Remdesivir is not the lone life-saving drug against Covid-19. Instead, it has been a careful mix of oxygen therapy, vitamin supplements, steroids and blood thinners that has been helping patients recover faster, medical experts have said.
In fact, the state task force, in a meeting on April 12, made it clear that it is absolutely possible to save patients without even using remdesivir.
“The drug is being rampantly prescribed. And people have developed this impression that the anti-viral will save lives,” Sanjay Oak, chief of the state task force, wrote in the advisory released on April 13.
Critical care expert Prasad Rajhans, the chief intensivist of the Deenanath Mangeshkar hospital, said patients and families should not put pressure on doctors to use remdesivir.
“Oxygen therapy, vitamins, steroids and low molecular weight heparin (blood thinners), when used at appropriate stages under medical supervision, make for an excellent recovery rate. People should not panic over the shortage of remdesivir in Pune,” Rajhans said.
Infectious disease expert, Parikshit Prayag, said, “Remdesivir only shortens duration of illness in carefully selected patients – like those with early hypoxia (low blood oxygen saturation) or high-grade fever with lower respiratory involvement. This impression, that it is life-saving, makes a patient desperate and anxious when she or he does not get it. Unfortunately, many people are being unnecessarily put on the drug.”
Antiviral drugs like remdesivir (given intravenously) and favipiravir (given orally) prevent viral replication.
“So it is not remdesivir alone that helps. It’s when the drug is given along with oxygen therapy, steroids and blood thinners that it benefits recovery. While remdesivir reduces viral load, other drugs bring ease inflammation triggered by the virus,” said physician Aniket Joshi, from theAssociation of Physicians of India (API), Pune branch.
Intensivists using the drugs only vouch for its efficacy when used in carefully selected patients.
“Remdesivir is certainly efficacious in the early phase of infection, to control virus replication. Similarly, tocilizumab in select critical patients also helps tame the abnormal immune response called ‘cytokine storm’. But these drugs’ indiscriminate use should absolutely be discouraged,” said Ruby Hall Clinic’s chief intensivist Kapil Zirpe.
Zirpe said good ICU care forms the backbone of Covid recovery.
“Covid can boost blood sugar levels in some patients as the virus causes pancreatic beta-cell changes. In addition, steroids used in treatment can also spike blood glucose levels. Administering insulin along with adequate hydration (saline) are key to manage patients’ sugar-related complications,” Zirpe said.