Coronavirus (COVID-19): At least two states with a high number of cases are recommending hydroxychloroquine (HCQ) as a preventive measure against coronavirus to its police personnel. While the Mumbai Police started last week, Rajasthan announced on Saturday that the anti-malarial drug, whose efficacy against COVID-19 is contested, would be given to policemen deployed in hot zones.
The Maharashtra government has also decided to begin offering HCQ to around a lakh slumdwellers in the settlement of Dharavi, Mumbai, that has emerged as a hotspot with 49 cases and five deaths, as well as to people living in other areas that have seen a serious outbreak, such as Worli-Prabhadevi-Lower Parel, who must be over the age of 15. National Health Mission Director Anup Kumar Yadav said the medication would be expanded to other hotspots gradually.
The drug is currently recommended as a prophylactic (preventive medication) for healthcare workers exposed to coronavirus patients or family members of positive cases taking care of them.
While taking HCQ will not be mandatory for Dharavi residents, officials said they would be counselled on the need to take it. The settlement holds 8.5 lakh people.
Maharashtra has a stock of about 35 lakh HCQ tablets, provided by the Central government. State officials said the exercise of administering the drug will begin in two days.
A technical committee, comprising AIIMS doctors, NITI Aayog experts, officials from the Maharashtra University of Health Sciences and the public health department, met on Monday on the matter. It was decided that the Dharavi residents taking the drug would be divided into two groups — one would be given HCQ along with vitamin C tablets, and the second, HCQ with zinc tablets. The dosages of HCQ will be given one week apart.
“We will assess the outcome of each group to see which combination works better,” Dr Subhash Salunkhe of the public health department, who framed the policy on its use, said. With social distancing difficult in slums and the virus transmitting fast, HCQ has become a necessary intervention, he said.
Rajasthan advised HCQ for policemen in hot zones on April 10 after a constable tested positive in Jaipur, with Chief Minister Ashok Gehlot giving the go-ahead. Additional Chief Secretary, Health, Rohit Kumar Singh said police personnel are at risk in such areas and, “keeping in mind that they can be infected too, it was decided to administer them a dose under medical supervision”.
Singh said Rajasthan has over 10 lakh tablets, a sufficient quantity. The Jaipur police has sought at least 1,000 doses. The Health Department said district chief medical and health officers have been instructed to provide HCQ if required by police officials.
The constable who has coronavirus was escorting a medical team conducting door-to-door survey in Jaipur’s hot spot Ramganj. After his infection was confirmed, 14 policemen were sent to quarantine. Next day, a head constable of the Ramganj police station also tested positive.
The Mumbai Police has told its personnel to first consult a medical officer and get an ECG done before taking two tablets of HCQ IP 200mg on day one, followed by a tablet of IP 400mg per week for the next eight weeks. An officer said, “One of the instructions was to have a Rabeprazole or Razo D tablet alongside to avoid acidity.”
The drug is known to cause gastrointestinal and liver complications and is contraindicated for people suffering from heart disease or from glucose 6 phosphate deficiency.
Seven Mumbai Police personnel, including two officers, have tested positive so far. Forty-seven are quarantined.
“We are waiting for protocols and medical advice from the state government on the use of this drug,” said Ramesh Pawar, Deputy Municipal Commissioner, BMC.
An oral prescription drug primarily used to treat malaria, HCQ is also prescribed for arthritis, lupus and inflammatory conditions. While it has shown anti-viral properties, clinical trials on its efficacy against COVID-19 are still on and experts are split on it. The US and France are administering it against coronavirus.
Over 10 days ago, the ICMR held a “very heated discussion” on the matter, but an option to administer the drug “at a population level” was “not taken forward”, sources told The Indian Express. This was before the US and 12 other countries officially sought the tablets from India, which is the world’s largest producer of HCQ.
A source said, “The option of using the drug as a population-level prophylactic was mooted by a very senior doctor. However, questions were raised about the evidence available on its efficacy and side-effects. It was a very heated discussion, mostly among doctors, after which the matter was not taken forward… But it would not be correct to say the option has been junked for good. We may still look at it for some categories.”
Last week, responding to questions from reporters, ICMR officials had denied any plan to use the drug for entire populations.
-Inputs by Tabassum Barnagarwala, Sagar Rajput, Hamza Khan, Abantika Ghosh
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