Without asking or going to a doctor in charge of the nearest health facility, there was home delivery of a medicine kit of five items by the staff of DMO, Ghaziabad-UP, to a Covid-positive patient in Indirapuram on the outskirts of Delhi-NCR last week. That is, within two hours of a patient receiving the results of the lab where testing was done. The lab may be doing parallel reporting to health officials. Impressive prompt action.
But the contents of the kit will soon disappoint you. They were tablets of ivermectin and azithromycin with paracetamol for three days. Also, Vitamin C and zinc for 10 days. Another kit of Lucknow Urban PHC includes Vitamin D granules sachet to be taken weekly.
The Telangana government kit, for five days instead of three, contains all of the above excluding ivermectin tablets. In addition, it has tablets levocetirizine, ranitidine and multivitamin, all once a day for five days.
Interestingly, the Karnataka government homecare kit has Vitamin C and zinc for seven days. Paracetamol, levocetrizine, cough syrup and pantoprazole for acidity, as per need. Some had fabiflu and doxycycline also. Similarly, in Maharashtra and several other states, irrational guidelines were being distributed via the Internet or medicine packets to Covid-positive patients. The Union Health Ministry recommends only paracetamol for mild symptoms.
There is a dichotomy between national guidelines and the practice of state and municipal corporation-run hospitals. If the government-controlled public health institutions cannot practice what they are preaching, the less said about the uncontrolled private sector the better. The private sector is awash with bizarre practices.
A prescription for mild Covid infection without any oxygen desaturation included potent antibiotics like clindamycin, azithromycin, tazobactam and antivirals like remdesivir, favipiravir and multivitamins for patients under a qualified physician in a super-speciality hospital in Delhi.
A prescription from Bengaluru for a home-care patient had the latest experimental protease inhibitor drug molnupiravir, rivaflo tablet, a blood thinner or anticoagulant and tapering doses of steroid prednisolone over 10 days.
When the pandemic started, we knew very little about handling SARS-COV2. So, we tried many drugs based on postulations and even plasma transfusion. But now we know what works and what does not work.
The vitamin combinations, azithromycin, doxycycline, hydroxychloroquine, favipiravir and ivermectin for treating Covid-19 are not working and are a waste of money; so, prescribing them is an irrational practice. Irresponsible, dangerous, life-threatening prescriptions give a false sense of security and add to medical impoverishment during pandemic times. What is the point of research in science otherwise?
Broad-spectrum antibiotic prescriptions for mild infections or for a viral infection like Covid leads to antimicrobial resistance. It is already an undocumented catastrophe in India. With the high burden of typhoid, a serious illness in which azithromycin is a wonder drug or in conditions like scrub typhus, cholera and leptospirosis, where doxycycline is life-saving, growing antibiotic resistance will only add to mortality.
What was the quantum of drugs distributed and what was the magnitude of the population that consumed these drugs via government or private practitioners or by self-purchase? Does anyone have any clue on azithromycin/doxy sales and consumption? A local pharmacist in Vadodara, Gujarat, says that azithromycin prescriptions he received from private practitioners went up five times the usual in the past two months.
Steroids should not be prescribed during the first five days of Covid virus multiplication. Moreover, widespread abuse can lead to deadly opportunistic fungal infections like mucormycosis. All cases of breathlessness cannot be treated with deriphyllin as it can be caused by severe anaemia, heart disease, lung disorders and psychological illnesses which need proper evaluation.
Control studies
Ivermectin, used for the treatment of head lice and other parasitic infestations, was initially tried but double-blind case-control studies proved its futility. Vitamins and minerals have no proven benefit in Covid. The same amount could be diverted towards providing pyridoxine or Vitamin B6 to patients on antitubercular therapy or to provide nutrition to TB patients. There is also an unnecessary demand generated commercially through the pharma sector influence for antacids, vitamins and minerals under the false pretext of building immunity against Covid.
As there is rampant misuse of monoclonal antibodies casirivimab and imdevimab in the private sector, the Kerala government has issued strict guidelines regarding its use. Each health institutional medical board is to take a joint decision following the ICMR guidelines and rule out the possibility of Omicron variant as it is ineffective to neutralise Omicron antigens.
The public and the medical community are subject to gross misinformation on social media. So, it is incumbent on state agencies and professional medical societies to put an end to this travesty in the best interest of the nation. Otherwise, it sets false precedence to younger practitioners and village practitioners, both qualified and unqualified. And there is no grievance redressal mechanism if something happens adversely to the patient due to misuse of medicines.
“Today the situation is such that the difference between fake news and authentic news is totally merged. This has resulted in creating confusion, with anxiety, stress and depression on the one hand and throwing caution to the winds on the other,” says Dr Mira Shiva, a crusader against irrational drug use.
If this virus is the same globally and even across the length and breadth of India; if some drugs do not work elsewhere, why should they be prescribed, and that too differently in different parts of India? We speak about ‘One Nation One Card’ for food supplies through the Public Distribution System. Why not ‘One Protocol for One Virus One Nation’ at least in the public health system?
(Dr Rangaswamy is a Microbiologist and Primary Care Physician; Dr Antony is a Paediatrician and Public Health Consultant)