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Saturday, May 08, 2021

‘No guideline, relying on anecdotal evidence’: Doctors on administering Remdesivir to children

The infant was among the few children who was also administered antiviral drug Remdesivir.

Written by Sohini Ghosh | Ahmedabad |
April 17, 2021 11:04:03 pm
Remdesivir, Remdesivir stolen, Madhya Pradesh Remdesivir, Remdesivir availability, Remdesivir news, india news, indian expressRemdesivir is designed to obstruct the stage of replication, when the coronavirus creates copies of itself, followed endlessly by the copies creating copies of themselves. (File Photo)

A 15-day-old girl, who had tested positive for the coronavirus and subsequently given plasma, died in Surat on April 15. The infant was among the few children who was also administered antiviral drug Remdesivir.

Surat-based pediatrician Dr Alpesh Sanghvi, who was treating the child at the Surat Diamond Hospital, says, “We saw rapid development of acute respiratory distress in a span of 24 hours on the seventh day after she was born. There is no national level guideline on treatment protocol for pediatric Covid-19 patients, so we relied on a guideline issued by Apollo Hospital in Mumbai and also consulted pediatricians in Surat to decide on the course of action. We administered Remdesivir, steroid and plasma, but after the fifth dose of Remdesivir, she ultimately went into a cytokine storm and died due to Covid-19-induced pneumonia.”

Pediatricians, he told The Sunday Express, were prescribing Remdesivir “experimentally” because there was no guideline “and we are relying on anecdotal evidence”. He added that some of his colleagues had seen improvement in one-month old and two-month-old babies with Remdesivir, “but it is too early to say whether it has any effect or not”.

“What do we give? Fabiflu has no effect on children younger than 14 years or less than 14 kilograms. It would at least require a month or 30 (pediatric) patients to come to a conclusion. In terms of sideeffects, we have not seen anything noticeable because we have been continuously monitoring liver function and no toxicity was reported,” Dr Sanghvi says.

The Apollo Hospitals Mumbai guideline lays down that for moderate neonatal and pediatric patients, Azithromycin, Remdesivir and steroids can be considered subject to monitoring of all bodily parameters. For severe patients, antibiotics, Remdesivir, steroid, Tocilizumab and Heparin (anti-coagulant) can also be considered.

Dr Mona Desai, pediatrician and past-president of Ahmedabad Medical Association (AMA), too, attests that there is no national guideline on treatment protocol for children but “in very sick children, with breathlessness, plummeting white blood cell and platelet count, oxygen saturation less than 80 per cent, pneumonia in lungs and high-grade fever”, Remdesivir can be given.

As the antiviral drug, Remdesivir continues to be in short supply in Gujarat — the Ahmedabad Hospitals and Nursing Home Association (AHNA) on Saturday said that the Ahmedabad Municipal Corporation (AMC) has informed the association Friday that they would not be able to supply the injection to home isolation patients in care of AHNA-affiliated doctors.
Some patients — asymptomatic and mildly symptomatic — in Ahmedabad, with whom The Sunday Express spoke to, attested that they recovered even without Remdesivir.

Take the case of Jallavi Panchamia (41), assistant professor at Indian Institute of Public Health (IIPH-G), who tested positive for Covid-19 on March 18 with mild symptoms of a low-grade fever. On doctor’s recommendation, she recovered only on Azithromycin prescription. In the case of her 63-year-old asthmatic mother, who had no symptoms of the Covid-19, Fabiflu was prescribed and she, too, recovered.

An RT-PCR test on her 70-year-old father, who developed a sore throat and slight fever, had showed him to be negative on March 19. A subsequent a chest scan, however, showed lung involvement with a CT score of nine, indicating Covid-19. After running a fever for three days, the doctor advised Remdesivir based on three critical indicators, — continued fever, oxygen saturation level decreasing to below 95 per cent and lung involvement.

“He was in home isolation throughout and nursing staff would come for two hours to administer the drug through intravenous drip. He was better after the first day of Remdesivir dosage but the course of five days was completed. It is important for all to understand that a positive test result or being diagnosed with Covid-19 should not send them rushing for Remdesivir. It must be only on doctors’ advice… The panic only results in deserving/ genuine patients in need, unable to get the medicine. Hydration, rest and simple medicines to control fever are key. I have been seeing a lot of patients unnecessarily purchasing Remdesivir, no sooner they are diagnosed with Covid-19”, Panchamia, who works in the area of behavioural sciences at IIPH-G, says.

Panchamia, however, acknowledges that a month ago, when she and her family were infected, the panic as well as the upsurge in cases were few, making it easier for the family to have access to medicines and care.

Dr VN Shah, director at Zydus Hospital in Ahmedabad and part of the Covid-19 medical expert task force of the Gujarat government, reiterated that Remdesivir is “not a life-saving drug” and added that “most patients require general medicines (Azithromycin, Paracetamol, etc) and home quarantine.”

“Stop hoarding (the antiviral) at home and without panicking, follow your doctor’s advice. Stop going around in hospitals as soon as your Covid-19 test report is positive. This is not a miracle treatment, it has been proven (in trials) across the world, by WHO, …that it is not a miracle drug,” says Dr Shah.

In Ahmedabad, AHNA president Bharat Gadhvi, however, says there are patients who are on oxygen support but in home isolation (owing to non-availability of beds in hospitals) who need the drug. “We don’t know why there is still a shortage for those who need it, when the government and AMC are supposed to be arranging for only two things — Remdesivir and oxygen. AMC told us they do not have a stock and we do not know when it will come. It is also unavailable in the open market,” Dr Gadhvi adds.

On Saturday, Chief Minister Vijay Rupani announced the state was getting an average of 20,000 injections daily. “We have fixed priority there too. The government hospitals of Gujarat will be given Remdesivir first. Thereafter, registered private Covid-19 hospitals will be given. We are in touch with the manufacturers. Currently, additional production is being planned and in coming days when more stocks are available, then we will give Remdesivir in private. The government has taken the responsibility to ensure that every patient in Gujarat gets Remdesivir,” Rupani said in Jamnagar.

On April 15, the AMC had announced that would distribute Remdesivir injections to all eligible Covid-19 patients, including those admitted at any hospital and not necessarily an AMC-designated Covid-19 hospital, as well as to all home isolation patients under the care of a registered medical practitioner of AHNA through the association.

Patients admitted in all designated Covid hospitals, dedicated Covid health centres and Covid care centres, which the AMC had notified, would get doorstep delivery, the AMC had said. The stock was to be made available from SVP Hospital, with hospital authorities/employees authorised to collect the same. AMC had also cautioned that distribution will be subject to stock received from Gujarat Medical Services Corporation Limited (GMSCL).

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