What could possibly connect a 96-year-old person who died of COVID-pneumonia in Germany’s Hamburg to a critically ill 38-year-old in Wayanad in Kerala?
The autopsy of the COVID-19 patient and the findings are being used to standardize and formulate treatment methodologies to combat COVID. That is the link between the thousands who have died and those on the brink - and this is pure science at work. This is the magnificence of science at work.
Two new studies in recent times truly have been phenomenal. One is Recovery trial findings. It found that the medicine dexamethasone, if started at the right time, can prevent COVID from aggravating.
Another study from New York says the simple C-reactive protein test can detect if the disease is getting bad and a decision can be medically taken on starting dexamethasone.
All these show a paradigm shift in disease management – from large, sweeping things to specific, fact-backed methodologies.
The world laid much stress on Tocilizumab (monoclonal antibody). This drug was looked up to as the inference was that the disease affected the body due to cytokine release and subsequent immunity loss. But the drug was highly-priced. It was initially thought that Tocilizumab could handle cytokine release and hence stabilize the immunity levels of the body. Now, a study infers that Tocilizumab is not that effective in reducing the mortality rate.
Such studies help the medical community deviate from the notion that this drug is mandatory to treat COVID cases. The drug is now being used to treat only specific cases. Public health experts are also relieved as they need not worry about finding this drug in large quantities to be given to larger communities.
The other costly anti-viral drugs like Remdesivir and Favipiravir, which were extensively used, are now being used to treat only select and specific cases. The drugs are used on the basis of how a patient progresses during treatment.
A country like India should also look at the use of drugs like hydroxychloroquine and the HIV drugs lopinavir and ritonavir. These drugs, if found useful would help millions of people in India. Studies in developed countries have not reported positively on these medicines but research from places like Hong Kong points to positive results. Many countries still use lopinavir and ritonavir as anti-viral drugs.
The need of the hour is to create a country-specific, cost-effective treatment protocol for India. Doctors should be able to rely on it in the event of a mass outbreak in the future.
COVID also exhibits coagulation of blood in the later stages. Anti-coagulants like heparin should be administered at the right time. The medical protocol should also advise and equip to diligently use anti-coagulants.
Convalascent plasma therapy is another treatment that gives much hope. More plasma banks across the country will enable doctors and patients alike will get access to plasma therapy. Experts say, plasma could be made available in all centres with a little planning.
COVID has also thrown up a human resource crisis. The front-line treatment centres were set up to reduce the load on the actual health facilities. The government has modified the hospital admission guidelines and those without symptoms but tested positive are being sent to room/home quarantine. This will give some respite to frontline health workers and doctors.
To defeat COVID, health administrators need the support of people outside the health profession too – including health volunteers and those cured of COVID-19. Taking care of COVID patients is not the responsibility of health workers or the government alone.
Those outside the health fraternity can ensure that those tested positive or in need of quarantine/isolation have the requisite facilities. They can also provide care to those in the high-risk category like senior citizens and small children. Their work assumes more significance now as rain is also wreaking havoc in the state.
Now, frontline treatment centres house those with mild symptoms (category A). In future, these facilities may also have to house those with more serious symptoms (category B). basic testing facilities would need to be set up here too. There should be facilities to do liver and kidney function tests too.
Ventilators and more
The common refrain has been, “are there adequate ventilators?” But statistics indicate that the number of patients requiring ventilator support is very low. And, studies indicate that the outcome of ventilator-supported treatment has not been very positive. In reality, oxygen dispensing units are required more than ventilators. With this, the care centres/hospitals should have the requisite equipment to detect the reduction of oxygen in the body. There should be adequate numbers of finger-type pulse oximeter, a device which can easily detect the level of oxygen. Patients themselves or health volunteers can use these devices without any health implications.
Another important equipment is the high-flow nasal cannula (HFNC), which costs less than Rs. 3 lakh. This helps in better patient ‘oxygenation’ and could be more helpful than ventilators. One can easily speak and have food with the nasal cannula on. So, this will be more acceptable to people in general. Also, a patient wearing an HNFC can still wear a mask on it, thereby reducing the risk of transmission to health workers and others.
Another important, cost-effective thing is the non-rebreathing mask. No doubt, the above-said devices and equipment would play a pivotal role in COVID management in the coming days.
The world over, ‘awake proning protocol’ or the method by which more oxygen intake is enabled by changing the position of the patient is gaining acceptance as well.
Also, there should be steps to increase trained manpower as the number of COVID cases and care facilities go up. There should be long- and short-term strategies for this.
When we fight a powerful adversary, the most important factor in our success could be planning. The days ahead would not be easy in any way. So, the focus should be on considered, equitable, and planned deployment and use of human resources.