After the drug flip-flops last year, doctors said they now know what medicines are working against the coronavirus. And a key indicator of that confidence is the country’s recovery rate — at 96%, it’s among the world’s highest.
“Quite a few drugs such as HCQ (anti-malarial), the antiparasitic ivermectin and others failed to improve patient outcomes in 2020. But oxygen therapy, high doses of vitamin supplements (C and D) and minerals (zinc) that boost immunity are still encouraged, along with rational use of steroids and some anti-virals,” said Ahmedabad-based critical care expert Rajesh Mishra.
Besides drugs and supplements, doctors said focus will also be on patients’ oxygen intake, sugar-control and general nutrition.
Trouble began towards the middle of 2020 when some repurposed drugs against Covid, despite positive lab data and anecdotal evidence, failed to impress in large trials. A prominent example is the anti-viral drug remdesivir, which the World Health Organization said had not boosted recovery in those with Covid-19. “But remdesivir is certainly effective during the early stages of Covid, to control virus replication. Similarly, ‘under-theskin’ administration of the anti-rheumatic tocilizumab in carefully selected critical patients can limit the abnormal immune response called ‘cytokine storm’. These drugs have benefited many patients,” said Ruby Hall Clinic’s chief intensivist Kapil Zirpe.
He said Covid recoveries rely heavily on swift and effective ICU care. “The illness boosts blood-sugar levels in some patients as the virus causes pancreatic beta cell changes. Steroids can also cause spikes in blood-glucose levels. So administering insulin, along with adequate hydration (saline), are key to managing a patient’s sugarrelated complications.”
Covid autopsies also provided insight into increased blood clotting in vessels in those affected with severe disease. They called for the use of anticoagulants or bloodthinners.
Such analysis allowed doctors to redefine the illness as an excessive host-immune response (person’s own immunity attacking itself), often leading to escalation of symptoms.
“The research paved the way for immunomodulatory agents (drugs that stabilize abnormal immune response) in suppressing a huge inflammatory reaction that causes lung damage,” said critical care expert Kapil Borawake.
Specialist Subhal Dixit, said, “The key point of any Covid-19 therapy, be it remdesivir or tocilizumab, is the selection of patients. Prudent use of blood-thinners such as heparin or low molecular weight heparin is also important for those with high D dimer values that indicate high blood-inflammation.”