Why Remdesivir is no ‘Ram-Ban’ to cure COVID-19

New Delhi, Apr 22: Through a graded, pre-emptive and pro-active approach, Government of India is taking several steps along with the States/UTs under a 'whole of government' approach for prevention, containment and management of the recent surge in COVID-19 cases. These are also being regularly reviewed and monitored at the highest level.

The DPIIT, in consultation with all stakeholders has issued a supply mapping plan for 12 high burden states till 30th April. The Home Ministry's advisory on unhindered movement of oxygen across states, the installation of 162 PSA Oxygen plants (154.19 MT capacity) in 32 States/UTs from PM-CARES fund, Operationalization of the IT application, 'Medsupply' which tracks site readiness, plant delivery, installation & commissioning, augmentation of Remdesivir production to around 74.10 lakh vials/month (May)from 27-29 lakh vials/month (Jan-Feb), Prohibition on the export of Remdesivir API and formulations by the DGFT, Stringent actions on black marketing and hoarding of the drug are some of the decisions taken to ease the difficulty of those affected by COVID.

There has been an unprecendented surge of daily new COVID cases across the country, with the resultant increase in the consumption of some drugs such as Remdesivir. Clinical management of COVID patients with severe symptoms in hospitals has also lead to a high consumption of oxygen. The Union Government has taken various steps to boost the supply of oxygen in the hospitals across the country, in the recent days.

Three prominent doctors of the country, Prof (Dr) Randeep Guleria, Director, AIIMS, Dr. Devi Shetty, Chairman, Narayana Health and Dr. Naresh Trehan, Chairman, Medanta Hospital, addressed various issues being related to the rational utilization of Remdesivir, included under the category of Investigational therapy under the National Treatment Protocol of the Health Ministry, and use of Oxygen for treatment of COVID patients in hospitals.

Vaccine:

Dr. Guleria exalted the vaccine as the key to beat the gloom that is usually associated with COVID: although it may not prevent us from getting the infection, the vaccine prevents us from getting the disease in the form of severe illness. He said that it was important to understand that even after the vaccination, we may become infected with COVID which makes it important to continue to wear a mask even after getting vaccinated.

Oxygen:

Dr. Guleria reassured that healthy individuals with oxygen saturation in the range 93-94% do not need to take high flow oxygen just to maintain their saturation at 98-99%. Even those with oxygen saturation less than 94 need close monitoring (oxygen being optional).

"Oxygen is a treatment, it's like a drug" he stated to drive home the point that taking oxygen intermittently is an absolute waste of oxygen. There is no data that shows that this will be of any help to the patients and is therefore ill-advised.

Dr. Trehan echoed his observations and observed that the country has enough oxygen if we try to use it judiciously. He requested the audience not to use Oxygen as a "security blanket". Waste of oxygen will only lead to depriving someone who needs it.

Dr. Shetty noted that a saturation above 94% is no problem. A doctor may be consulted if it dips after exercise/effortful work.

Remdesivir:

All the doctors unanimously requested the audience to desist from seeing Remdesivir as a wonder drug. Most of the active cases who are in home isolation or in the hospital don't actually need any specific treatment. Only a small percentage require Remdesivir.

They were of the view that as a country, if we work together, use oxygen and Remdesivir judiciously, then, there will be no shortage anywhere. In terms of the number of people who need oxygen and oxygen supply, we are well balanced, they noted.

Dr. Trehan agreed and added that his hospital has now made a protocol that Remdesivir is to be given not to everyone who tests positive. It is to be given only after doctors look at test results, symptoms, comorbidities of a patient. Remdesivir isn't a 'Ram-ban', it only decreases viral load in people who need it.

General Issues

Dr. Guleria said that when it comes to COVID, more than 85% of people will recover without any specific treatment in the form of Remdesivir etc. Most will have symptoms like common cold, sore throat etc and over 5-7 days, they will recover with symptomatic treatment. Only 15% may go to moderate phase of the disease.

He advised against being in groups irrespective of somebody being infected and observed that Cross ventilation reduces the risk of infection in closed places.

Dr Trehan echoed the sentiment that since less percentage of people require hospitalization, the hospital beds should be utilised judiciously & with responsibility which rests on all of us.

Dr Shetty advised to see a doctor and get their opinion if one is positive. He further advised to not panic if the report is positive as the problem can be solved provided one gets the medical help at an early stage & follow doctor's instructions.

There is a possibility that patient may be asymptomatic prompting the doctors to tell them to stay at home, isolate themselves, wear a mask and check their oxygen saturation every 6 hours. He also suggested to get tested if anyone have any symptom like body ache, cold, cough, indigestion, vomiting since that is the basis of any further treatment.