, diagnosis, management of mucormycosis, issued by the union health ministry and Indian Council of Medical Research (ICMR).

The ministry also asked to make it mandatory for all these facilities to report all suspected and confirmed cases to Health Department through the district level Chief Medical Officer and subsequently to the Integrated Disease Surveillance Project (IDSP) surveillance system.

“In recent times a new challenge in the form of a fungal infection namely Mucormycosis has emerged and is reported from many states amongst Covid-19 patients especially those on steroid therapy and deranged sugar control. This fungal infection is leading to prolonged morbidity and mortality among Covid-19 patients,” the letter also stated.

As Rajasthan is seeing a surge in the number of cases of black fungus, the state government on Wednesday declared the disease to be considered as an epidemic. On 18 May, the Haryana government also formed regulations called, “The Haryana Epidemic Diseases (Mucormycosis) Regulations, 2021”.

Till now, cases of black fungus have been reported in various parts of the country including Karnataka, Uttarakhand, Telangana, Madhya Pradesh, Andhra Pradesh, Haryana and Bihar.

CM Kejriwal has said that the Delhi government will ensure adequate supply of drugs to treat this condition and spread awareness on how to prevent it. “As per reports coming in from hospitals, there are about 200 cases of black fungus in Delhi,” he said on Thrusday.

Kejriwal discussed preventive measures with officials, through which the Delhi government can raise awareness. To tackle the rising cases of black fungus, the Delhi government has dedicated three hospitals for its treatment. Dedicated centres for Mucormycosis treatment center will be established at LNJP, GTB and Rajiv Gandhi Hospital, with teams of specialized doctors constituted at each centre for efficient functioning. The Delhi government will also prepare a detailed plan and issue special SOPs on how to raise awareness amongst Covid-recovered people for the prevention of the disease.

The Delhi government will also procure medicines for the treatment of the disease from the Central government. Kejriwal said, “Delhi is the capital of the country and so, people from outside also come here for treatment. We should have a sufficient quantity of medicines to cater to everybody who is coming for the treatment of black fungus.”

Kejriwal tweeted, “Convened a meeting with officials and experts on the growing cases of black fungus disease. We also have to stop this disease from growing and those who are getting this disease have to be given better treatment as soon as possible. Some important decisions were taken in the meeting for the prevention and treatment of this disease. 1- Centers for treatment of black fungus in LNJP, GTB and Rajiv Gandhi Hospital 2- Adequate management of medicines used in its treatment 3- Spreading awareness among people about disease prevention measures.”

Meanwhile, a report from Gandhinagar said a detailed discussion on the Mucormycosis epidemic was held at a meeting of the core committee chaired by Chief Minister Vijay Rupani. During discussions at the core committee meeting, it was stated that the disease has been declared an epidemic under the Epidemic Diseases Act, 1897. In this regard, government and private hospitals and medical colleges treating the disease will now have to follow the guidelines laid down by the Department of Health, Government of India as well as the ICMR for screening diagnosis and treatment. Details of suspected as well as confirmed cases of this disease should be sent to the Government of India from time to time.

In Gujarat, there are more than 1,200 cases of Mucormycosis in the four big cities. There are around 500 cases in Asarwa Civil of Ahmedabad.

Mucormycosis is slowly spreading to the villages along with the cities of the state, which has led to shortage of medicines for the disease in Gujarat, which is suspected to be due to hoarding and black marketing. So, the sale of medicines for the disease is also likely to be curtailed.

WITH AGENCY INPUTS