For the first time, the Union Health Ministry has recently released a new evidence-based comprehensive guideline for the treatment of Covid-19 in the country. The evidence-based treatment guideline, however, has excluded certain drugs which doctors in Odisha have used extensively to treat the Covid-19 cases in the State.
In Odisha, the primary treatment protocol for Covid-19 in all government hospitals have been prescribing Ivermectin 12mg for 3-days by doctors, along with antipyretics (paracetamol). And if the fever is around 103 deg F, then the treatment protocol advises prescribing the anti-viral drug Favipiravir.
However, the evidence-based guideline released by Union Health Ministry has dropped these drugs from its Covid-19 treatment protocol.
Earlier, ICMR treatment protocol has included these drugs for treatment but has made an important observation then that these therapies are based on low certainty of evidence. So, it put the drugs in the list of 'May Dos', not 'Must Dos'
Must-Dos For Covid-19 Positives: see the 2 images below.
- Image 1: The Dos To Save Life
- Image 2: To detect Hypoxia and preventing from slipping into severe category
- ^-minute walk to Detect Hypoxia
Ivermectin tablets are basically approved by FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms. In addition, some topical (on the skin) forms of ivermectin are approved to treat external parasites like head lice and for skin conditions such as rosacea.
FDA has categorically observed that this is not an antiviral drug. As a consequence, the FDA has not approved the drug for treating Covid-19 in USA. FDA said there is no scientific evidence regarding the drug's role in reducing the viral load in patients. There is no evidence to show it as virucide not reducing lung infection.
But in India, especially in Odisha, all government hospitals prescribe Ivermectin for three days to all Covid-19 positive patients.
However, toeing the US line, the DGHS has not included Ivermectin in its latest Covid-19 treatment protocol.
What Is Favipiravir?
This drug has antiviral properties. Favipiravir was known to be an effective antiviral drug against influenza virus infections; it has also been shown to be efficient against a large number of RNA viruses (Ebola virus).
Since novel Coronavirus is an RNA virus, the anti-viral drug has been prescribed to treat Covid-19 in India and elsewhere in the world.
But in the US, medicine is not available commercially. The FDA has approved it for clinical study and use.
As per a study published in International Journal for Pharmaceutical Science and Research, the drug has a whole lot of safety concerns, though, in an open-label non-randomized study of 80 patients with COVID-19 in China, a significant decrease in SARS-CoV-2 viral clearance was observed in patients treated with favipiravir compared to those treated with lopinavir/ritonavir.
Similarly, in another multicentered randomized clinical trial in China, favipiravir treatment has been demonstrated to increase the 7-day clinical recovery rate (from 55.86% to 71.43%) and significantly reduce fever and cough relief time in COVID-19 patients.
Owing to the low certainty of the evidence, the DGHS has dropped the drug from its new treatment guideline.
What New Treatment Protocol Says?
• For Asymptomatic patients: The DGHS mainstay treatment says no medication.
• For Mild Patients: Paracetamol and cough syrup for symptomatic relief. No other Covid-19 specific medication required. But patients need to self-monitor fever, oxygen saturation level and other worsening symptoms. Inhalational Budesonide prescribed.
• For Moderate Patients: Steroid treatment if Oxygen saturation level drops to 92 per cent. Baseline investigations must.
How To Identify Asymptomatic, Mild, Moderate And Severe: Read the details given below
What Are The Baseline Investigations? (see the box given below)
• On Remdevisir: details in the box.
• On Tocilizumab: See the box below.
• On Steroids: take a glance at the image below
• On Anti-coagulants: Read the image below