A day after the Gujarat High Court sought a revision of the Gujarat government policy that prioritised distribution of remdesivir injections to patients in government hospitals over private hospitals, principal health secretary Jayanti Ravi on Thursday quoted World Health Organisation (WHO) chief scientist Soumya Swaminathan as saying “it (remdesivir) is being excessively misused and overused”.
The court had opined that the access to the drug by a patient be solely determined on the basis of the patient’s condition and not on the basis of whether they are being treated in a government facility or private facility.
At a press meet to discuss Covid treatment protocol on Thursday, Ravi also cited a WHO recommendation in November last year against the use of Remdesivir for treating Covid patients. She said she had a telephonic discussion with Swaminathan, chief scientist at WHO on Thursday morning, adding that Swaminathan reiterated “that it [Remdesivir] is being excessively misused and overused.”
Asked about WHO’s observations from its Solidarity trial, where it had recommended against the use of Remdesivir for hospitalised patients, as early as November last year, which is only being reiterated now by the Gujarat government, Ravi told The Indian Express, “We are not saying absolutely don’t use Remdesivir, but it is to be used in only hypoxic and critical cases, where patients are on oxygen… that is where it has to be used.”
In November last year, WHO following interim results from the Solidarity trial, said regarding Remdesivir that “the evidence suggested no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes.”
In the New England Journal of Medicine where the WHO Solidarity trial result was published in February 2021, it was concluded, “These Remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalised patients with Covid, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.”
AIIMS Delhi, revising the treatment protocol on April 22, also suggested that Remdesivir may be considered only in patients with moderate to severe disease requiring supplemental oxygen, who are within 10 days of symptom onset, have no kidney or liver dysfunction. The earlier guideline of April 7 had not included the supplemental oxygen requirement in patients as a precondition and neither did it include a precondition of using it within a 10-day window of symptom onset.
Meanwhile, Dr Raghavendra Dixit, additional director of medical education of the state health department, added that drawing from several treatment protocols across different states such as Maharashtra and Kerala, it has been held that “majority cases are mild and mild cases can be dealt with Favipavrir (antiviral) and Ivermectin (anti-parasitic drug).”
Notably, WHO’s March 31, guideline on Covid treatment, states that based on results from systematic review and meta-analysis of data from 16 randomised controlled trials, it was found, “The effects of ivermectin on mortality, need for invasive mechanical ventilation, hospital admission, duration of hospitalization and time to viral clearance all remain very uncertain (all very low certainty evidence).” It was noted that the uncertainty of efficacy may also be because of risk of biases in the study, among other factors.
The Ahmedabad Medical Association (AMA) came out in support of the state government’s stance in a written appeal, stating,”There are no studies to state that Remdesivir clears viral load, no studies stating that it reduces death rate in patients of Covid infection, it is not recommended in patients of Covid positive with mild to moderate symptoms without supplemental oxygen requirement.”