Busting Covid myths on plasma therapy and remdesivir, and what India’s falling numbers mean

In episode 602 of #CutTheClutter, Shekhar Gupta analyses India's declining Covid numbers, and explains the science behind remdesivir and plasma therapy.

A medical worker collects sample for Covid testing | Representational Image | Suraj Singh Bisht | ThePrint

New Delhi: In the past few weeks, several questions have been raised around various Covid treatments including plasma therapy and the anti-viral drug remdesivir, which is part of India’s Covid treatment protocol.

There has also been much discussion on India’s fatalities after health ministry data indicated that 47 per cent of those who died due to Covid are below 60, making people wonder if the virus is attacking the younger population more.

In episode 602 of ‘Cut the Clutter’, ThePrint’s Editor-in-Chief Shekhar Gupta busted three Covid-related myths — on plasma therapy, remdesivir and the link between age and mortality.

Gupta also decoded what India’s falling numbers meant for the country’s fight against the pandemic.

According to the health ministry’s data, 47 per cent of India’s Covid fatalities were below the age of 60.

Gupta noted that one must look at absolutes while considering percentages. “When you flip this data, you ask a second question, how many people in India are above 60 years of age and how many people in India are below 60 years of age.”

The percentage of Indians above 60 years of age is about 8 per cent, which means 10 crore out of the 138 crore Indians are above the age of 60.

“When you flip it (the data), you see that 92 per cent Indians below the age of 60 accounted for 47 per cent of Covid-19 mortalities. Whereas, just 8 per cent Indians above the age of 60 accounted for 53 per cent of mortalities,” Gupta explained.

Therefore, the data indicates that people older than 60 are extremely vulnerable to the virus.

Confusion regarding remdesivir 

An American firm in the WHO’s multi-country Solidarity trial found that anti-viral drug remdesivir wasn’t effective in reducing mortality.

Despite this revelation, Gupta noted, Indian doctors have been liberally using the drug and even the US Food and Drug Administration has given clearance to remdesivir.

He also referred to a tweet by Gagandeep Kang, professor of microbiology at the Christian Medical College in Vellore.

Important. Remdesivir was shown not to prevent mortality in the Solidarity trial. Does this mean that remdesivir does not work at all to treat illness or progression to severe disease? It does not, since that is not what Solidarity was set up to measure.

— G Kang (@GKangInd) October 24, 2020

In the tweet, she maintained that just because WHO’s study states that remdesivir does not reduce mortality does not mean that it is ineffective, because that trial was only about mortality.

The drug has been found to be useful in reducing recovery period. For instance, a patient who may take 15 days tor recover would only take 10 to 11 days with the drug.

“It reduces hospitalisation in patients, so when you use this on trials, on patients who are already in ICU, then it doesn’t reverse mortality. But if you use it early enough, it may save a lot of patients from going to the hospital in the first place,” Gupta said.

“The logic is remdesivir’s action is to reduce viral replication,” he added.

When our body attempts to fight the virus, it can get overwhelmed. Remdesivir could reduce the rate of viral replication so the number of virus in our bodies remains smaller.

In the first week of the disease, our body has the virus and our immune system is fighting the virus. The virus goes away in a week. But then, it is our body’s “over-excited or irritated or angry immune system” which is acting on itself and eating it up — called a cytokine storm. Steroids are then needed to calm the immune reaction.

Both steroids and anti-virals are needed at different points in the disease. “The current view is that the time for anti-viral is in the first week…The time for steroids is in the second week, if you need it, and doctors make that choice in the hospital,” Gupta said.

If remdesivir is used in the second week, by that time our body doesn’t have the virus so it is not cutting down on any viral infection.

Similarly, if steroids are used early in the infection, then they block our body’s immune reaction too early and it isn’t able to fight the virus and the virus keeps replicating.

Breaking down misconceptions on plasma therapy

An ICMR study has revealed that plasma therapy is “not working” and recommend that it be stopped, Gupta said.

He asked, “Would it be right then to enforce a blanket stop on plasma therapy?”

“Now if plasma therapy isn’t working, it means antibodies don’t work. Then, how come monoclonal antibodies work because the principal is the same, that your body gets these antibodies as a reinforcement to fight the virus,” Gupta said.

Monoclonal antibodies are widely used to treat cancer, rheumatoid arthritis and many other such conditions.

It is true that not all antibodies help a patient fight coronavirus, he added.

There are two kinds of antibodies — normal antibodies and neutralising antibodies, The latter is key to the plasma therapy process.

Each patient who has recovered from coronavirus and has antibodies in their plasma may not necessarily have neutralising antibodies. In order to use that plasma, one should be able to separate neutralising antibodies (which is the principal followed by monoclonal antibodies).

“Scientifically, it is important to first figure out whether the plasma that you might transfuse in a patient carries neutralising antibodies or not. Now, that is a complex bit of research work to do, every lab is not equipped to do it,” he said.

Therefore, plasma therapy can be effective if it is used after checking for neutralising antibodies.

What do India’s falling number indicate?

In India, Covid-related deaths were below 500 Monday, for the first time in three months.

While Monday’s data can be misleading since complete figures are not revealed Sunday, this count has been declining for two weeks now.

India’s recovery rate is above 90 per cent, while the case fatality rate is 1.5 per cent. Thus, 98.5 per cent cases are eventually likely to recover.

Gupta noted that India’s fatality rate had been about 3 per cent to begin with. “Since the base is very large now, it is a six-month base, you will not have a fall in the overall percentage that is steep. However, even if there was a 0.1 per cent fall, it means there has been a substantial improvement.”

“There are four states that are giving India trouble and are distorting its overall figure (on fatality rate),” he said.

Punjab has the highest case fatality rate in India at 3.14 per cent. This is twice as much as the national average. For all the large states in India, Maharashtra has the worst fatality rate at 2.63 per cent. However, the state has made improvements and is testing more than before.

The state’s test positivity rate initially was 20 per cent but now it has come down to about 10 per cent. Gujarat has the third-worst fatality rate at 2.21 per cent and West Bengal is at the fourth place at 1.86 per cent.

An important statistic is the number of people on ventilators. When the pandemic had started, everyone had thought India would need half a million ventilators.

“The fact is, India today has about 40,000 ventilators most of which are fortunately unused,” he said.

The peak of the entire demographic needing O2 (oxygen) beds, ICU or ventilators was on 25 September. During the peak, 75,000 patients needed O2, ICU or ventilator beds, and this number has now declined to lower than 50,000.

Finally, India’s tests have now crossed the 10-crore mark. “India has gotten hold of this graph and is able to bend it in the right direction,” he said.

Gupta, however, warned that this does not mean that the virus has been defeated. Countries like the US and Europe are now heading towards their second wave.

“In America and Europe, these countries are heading for their second hump, like in a Bactrian camel, you don’t want the Indian graph to be like that,” he said.

Watch the latest episode of CTC here: