HCQ breakthrough: ICMR finds it’s effective in preventing coronavirus, expands its use

Three studies find that hydroxychloroquine reduces chances of contracting Covid, so ICMR allows more frontline workers to take it as a preventive drug.

Packets of Hydroxychloroquine Sulfate medication | Bloomberg

New Delhi: The Indian Council of Medical Research (ICMR), the country’s apex body in the field, has found that consuming the drug hydroxychloroquine reduces the chances of getting infected with Covid-19.

As a result, ICMR released an advisory Friday to expand the usage of HCQ — an anti-malarial drug — as a preventive treatment against the novel coronavirus.

The conclusion has been drawn on the basis of three studies conducted by the ICMR.

The advisory suggests surveillance workers, paramilitary and police personnel, as well as medical staff working in non-Covid hospitals and blocks to start consuming the pill as “preventive therapy”.

ICMR had issued an advisory to begin using HCQ in March, but it had drawn criticism for lacking scientific evidence that the drug works against the novel coronavirus.

The studies

According to the advisory, the premier health body undertook investigation at three central government hospitals in New Delhi. While it did not reveal the names of the hospitals, it said the investigation indicates that “amongst healthcare workers involved in Covid-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it”.

The advisory also states that the National Institute of Virology in Pune has found in laboratory testing that HCQ reduces the viral load.

The ICMR also analysed data collected previously, known as retrospective case-control analysis, and found “a significant” relationship between “the number of doses taken and frequency of occurrence of Covid-19 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection”.

It further said “the benefit was less pronounced in healthcare workers caring for a general patient population”.

Another observational study was conducted among 334 healthcare workers at the country’s largest public hospital, New Delhi’s All India Institute of Medical Sciences (AIIMS). The 248 workers who took HCQ as preventive drug for an average of six weeks had lower incidence of the infection than those not taking the pill.

Which workers will use it now?

Based on the findings of the studies, the government has decided to administer the drug as a ‘prophylaxis’ or preventive therapy to asymptomatic healthcare workers working in non-Covid hospitals as well as non-Covid blocks of hospitals earmarked for Covid treatment.

Asymptomatic frontline workers, such as surveillance workers deployed in containment zones, as well as paramilitary and police personnel involved in Covid-related activities will be asked to pop HCQ pills.

Until now, only high-risk individuals, including asymptomatic healthcare workers involved in containment and treatment of Covid-19 patients, and asymptomatic household contacts of laboratory-confirmed cases, were being administered the drug. They will continue to consume the drug.

While the dosage will remain the same as before, eight weeks, the ICMR advisory suggests that it can be used beyond that period as well, but with close monitoring.

“With available evidence for its safety and beneficial effect as a prophylactic drug against SARS-CoV-2 during the earlier recommended 8 weeks period, the experts further recommended for its use beyond 8 weeks on weekly dosage with strict monitoring of clinical and ECG parameters, which would also ensure that the therapy is given under supervision,” it stated.

“In clinical practice, HCQ is commonly prescribed in a daily dose of 200mg to 400mg for treatment of diseases such as rheumatoid arthritis and systemic lupus erythematosus for prolonged treatment periods with good tolerance,” the advisory added.

Discontinue if ‘rare side effects’ are noted

The ICMR had earlier announced that some side effects, such as abdominal pain and nausea, have been observed in healthcare workers who were administered HCQ.

The anti-malaria drug is often blamed for triggering irregular heartbeat.

However, in the final results of the studies (HCQ prophylaxis among 1,323 healthcare workers), the ICMR found mild adverse effects such as nausea in 8.9 per cent workers, abdominal pain in 7.3 per cent, vomiting in 1.5 per cent, low blood sugar (hypoglycaemia) in 1.7 per cent and cardio-vascular effects in 1.9 per cent.

The advisory states the drug should be discontinued if it causes the “rare” side effects related to the heart, such as cardiomyopathy, a disease which makes it harder for heart to pump blood to the entire body, and heart-rate disorders.

The advisory mentions that HCQ, in rare cases, can cause visual disturbance, including “blurring of vision, which is usually self-limiting and improves on discontinuation of the drug”.

ICMR has clarified that “for the above cited reasons — heart and vision — the drug has to be given under strict medical supervision with an informed consent”.