Increasing research on drugs and doctors gaining experience in the last 10 months have lessened their initial reliance on anti-virals, plasma therapy and drugs to treat Covid-19 patients. They now prefer managing the symptoms as well as providing early treatment and oxygen support to patients.
“Initially, we didn’t know what would work. We used Azithromycin and Hydroxychloroquine. Now, we have recognised that Covid-19 can be managed if treatment is started early. Prone position, steroids and high flow oxygen works,” said Dr Shashank Joshi, a member of the Mumbai Covid-19 Task Force.
Hospitals have modified their stand from advising admission to all senior citizens and high co-morbidity groups to only those who require oxygen support. Senior citizens, too, who have oxygen saturation levels above 94, are advised home isolation.
Many doctors ask patients to walk for six minutes and observe pulse oximeters, instead of waiting for a CT scan report. If levels fall below 94, they are advised hospitalisation.
Dr Shahid Barmare, physician with S R V hospital in Chembur, said that once admitted, he puts patients on oxygen support and treats them for fever and pneumonia. “We know now there is no curative treatment. Anti-virals do not prevent deaths. At most, they reduce the duration of hospitalisation and clear the viral load early,” he added.
While anti-virals like Remdesivir and Favipiravir as well as immuno-modulators like Tocilizumab and Itolizumab were prescribed to almost all patients, their use have now been substantially reduced.
Remdesivir and Favipiravir are given only within 72 hours after the first symptoms emerge. Once touted as a miracle drug with patients’ kin lining up to source it at pharmacies and distributors’ godowns, Remdesivir’s use has dipped by 82 per cent in Maharashtra over the last three months.
Food and Drug Administration (FDA) data shows from 10,000 to 11,000 vials in demand on a daily basis in July, the demand shot up to 27,000 to 29,000 vials per day in September. It has now dropped to 3,000 to 5,000 vials.
J B Mantri, Joint Commissioner (Drugs) in FDA, said, “Now, both the number of cases and the demand for Remdesivir have reduced. There is enough stock of Remdesivir, Tocilizumab and Favipiravir. In fact, some distributors in Nagpur have so much Remdesivir in stock that they are unable to sell it.”
Immuno-modulators like Tocilizumab and Itolizumab are now given to a small sub-sect of critical patients only. The state task force has removed Tocilizumab from the list of prescribed drugs. Also, the use of convalescent plasma therapy has dwindled since October when Indian Council of Medical Research (ICMR) conducted a trial and found that it did not improve mortality rate or prevent progression of the disease into its severe form.
Till December 2, over 17,373 plasma units have been used on Covid-19 patients. “Now, we do not use plasma at all. It is effective only if used very early. We rely on antibiotics and steroids… we use blood thinners in some cases to prevent clotting,” said Dr Gautam Bhansali, consultant physician with Bombay hospital.
Bhansali added even if high-risk patients are admitted, they are only monitored and not administered drugs unless their oxygen level drops or they develop fever and cough. “Second week of infection is important, it could lead to happy hypoxia. We have to monitor patients during that duration,” he said.
Mumbai’s daily case fatality rate has now come down to less than 2 per cent. The severity of the infection has reduced with early diagnosis and close monitoring. Of the over 60,000 active Covid-19 patients in Maharashtra, 87 per cent have either mild symptoms or are asymptomatic. Only 6 per cent remain critical. Another 7 per cent are stable but on oxygen support.
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