Each time a new guideline was issued — there have been five since April — the use of hydroxychloroquine (HCQ) as the principal drug has come down, with those like remdesivir replacing it, especially in severe cases. Hundreds of mild or asymptomatic patients have recovered without any Covid-specific drug and have merely taken paracetamol, cough syrups and vitamins; some haven’t even needed these.
Even as there was a scamper to prescribe and procure HCQ at the onset of the pandemic in March, its use has slid over the next four months. According to the latest government-recommended Covid-management protocol, HCQ is to be prescribed only for the ‘high-risk group’, while the mild cases are to be treated with paracetamol and oral fluids.
Again, a section of doctors is prescribing both azithromycin and HCQ for all mild to moderate patients. While the former is an antibiotic, anti-bacterial medicine, they point out that HCQ is not safe for certain cardiac patients.
“This combination is the most widely used so far, except in the case of patients with cardiac arrhythmia and similar diseases. It has worked and is a safe mode of treatment, though mild patients are likely to recover even without them,” said Arindam Biswas, a consultant at RN Tagore International Institute of Cardiac Sciences (RTIICS).
Yet others are prescribing favipiravir — an anti-viral drug — as a first-line medicine for mild to moderate patients, along with vitamin supplements. For the high-risk group (elderly, with co-morbidities), HCQ and azithromycin are being used in combination. Alternatively, some are prescribing remdesivir and dexamethasone.
“I am not a great fan of HCQ and in my opinion it doesn’t work. For moderate to severe patients, I recommend remdesivir. It is an effective drug for patients who require oxygen,” said Fortis Hospital pulmonologist Raja Dhar. He also recommends drugs to prevent cytokine storm in case a severe patient suffers a violent immune response. “That apart, blood thinners or anti-coagulants are also used for severe patients and these are there in the government guidelines,” said Dhar.
While mild and asymptomatic patients were prescribed HCQ till May, they are now recovering with just paracetamol and vitamins, said Belle Vue Clinic internal medicine consultant Rahul Jain. “Only the moderate to severe cases need HCQ and azithromycin. I have come across many mildly symptomatic patients who have recovered in home quarantine even without these. Our knowledge of Covid is still evolving and I guess we are yet to hit upon the right combination of drugs,” said Jain. He, however, added that those with severe symptoms needed remdesivir and dexamethasone.
Dhar agreed, saying very mild or asymptomatic patients needed nothing. “They should treat Covid like common cold unless the symptoms start turning severe,” he said.
Broadly, two drugs are being used for mildly symptomatic and severe patients, said Apollo Gleneagles Hospital consultant Shyamashish Bandopadhyay. “The first group should be given favipiravir and the other remdesivir. But the latter should be prescribed only to patients on oxygen support,” said Bandopadhyay.