SEARCH FOR DRUGS

It’s important to remember that till late 2019 or early 2020, the world really didn’t know of the existence of the Sars-cov-2 virus that causes the coronavirus disease. Since then, our knowledge of this virus has expanded at an unprecedented rate. Pharma companies, scientists and researchers have not had much luck with therapeutics, either new or repurposed. They have, however, made up for this by coming up with a handful of vaccines that work – and in record time. Still, the absence of therapeutics (so far) means a continued search – and a bunch of traditional, homegrown, and experimental therapies are being pitched, not just by those who learn at the shiny altar of Whatsapp University, but even doctors who should know better, and lawmakers and administrators who have a responsibility to not pitch or endorse (if only by their silence) miracle cures that are often packaged snake oil.

It’s easy to criticise a lawmaker who says a regular dose of cow urine keeps her safe from Covid-19, just as it is a government department that claims a repurposed decades-old malaria drug (that didn’t work on malaria) actually cures Covid-19. But most people have been worst served by allopathic drugs. A preamble on how drugs are tested for efficacy and safety may be required here. They can be tested in silico (or through a computer simulation); in vitro (in a petri dish in the lab); and in vivo (in a human body). The fact that Covid-19 was a new disease, and the intensity of the first wave in some countries (subsequent waves would go on to be worse, but no one knew this back then) prompted a desperate search for drugs, in some ways made it acceptable to lower the bar for them. For instance, it is highly unlikely that a drug that works only in vitro will ever be allowed for widespread use (even under an emergency use authorisation), but that’s just what has happened with ivermectin (especially in India). This is one of those drugs that does very well in vitro (against the dengue, Zika, and yellow fever viruses, among other pathogens), but fails to replicate that in vivo (there can be countless reasons for this, including the body’s ability to absorb the drug). Think of it as a Ranji Trophy player pushed into Test cricket (and on a wet and windy morning at Trent Bridge). Unfortunately, subsequent in vivo studies have shown that ivermectin does not seem to help someone infected with Covid-19. That’s also true of Favipiravir, Itolizumab, Doxycycline, even 2-DG. There may eventually emerge well-conducted human clinical trials that show that some of these do actually work, but current scientific evidence (and I use the term carefully, because in this era of alternative facts, there is also alternative scientific evidence) does not justify the enthusiasm with which these drugs are being prescribed, and consumed. More worryingly, drug regulators around the world (and in India) are being far too quick (and worse, inconsistent) in their approval of such therapies, even if for emergency use.

There’s usually a price to pay for the misuse of drugs, even if this isn’t immediate. One study has shown that there is a link between the use of convalescent plasma – the Indian Council of Medical Research finally removed it from the treatment protocol on May 17 – and mutations in the Sars-cov-2 virus (more research is needed before this can be conclusively said, though). And many doctors believe (as do I) that there is a clear link between the overuse of steroids in Covid treatment and the growing incidence of mucormycosis, or the black fungus.

The damage caused by Covid-19 is significant, but it would be a pity if, in our justifiable urgency to get the better of the coronavirus disease, science- and evidence-based medicine is a casualty.

There’s been a lot of talk about the third wave of Covid-19 in India affecting children more than it does any other segment of the population. It’s important to point out that this is a generic threat assessment. Since it is unlikely that children (those under the age of 18 years) will be vaccinated by the time a third wave breaks, it is obvious that they are as much at risk as any other unvaccinated group. There’s also no data or research that suggests that children are suddenly more vulnerable to the SARS-COV-2 virus that causes Covid-19, or any of its variants, than they always were (so, the bit about children rarely dying from Covid-19, or even needing to be hospitalised remains true) . That said, it makes sense to vaccinate them, and as early as possible.

The fact that Covid-19 was a new disease, and the intensity of the first wave in some countries (subsequent waves would go on to be worse, but no one knew this back then) prompted a desperate search for drugs, in some ways made it acceptable to lower the bar for them.