In second year of pandemic, treating Covid-19 still in trial and error...

In second year of pandemic, treating Covid-19 still in trial and error mode


(This story originally appeared in on Apr 14, 2021)

One year into the pandemic, are we any wiser on how to treat Covid-19? Critical care specialists say the experience of dealing with thousands of patients over a year has certainly helped understand how to manage the disease.

But many questions still remain unanswered.

Among uncertainties are the biomarkers to predict the severity of disease in a young patient with no known risk factor.

Dr Anupam Sibal, group medical director,

, said, “Some young patients recover without any serious complication while others suffer a sharp deterioration.”

He also said there was a lot of confusion on the efficacy and timing of the administration of plasma therapy in Covid patients.

Like Apollo Hospitals, AIIMS has also revised its guidelines for clinical management of the viral infection six to seven times since the outbreak.

Dr Ambuj Roy, member of the Covid taskforce at AIIMS, said, “When the pandemic began, doctors put a patient on mechanical ventilation immediately if the oxygen saturation was very low. However, with experience, doctors realised that the escalation of oxygen therapy or ventilation had to be done in a graded manner. The high-flow nasal cannula — the heated and humidified system that allows the prescribed fraction of inspired oxygen (FIO2) levels to be delivered at very high flow rates — turned out to be crucial in this.”

AIIMS protocol for Covid

Roy also pointed out how anti-malaria drug hydroxychloroquine was used initially as a prophylactic drug as well as to treat the infection.

However, with multiple studies showing no significant benefit its use was discontinued.

Treatment for Covid involves three key components: drugs to reduce the viral load, steroids that can suppress a cytokine storm and drugs to prevent clotting of blood.

Dr Manish Soneja, additional professor, department of medicine, AIIMS, who was part of the medical team that prepared the national guideline on Covid management, said the right selection of patients who could benefit from these therapies and the timing of their usage have proved to be the most important learning.

“Remdesivir, an injectable antiviral which is heavily in demand, should be given to patients with moderate to severe infection, not those with mild symptoms,” noted Soneja added.

The central government said on Tuesday that doctors should ensure “rational and judicious” use of Remdesivir, underlining its use mostly for Covid patients admitted in hospitals but not to be used in home settings.

As for plasma therapy, Soneja said there have been several studies globally and results showed limited benefit in a very small subset of patients. “It is not required in all admitted patients,” he said.

According to Dr Sumit Ray, head, critical care division, Holy Family Hospital, plasma therapy helps a very small subset of patients, particularly the elderly who have low antibodies.

“In younger patients, the therapy may prove to be counterproductive as it may lead to more aggressive immune response and clotting,” he explained.

Dr Ray added a year into the pandemic the medical fraternity had certainly learnt a lot on how to manage the disease and that the outcomes were better in the bigger centres.

“We have been able to identify certain drugs, for example Remdesivir and the steroids, that can help manage the symptoms when used at the right time,” said Ray.

“Remdesivir, for example, needs to be administered early in the disease course when there is an oxygen requirement. Administering the same after 14 days of the onset of symptoms, when the virus has already been cleared from the body, isn’t warranted. Similarly, plasma therapy has a very limited role in Covid management.”

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