Coronavirus: ICMR doubles down on HCQ as preventive medicine though studies show it offers no benefit

Days after publication of fresh scientific evidence on the futility of using hydroxychloroquine against COVID-19 patients, the Indian Council of Medical Research has decided to double down on the anti-malarial drug as it expanded its use as a preventive medicine against the novel coronavirus not only for high risk individuals but also for the contacts of asymptomatic COVID-19 positive patients.

The ICMR advisory comes close on the heels of two studies in the Lancet and British Medical Journal showing that the medicine does not offer any additional benefit for COVID-19 patients, rather it increases the death rate in such patients.

In the new advisory, the ICMR has recommended use of HCQ as a preventive medicine among all asymptomatic healthcare workers working in Covid and non-Covid hospitals.

In addition, the medicine has been recommended for use in surveillance workers deployed in containment zones, police and paramilitary personnel involved in COVID-19 related activities and asymptomatic household contacts of confirmed cases.

The guidance from the ICMR national task force on COVID-19 is on the basis of three small scale trials, none of which are peer reviewed, and an in-vitro study at the National Institute of Virology, Pune.

ICMR's own safety profile shows that out of 1,323 healthcare workers examined to check the safety of the drug, 214 persons exhibit some form of adverse effects, described by the council as mild.

The council acknowledges that the drug do pose some risks to the heart and eye, and should be taken under medical supervision for such cases.

DH query on the HCQ to an ICMR spokesperson remained unanswered, but another ICMR scientist pointed out that a large scale observational study involving 1000-1500 health care workers has just begun.

Under the new study, doctors, nurses, paramedics and sanitation staff at AIIMS, Jodhpur; Maulana Azad Medical College, Delhi; Sir Ganga Ram Hospital, Delhi; Apollo Hospital, Chennai and AIIMS, Patna would be given HCQ as a preventive medicine and its effects would be examined.

"We have started the trial in early May and it will continue till July. The results are expected in August," principal investigator Suman Kanungo, an ICMR scientist, told DH.

On Friday, a similar observational study appeared in the Lancet, in which researchers examined the efficacy of HCQ and chloroquine on 15,000 COVID-19 patients and compared the results with more than 80,000 other novel coronavirus patients.

The study by American and European researchers suggest that treatment with antimalarial drug chloroquine or its analogue hydroxychloroquine (taken with or without the antibiotics azithromycin or clarithromycin) offers no benefit for patients with COVID-19.

The study also concluded that use of the two drugs is associated with increased mortality risks for COVID-19 patients.

A second study published in the BMJ earlier this week came to a similar conclusion.

Administration of HCQ did not result in a significantly higher probability of negative conversion than standard care alone in COVID-19 patients in hospital. Adverse events were higher in HCQ recipients than in non-recipients, noted the BMJ study carried out by Chinese researchers.