The Maharashtra government has said in a new circular that hydroxychloroquine (HCQ) may be administered to all high-risk contacts of confirmed COVID-19 patients, and those admitted to quarantine centres.
It has also recommended that the drug be administered, after obtaining consent, to all health workers, nurses, and frontline workers, including those working in COVID care centres, COVID health facilities, and dedicated COVID hospitals in the state.
With this, it appears that the state government has shelved a controversial earlier plan to administer the prophylactic to all residents of containment zones within Dharavi and other areas, and is now recommending it for contacts of confirmed cases, and frontline workers, in line with ICMR guidelines.
Separately, a high-power committee to audit COVID-19 deaths in Maharashtra (except those in Mumbai), has cautioned the state health department that the use of HCQ in combination with the antibiotic azithromycin for confirmed COVID-19 patients should be closely monitored due to the likelihood of cardiac toxicity, The Indian Express has learnt.
The state government-appointed committee submitted its report last week.
Sources in the state health department said that during the audit of the first lot of 31 COVID-19 deaths, mainly in Pune, Yavatmal, and Ratnagiri, in at least 3-4 cases, it was found that a combination of HCQ with other drugs may have caused the “QT interval” to become prolonged in the electrocardiogram — meaning the heart muscle took longer than normal to recharge between beats — leading to cardiac toxicity.
The state government circular, on the other hand, recommends the use of HCQ only for suspected cases of COVID-19. A ‘high-risk’ contact is a family member and anyone else who came within three feet of the infected person. Quarantine centres have a mix of high- and low-risk contacts who have not been tested, and have no symptoms.
In Mumbai, the Brihanmumbai Municipal Corporation (BMC) has begun distributing 7.12 lakh doses — each dose is 6-8 tablets, to be taken one per week — of the preventive medication since Sunday, in 85 quarantine centres and ward areas.
The ICMR-constituted national task force for COVID-19 recommends HCQ as a preventive medication for high-risk population, which includes asymptomatic healthcare workers involved in the care of suspected or confirmed COVID-19 patients, and asymptomatic household contacts of laboratory-confirmed cases.
Depending on the number of COVID-19 cases, 1,000 to 5,500 doses are being distributed in wards. K-West (Andheri West) and G-South (Worli) ward are getting over 5,000 doses, while most others wards are getting 2,000 doses. In hospitals treating COVID-19 patients, 5,000 doses will be distributed for health staff.
Mumbai health workers began taking HCQ about five weeks ago, based on an advisory from the Centre. Mumbai Police, too started distributing the medicine to its personnel about three weeks ago. Until now Mumbai Police has procured 15,000 doses.
The notification issued by Health Secretary Dr Pradeep Vyas has mandated that the medication can only be given after due consent. For any reaction due to medication, the patient has to immediately report to the local government authority. The notification has mandated that heart patients, diabetics, people with blood disorder, those with retinopathy, must be assessed by a doctor first.
The medication is for people aged 18-55. In Mumbai, the BMC plans to give the medicine to the categories of people mentioned in the circular, who are above 15 years of age. Those in quarantine centres will also be given HCQ, but will continue to remain in 14-day quarantine.
The government’s circular does not have a date, but Dr Vyas confirmed that it had been issued. “This is a reiteration of earlier instructions. It was issued a few days back,” he said.
Dr Archana Patil, chairperson of the state death audit committee, was unavailable for comment, but officials in the health department said one of its recommendations was that the QT interval should be closely monitored, and if the interval got prolonged, HCQ should not be administered.
Dr Subhash Salunkhe, chairman of the state technical committee to prevent communicable diseases, who is coordinating the COVID-19 response, said the treatment protocol undergoes updation from time to time. “There are no studies indicating what is useful or not, and there are a lot of grey areas. However, there is a need to tread carefully while using HCQ in combination with other drugs,” Dr Salunkhe said.
The death audit also found that the third most common co-morbid conditions after diabetes and hypertension were morbid obesity and chronic alcoholism. Some case studies also showed gastrointestinal and diarrhoea symptoms.
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