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This Indore hospital ‘first in India’ to try TCZ in critical Covid cases, claims good results

Pulmonologist Dr Ravi Dosi, who leads 100-member team at the Indore hospital, tells ThePrint TCZ fights off 'cytokines' blamed for causing mortality in critically ill Covid patients.

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Indore: In what is claimed to be a first in the country, doctors at Indore’s Sri Aurobindo Institute of Medical Sciences (SAIMS) have started treating Covid-19 patients with tocilizumab (TCZ), an immunosuppressant mainly used to treat rheumatoid arthritis.

A 100-member team of doctors, nurses and paramedical staff has been treating over 350 Covid-19 patients at the 1,156-bed private hospital in the Madhya Pradesh city. In an interview to ThePrint, pulmonologist Dr Ravi Dosi, who is leading the team, said the tocilizumab therapy has been used on five critical patients, two of whom have made a drastic recovery.

“We have a few middle-aged patients on whom this has yielded good results. In India, as far as I know, no centre has done it. We have evidence from Wuhan and in the States (US), there was an unpublished study too,” Dosi said.

This therapy, he said, was administered in cases where the conventional treatment, including doses of hydroxychloroquine, steroids, oseltamivir, higher antibiotics and ventilatory support, had failed.

The number of cases in Indore was recorded at 897 Monday with 52 deaths, according to data from the office of the district’s Chief Medical and Health Officer.

Also read: These 10 cities have over half of India’s Covid-19 cases. Ahmedabad, Indore among top 5

How it works

Tocilizumab therapy is used against a cytokine storm, which is what causes mortality in several Covid-19 patients. A cytokine is a type of protein secreted by the immune system that helps to ward off infection. A problem occurs when they are produced in excess, leading to ‘cytokine storm’.

“Your body is up in arms against the virus, so much so that it starts harming its own cells. This is what actually causes mortality in corona — the response to the infection becomes so uncontrolled that ultimately we end up losing ourselves,” Dosi said.

A study conducted in The Lancet said the hyperinflammation caused by the cytokine storm should be treated in order to reduce mortality. The TCZ treats critically ill patients by fighting off these cytokines.

“This antibody helps in that particular phase of the disease and if we give it appropriately we can save a lot of patients,” said Dosi.

The treatment was first administered in the hospital on 10 April to a patient in their late 40s. His situation, Dosi said, improved in a week during which the dose of TCZ was administered in an interval of two days. The second patient who improved because of the treatment is a diabetic patient in his early 50s, said the doctor.

The TCZ’s effects on the three other patients are still being studied as they underwent the treatment only recently, added the doctor.

Also read: AIIMS, Safdarjung Hospital begin testing bodies for Covid-19 before conducting autopsies

Deciding on treatments

Dosi said an 11-member task force of senior state leaders, temporarily formed to help the Madhya Pradesh government to tackle the situation before the one-man cabinet is expanded, regularly discusses treatment protocols.

According to guidelines floated by the task force, the TCZ treatment should be considered in grade 3 patients with “rapidly worsening respiratory status…” The guidelines also prescribe different doses based on the age and weight of the patients.

“My colleagues and professors here are also sitting down in the morning and evening to discuss the treatment protocols. We are modifying (the treatment strategy) as per our experience on a daily basis,” he said.

The TCZ treatment has been used in China, the initial epicentre of the infection. A study conducted on 15 Covid-19 patients found that multiple doses of TCZ were effective in treating critically ill patients. A clinical trial of this treatment is also under way in the US by one of the world’s largest biotech company, Roche Pharma.

Covid complications

According to Dosi, the main issue in treating Covid-19 is the rapid deterioration it causes in patients’ condition. “I can quote from the experience of one of my patients only. One of his brothers fell ill and succumbed to the disease on the fourth day,” he said.

The other complication the doctors face is in treating patients with comorbidities. The doctors at the hospital keep a close watch on their older patients who have comorbid conditions like cardiovascular diseases. SAIM’s Intensive Care Unit currently houses 50 such patients.

“Apart from the standard protocol for Covid-19 pneumonia [symptoms] prescribed by All India Institute of Medical Sciences, Delhi, we are taking care of the other ailments like hypertension, diabetes, and strict sugar control by monitoring their cardiovascular function. There is a full team of anesthetists, pulmonologists, who are monitoring these critical patients for 24 hours,” he said.

For now, the team is administering hydroxychloroquine (HCQ) in some patients with a lot of care — electrocardiogram or ECG tests are performed before the drug is prescribed.

Dosi, however, described the HCQ as only a “glimmer of hope”. “It is not an absolute therapeutic drug, because it increases the penetration of the virus into the part where it is destroyed. It has an additive effect but it is not the treatment of choice,” he said.

Also read: ‘At least Modi is feeding us’ — migrants, poor say lockdown is tough but give PM a thumbs up


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    According to news reports published on 7 April 2020 , scientists have found a trial drug that effectively blocks the cellular door SARS-CoV.2 uses to infect its hosts . The scientists are expecting it to provide a potential treatment for the Coronavirus. An European company is likely to test the drug soon. The study , published in the journal Cell , provides news insights into SARS-CoV-2 , the virus that causes COVID-19. Some encouraging messages are emanating from other quarters across the world suggesting that some effective cure could appear early.
    In this context , it may be relevant for readers to know this Vedic astrology writer’s predictive opinion. Last year 2019 , during October to December , this writer had covered India , Singapore , Japan , Italy , Canada , Ireland and the U.S.A. for purpose of yearly 2020 predictive alerts , separately for each country. One major predictive alert , common to all the aforesaid countries , had covered the period of about three and a half months from mid-March to June in 2020. It looked to be a period testing ‘ patience’ and ‘ perseverance’ of the people through a variety of major worrisome concerns. In some cases , it was specified to be relating to health woes or health hazards involving digestive system , nervous system , sex , respiratory system in the body and the like. But beyond June , from July to October , in 2020 , this writer had predicted of ‘ change of weather’ or at least a time that could address the woes of the immediate past. So reading in between the lines , it can be said that some effective drug or remedy can arrive by mid or towards last week of June 2020 to provide some relief during July to September , 2020 , to some good extent. But the need to be alert does not come to a stop here. Complacency can have tendency of re-appearance during October- December 2020. So continued vigilance may pay some dividends. One more alert prediction here for exercising more care and appropriate strategy. A period of nearly one and a half month from mid-April to 31 May in 2021 , particularly last eleven days of May 2021 would call for more alertness and appropriate strategy. In the absence of alertness and appropriate strategy , COVID-19 can re-emerge with greater strength and mischief in vulnerable most parts of the world. The planetary impact appears to be prone to suggest another reading covering mid-April to 31 May in the coming year 2021 – full-fledged war somewhere , could even be something most dreaded WW3 besides crisis in economy , trade and food sectors.
    Note :- This writer had similarly alerted , much prior , countries like India , Japan , Italy , Canada , US , and Ireland. Some links are being given here ;
    1. The United States of America , having predictive alerts submitted on 11 November 2019 by this writer to the editor for publication. These were published on 1 January 2020.
    2. Italy , published on 15 December , 2019.
    3. Canada , article – “ Coming year 2020 for Canada in Vedic astrology view” – brought to public domain widely on 28 November to 30 November 2019.
    4. Singapore , article – “Some glimpses of coming year 2020 for Singapore ” – brought to public domain widely on 23 October , 2019.
    5. Japan , article -“ Vedic astrology highlights for Japan in coming year 2020” – brought to public domain last year 2019 on 23 and 24 October.
    6. Ireland , article – “ Planetary indications for Ireland in 2020” – brought to public domain widely on 12 January , 2020.
    7. India , this Vedic astrology writer’s predictive alerts in article – “ Predictions for coming year 2020 by kushal kumar” – published last year 2019 on 10 October at
    8. This writer had contributed the following predictive alert last year 2019 on 18 November , to the opinion piece by Mr. Madhav Nalapat published at :-

    “ kushal kumar says :
    November 18 , 2019 at 7 : 44 am
    This Vedic astrology writer has been , for some years past , making yearly predictions every October-November before commencement of new year for nations like India , Singapore , Japan , Canada , Italy and the U.S. In relation to coming year 2020 , this writer’s predictive alerts for more care and appropriate strategy were published as early as on 10 October , 2019 through article – “ Predictions for world in coming year 2020 by kushal kumar” – at Singapore and Japan in coming year 2020 have been covered in October 2019 by bringing those to public domain widely. The U.S. predictions for 2020 have been submitted to Wisdom Magazine for publication in its monthly Webzine. It is expected to be published on 1 December 2019. In relation to worrisome concerns of war , there could be even some kind of WW3 , April to June in 2020 have been indicated as potential time. In any case , even if better wisdom prevails not to venture WW3 , widespread catastrophic times involving huge shortages , disease and destruction , massive earthquakes , floods , storms and the like look to be likely in vulnerable regions and countries , deep economic stress or disaster during the said period”.

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