Patients at the Covid OPD at Bhandari hospital, Indore | Revathi Krishnan | ThePrint
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Bengaluru: As the Covid-19 pandemic rages on, social media and WhatsApp have been flooded with desperate pleas for drugs such as remdesivir, favipiravir, and even convalescent plasma. 

However, most interventions and drugs patients are being prescribed have not proven to help with treatment of Covid-19. 

Antivirals that treat viruses are hard to produce and make effective, which is why doctors and scientists repurpose existing drugs first before they try and create a new one to treat a new virus. 

Here is a look at all the drugs being used today and their scientific merit, outlining which ones work at what stage and which ones do not. 

What works well

Dexamethasone

What is it?
Corticosteroid. 

How does it work?
Steroids help in tempering immune reaction and calming down the immune system. This is one of the only drugs we know that works to treat Covid patients and ease symptoms. It relieves inflammation and swelling in the body and lungs.

Stage of use: Steroids are administered in a careful setting when a patient requires supplemental oxygen, and doses need to be tightly monitored. Oral dexamethasone is often prescribed for moderate to severe cases with breathing distress and pneumonia. In very critical cases, it is prescribed when the body enters the cytokine storm stage, where the overactive immune drive starts to destroy the body.

Method of administration: Injection or oral.

Benefits: Reduction in mortality among those needing oxygen or ventilation or other forms of respiratory support.

Side effects: Irritability, insomnia, increased appetite, weakness, increased blood sugar levels, headaches, mood swings.

Other uses: Since  it modulates the immune response, dexamethasone helps in treating autoimmune diseases such as rheumatoid arthritis. It is also used to treat other inflammatory conditions such as allergies, breathing disorders, skin conditions, among others. It was first produced in 1957 and has been in use since 1958.

Tocilizumab (Atlizumab, Actemra)

What is it?
Humanised monoclonal antibody

How does it work?
Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. Interleukins are cytokines or proteins that are involved in immune system cell signalling. The drug works by blocking IL-6, a cytokine produced by the body that plays a key role in transitioning inflammation from acute to chronic. 

Stage of use: Severe or critical illness requiring rapid increase in oxygen levels

Method of administration: Intravenous (IV) infusion or injection

Benefits: Reduction in mortality in severe patients requiring ventilation, reduces progression from oxygen to ventilation. 

Side effects: Runny nose, sore throat, headache, dizziness, stomach cramps.

Other uses: Since it modulates the immune response, tocilizumab helps in treating autoimmune diseases such as rheumatoid arthritis. It was licenced in Japan in 2003, and has been in use since 2005.

Anticoagulants (low molecular weight heparin)

What is it?
Medication to prevent blood clotting

How does it work?
By interfering with processes or chemicals needed for clotting.

Stage of use: In some patients, these are associated with better outcomes in the severe stage of the disease, only among patients who show coagulopathy (blood clotting) or elevated D-dimers. 

Method of administration: Injection

Benefits: Can prevent the symptom of blood clots in severe patients.

Side effects: Possibly excessive bleeding including heavier menses, long nosebleeds, gum bleeding, and passing blood in urine or faeces. 

Other uses: Anticoagulants are routinely used in medicine when thrombosis or internal blood clots occur or have a high risk of occurring, and could potentially block blood vessels, such as in heart medication. For moderate rise in D-dimer levels, baby aspirin, which contains the best dosage for heart patients, is often given.

Budesonide (Pulmicort)

What is it?
Inhaled corticosteroid.

How does it work?:
By tempering immune reaction and relieving inflammation in the inner lining of airways, chest, and lungs.

Stage of use: Mild breathing distress with oxygen saturation levels falling below 92-94 per cent. Steroids are to be used strictly only when prescribed by a medical professional. 

Method of administration: Inhaler 

Benefits: Recent studies have shown it is capable of reducing the likelihood of disease progression to severe. Large scale studies are ongoing.

Side-effects: Headaches, vomiting, body pain.

Other uses: It is commonly used to treat allergic respiratory distress such as those caused by asthma and allergic rhinitis.

Oxygen

What is it?
Oxygen extracted and filtered from air. 

How does it work?
Inhaled oxygen passes from the lungs to the bloodstream through diffusion. Oxygen in the blood is then circulated in the body and reaches every single cell, which uses the gas to create energy for normal bodily functions. 

Stage of use: When oxygen saturation (SpO2) as measured by a pulse oximeter falls to below 92-94 per cent at sea level and does not come back up and stay stable with deep breathing. Some patients are asked to adopt the prone position (lying on their stomach) for raising their oxygen levels better.

Method of administration: Non-invasive supplemental therapy from a cylinder or concentrator. 

Benefits: Helps patients stay alive.

Side-effects: None in the context of Covid-19 but oxygen poisoning from breathing oxygen at higher-than-normal atmospheric pressure, such as when diving underwater or by inhaling through a leak in an oxygen tank or ventilator, can lead to cell damage and death. 

Others 

Paracetamol every six hours is typically advised to treat symptoms of fever and body pain. 


Also read: In UP, oxygen is now exclusive for hospitals. Patients in home isolation not getting any


What works under limited conditions

Remdesivir

What is it?
A broad-spectrum antiviral drug or agent (BSAA)

How does it work?
BSAAs inhibit the replication of a wide range of viruses by targeting viral proteins or host cell proteins used for the replication process.

Stage of use: Low flow oxygen state, when a patient has pneumonia and requires oxygen but not a ventilator. Remdesivir is ineffective after a patient is put on a ventilator, and is also ineffective for asymptomatic, mild, or moderate cases. 

Method of administration: Intravenous injection.

Benefits: Shortening progression of disease and shortening hospital time, but only under limited conditions. Some studies have shown a benefit in using remdesivir within the window of patients requiring oxygen but not yet on a ventilator, in a low flow oxygen state. It prevents escalation of the disease to ventilators, and is advised for use in this stage in other countries as well.

However, studies have shown that it is not effective in lowering mortality or duration of mechanical ventilation. The WHO has issued a conditional recommendation against using remdesivir. A conditional recommendation is when there isn’t enough evidence to support a drug’s use. 

ICMR and AIIMS said last week remdesivir is of no use beyond 10 days of onset of symptoms.

Side-effects: Nausea, abnormal liver and kidney function test readings. 

Other uses: Remdesivir was first developed to treat hepatitis C, unsuccessfully, before being investigated for respiratory syncytial virus (RSV), Ebola, and for treating the Marburg virus infection. It failed to show a benefit in treating any disease. It did show preliminary limited efficacy in Ebola trials in 2018 but was replaced with the more effective monoclonal antibody treatments available then. 

Convalescent plasma

What is it?
Convalescent means being in the process of recovery, and plasma is a component of the human blood that carries antibodies. 

How does it work?
Convalescent plasma is obtained from a recently recovered, non-pregnant individual and transfused into the patient. The antibodies offer temporary protection as the recipient’s own antibody production ramps up independently. 

Stage of use: Various studies have indicated that for convalescent plasma to be effective, the treatment has to be received within 72 hours of first symptom onset. Additionally, the dose received should contain high titres of antibodies.

Studies have shown that plasma is ineffective once the disease progresses beyond the early symptoms stage. Some trials have even reported increased deaths in the group receiving plasma and have been discontinued midway.

ICMR and AIIMS said last week that it is of no use beyond seven days of onset of symptoms.

Some studies have indicated that in chronic infections, the use of convalescent plasma therapy has the potential to lead to new immune-evasive variants and mutations.

In many other countries, plasma has been approved as an investigational therapy or under a trial.

Method of administration: Intravenous process.

Benefits: When given after disease has become severe (requiring oxygen or ventilator), it has no benefit.

Side-effects: Typically none, but allergies can occur.

Other uses: Convalescent plasma transfusion has shown tremendous benefit in autoimmune diseases, where the body produces antibodies against its own self. It is used as a means to remove large amounts of antibodies from plasma and put back healthy plasma into a patient. It has shown limited success in infectious or communicable diseases in the past. 


Also read: Chhattisgarh’s latest Covid crisis symptoms: Testing kits run out, long lines at centres


What does not work

Ivermectin

What is it?
Antiparasitic.

How does it work?
It targets worms, insects, and parasites to kill them. Studies in monkey cells showed that it could inhibit replication of the SARS-CoV-2 virus but these failed to produce positive results in humans. 

Stage of use: None. 

Method of administration: Tablets

Benefits: None. Studies have shown it is ineffective in treating both critical and non-critical hospitalised patients, as well as those with mild symptoms. It also does not work as a prophylaxis (prevent disease). Early studies that claimed benefits were withdrawn later for unreliable data. The WHO recommends against using ivermectin for Covid-19 treatment except in clinical trials, but the AIIMS/ICMR protocol allows it for mild cases. 

Side-effects: Typically none but there can be the occasional fever, itching, and rashes on the skin. Large doses can be dangerous. 

Other uses: It is effective in treating worms and parasites in both humans and animals. It effectively treats head lice, scabies, whipworm, heartworm, roundworm, and early stages of elephantiasis. It is used routinely in veterinary medicine in a different formulation, not to be consumed by humans. Ivermectin misinformation is rampant across countries with groups pushing for the usage of the drug, including those involved in anti-vaccination campaigns. Suspect research papers have also been taken down 

Favipiravir (FabiFlu, Avigan)

What is it?
Antiviral drug.

How does it work?
Similar to remdesivir, favipiravir works by preventing replication of viral material.

Stage of use: None.

Method of administration: Tablets.

Benefits: Likely none. Some studies have shown that the drug is ineffective even in the lab, while other limited studies have shown improved outcomes. More rigorous studies are needed to prove any benefit and determine stage of use, if any.

Side-effects: There is evidence to indicate that when used in pregnant women, it could cause danger to the foetus. 

Other uses: It is approved to treat influenza in Japan, with limited evidence. It showed promise in animal models for treating Ebola and Nipah but was not tested rigorously in humans. It has also demonstrated success in animal models against other viruses like West Nile virus, Zika virus, and yellow fever virus. 

Doxycycline, Azithromycin, Amoxicillin 

What is it?
Antibiotic

How does it work?
Antibiotics kill or prevent replication of bacteria

Stage of use: None. Antibiotics do not work on viruses. However, some doctors may prescribe these if hospitalised to avoid other bacterial infections. 

Method of administration: Tablets. 

Benefits: None for Covid. Additionally, indiscriminate use of antibiotics is leading to growing antibiotic resistance. The official AIIMS protocol does not list it but the institution’s treatment includes it.

Side-effects: A prominent side-effect is acidity or gas, which is why antibiotics are accompanied by tablets to reduce gastritis/stomach acid.

Other uses: Antibiotics are used to treat a wide range of illnesses caused by bacteria. 

Vitamin C, D, Zinc

What is it?
Micronutrients. 

How does it work?
They work to improve our normal bodily functions and immune response.

Stage of use: None

Method of administration: Tablets.

Benefits: Vitamins and other supplements do not offer any benefit to treating Covid, or any other disease. Even among those who are deficient, the supplementary micronutrients have offered little benefit for respiratory tract diseases. 

Additionally, supplements work over a long period of time and do not raise micronutrient levels immediately. Some less-rigorous studies have shown a more severe disease in those who are deficient in Vitamin D, but systematic reviews across studies show no benefit. 

Side-effects: Micronutrients are unharmful, but unregulated supplements and excess consumption are known to cause illnesses. 

Other uses: Useful for general health when deficient. 


Also read: The curious case of MP health minister who went missing for a month amid Covid spike


What is harmful

Hydroxychloroquine or HCQ

What is it?
Antimalarial and auto-immune medication.

How does it work?
In mosquito populations still susceptible to quinine, it kills the malarial parasite. For autoimmune diseases, it can help by lowering inflammation.

Stage of use: None.

Method of administration: Tablets.

Benefits: Early studies indicated that in vitro or in the lab, the drug was able to prevent the virus from replicating and binding to human cells. Additionally, immunomodulatory effects such as lowering inflammation was thought to hold promise for treatment of Covid.

In humans, all rigorous studies demonstrated no benefit at any stage of the disease, or as a prophylaxis. The AIIMS/ICMR protocol allows HCQ as an alternative to ivermectin.

Side-effects: Low blood sugar, damage to vision. Multiple studies have shown the usage of HCQ raises the risk of serious cardiac problems when used in Covid-19 patients.

Other uses: It is used in areas affected by malaria where the mosquito populations still have not evolved a resistance to quinine, chloroquine and HCQ. It is also used routinely to treat autoimmune diseases like lupus and rheumatoid arthritis.

(Edited by Arun Prashanth)


Also read: As Modi govt faces up to Covid disaster, BJP learns a tough truth — the virus doesn’t vote


 

 

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8 COMMENTS

  1. what the hell.. ACT 2 trial – remdesivir clearly works if given early- WHO used it after 10 days and said it doesnt work. Ivermectin 35 RCTS say it works – WHO says it doesnt work , (check the tess lawrie youtube video noobs) . steroids are probably saving more lives today with no oxygen avialbiltiy and as doctors we know how much it improves. Solidarity trial and WHO conclusion were only in hospitalised ideal patients and not designed to test the synergestic effect of various medicine. using that to tell what works or not is foolishness. if your a journalist – pick up top 20 covid care centers and see what they are using and how they are saving lives – its exactly the same medicines you have said does not work is being used in a different way other than the trial design .. do not misleed people . let doctors do their job and you stick your job..

  2. The use of Ivermectin has proven very successful in Zimbabwe.
    You can run a search for interview with Dr Jackie Stone on the use of Ivermectin for Covid-19 in Zimbabwe.

    In addition:
    Fighting COVID 19. Ivermectin: Myth or Reality?
    Dr Dr. Paul Marik, Chief Pulmonary & Critical Care Medicine, Eastern Virginia Medical School – also on youtube.
    If your journalists find this information false, then they need to provide a full detailed scientific refutation. Saying that there is “No evidence” or “no trials” is patently incorrect information. Also, their sources need to confirm no conflict of interest i.e. that they receive no funding from pharma companies or work for govt agencies.

  3. This is what happens when half pitcher science journalist posts about things she is not an expert in. Do not listen to her. She has spread a lot of misinformation over the last few days over instagram and twitter. Listen to your doctor and follow the issued guidelines. I repeat again DO NOT LISTEN TO HER. SHE IS NOT A DOCTOR OR AN ESTABLISHED RESEARCHER IN MEDICAL SCIENCE.

  4. Let me thank The Print and the author of this article. I wish, this article will open the eyes of many. Some ten months ago, I had proved scientifically that favipiravir or remdisivir are not the treatment options for Covid. Happy to share the link:
    https://youtu.be/oRKDR12veYM

  5. So according to the article you can only treat a patient when they get critical. What rubbish journalism! Get on the ground and conduct first hand research instead of copying from the internet. My family and dozens of friends have been prescribed Azithromycin with Ivermectin and it treated them fast and prevented from getting serious. Infact one of my friend’s doctor didn’t prescribe any ivermectin or favipiravir and his condition worsened after 3 days. He started experiencing difficulty breathing. He immediately switched doctors and the new doctor prescribed him Favipiravir, Ivermectin alongwith Steroids and within 2 days his condition improved.

  6. Maybe this is too much to ask but with such nuanced matters, always cite your sources and relevant scientific literature.

  7. It is very rare to find a combination of knowledge and expression.
    “Dexamethasone, remdesivir, plasma, doxycycline: Which works for Covid and which doesn’t”
    Would be more effective coming in a medical journal.

  8. Information provided in a most scientific way to a lay man. Congratulations to the Author… Sandhya Ramesh, who has always been excellent. Support of editor Arun Prashanth should have also been helpful

Comments are closed.