Govt approves remdesivir for moderate cases, HCQ early on
The health ministry on Saturday recommended the use of antiviral drug remdesivir in the moderate stage of Covid-19 while changing its earlier stance on hydroxychloroquine, saying the anti-malarial drug should be used only in the early course of the disease and not on critically ill patients. Convalescent plasma therapy has also received approval for off label use. This involves transfusion of the plasma of recovered individuals into Covid-19 patients. “…may be considered in patients with moderate disease who are not improving (oxygen requirement is progressively increasing) despite use of steroids,” says the health ministry protocol.
These changes are part of the revised clinical management protocol for the disease released on Saturday by the Union health ministry.
The revised guidelines say HCQ should be given early on in the course of the disease for maximum benefit and should not be given to severely ill patients.
The earlier protocol recommended HCQ for critically-ill patients in the intensive care unit. The antibiotic, azithromycin, that was being given in combination with HCQ has been dropped, even as some precautions have been added to make the use of the latter safer.
“... this drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease. An ECG should ideally be done before prescribing the drug…” say the updated recommendations. A government official, a domain expert who asked not to be named, said the evidence against the use of HCQ is not compelling enough to withdraw its use. “If tomorrow, we get more robust evidence for or against any medicine, then the experts concerned will take a call accordingly.” As part of investigational therapies, the new treatment protocol also includes immunosuppressant drug tocilizumab (off label).
Dr Yatin Mehta, the head of Medanta Hospital’s critical care department said: “These antivirals have shown promise against Sars-cov-2 [which causes the disease] in initial studies and tocilizumab blocks the cytokine storm that starts building inside the body after a week or so. However, there are certain contraindications in the use of these medicines. So the medicine is not for everyone and needs to be started under strict medical supervision.” Dr Vanshree Singh, director (blood bank), Indian Red Cross Society, said: “Plasma therapy has shown promise but not all patients will benefit, which is why there is a protocol for administration of plasma therapy.”
Centre has issued an advisory to states with measures to revive urban transport amid the coronavirus disease pandemic.
The states have been asked to encourage and revive non-motorised transport, recommence public transport by adopting the right sanitization, containment and social distancing measures and utilize technology to curb the spread of virus through contact-less payment and common mobility card.
“Covid-19 pandemic has suddenly impacted our way of life and that of our local, regional and global transport systems. Evidence shows that there is a steep drop in public transport ridership volumes by 90%,” the advisory said.
The advisory issued by the ministry of housing and urban affairs on Friday has provided a three-pronged strategy to states.
The advisory suggests nonmotorised transport (NMT) for trips under five kilometres. “As most of the urban trips are clocked in under five kilometres, NMT offers perfect opportunity to implement in this COVID 19 crisis as it requires low cost, less human resource, easy & quick to implement, scalable and environment friendly,” it said.
Public places will need to become more suited for pedestrians and walking and cycling networks will need to be expanded, the ministry had said earlier.
“They need to demonstrate it in Delhi, where urban development is directly under the Centre’s control,” said KT Ravindran, former chairman of Delhi Urban Art Commission (DUAC).