COVID-19 Treatment: Remdesivir or Ivermectin? What to use and when? Experts say

New Delhi: As the second wave of COVID-19 strikes the country, some of the experts have suggested what is good for the COVID patients, especially the adults.

With the advice of the medical experts and doctors, here are some of the treatment protocols to follow:

COVID TREATMENT PROTOCOL FOR PEOPLE WITH MILD DISEASE:

In the case of mild infection, upper respiratory tract symptoms like fever without shortness of breath are seen. In such cases, medical experts suggest home isolation and proper care at home. While at home, physical distancing, use of masks, and hand sanitizations are important. Hydration and multivitamins are to be given to the patient but only in consultation with a doctor. Monitoring of oxygen and temperature is also required.

Experts say immediate medical attention is needed if there is difficulty in breathing, high fever, cough, or if symptoms are persistent beyond five days of the onset of the disease.

Medicines Needed:

• As per doctors' advice, Ivermectin must be avoided by lactating and pregnant women. An alternative to Ivermectin is Tab HCQ unless contraindicated, and inhalational budesonide.

• In humans, this includes head lice, scabies, river blindness. Meanwhile, HCQ is a medicine to treat and prevent malaria. Other uses include the treatment of rheumatoid arthritis and lupus.

• Budesonide in the inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease.

This medicine has recently been included in the Union Health Ministry's revised national COVID-19 treatment protocol for people with mild disease. Its makers, however, has clarified that there is no evidence of its efficacy against the viral disease. Read more

German multinational science and technology company Merck said that there is no meaningful evidence for a clinical activity or clinical efficacy in patients with COVID-19 disease, as the company flagged a "concerning lack of safety data in the majority of studies."

COVID TREATMENT PROTOCOL FOR MODERATE CASE OF COVID-19:

In the cases of the moderate disease, the respiratory rate is more than 24 per minute. Patients experience breathlessness as the oxygen saturation rate plummets to 93. In such cases, the government has advised admitting the patient to a COVID care facility. Target SpO2 and ensure that saturation is between 92 to 96 per cent. Experts say that the preferred device for oxygenation is a non-rebreather face mask in such cases, and awake proning is advised. Anti-inflammatory or immunomodulatory therapy is also advised.

Medicines Needed:

• Injectable Methylprednisolone is to be prescribed.

• Anticoagulation, which is a conventional dose of unfractionated heparin, or low molecular weight heparin is advised.

• Clinical monitoring of breathing, hemodynamic instability, or change in oxygen requirement is to be done.

• HRCT chest is to be done only if the condition worsens. Lab monitoring of CRP and D-Dimer is to be done on a 48-72 hourly basis. Tests like CBC, LFT, KFT are to be done, and IL-6 if the levels worsen.

• Dexamethasone is a glucocorticoid medication a steroid used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, along with antibiotics in tuberculosis.

• Medications like Remdesevir and Tocilizumab and convalescent plasma can be explored too.

Remdesivir, which was made to treat Ebola, is a broad-spectrum antiviral medication.

Tocilizumab, also known as Atlizumab, is an immunosuppressive drug, mainly used for the treatment of rheumatoid arthritis.

COVID TREATMENT PROTOCOL FOR SERIOUS CASE OF COVID-19:

A moderate case of COVID-19 becomes severe when the patient's respiratory rate is more than 30 and oxygen saturation less than 90. Experts say that the use of NIV is advised in patients with oxygen requirements. The use of HFNC is also suggested. In such cases, intubation should be used in patients and use conventional ARDSnet protocol for ventilator management.

Medicines Needed:

• Dexamethasone and use of heparin are advised. In serious cases too, HRCT, CRP, D-Dimer and other blood tests are prescribed.

HEALTH EXPERTS WARN AGAINST THE USES OF REDELIVER:

The health ministry's SoP has stated in the past that there is no need to use Remdesivir in the initial days of infection, and not to be used for mild or asymptomatic patients.

Doctors have asked people not to buy Remdesivir over the counter. It should be given between Day 1 and 7. It is not right if it is prescribed any later than that. "Different medicines have a different effect on people. Doctor's advice is needed while taking medicine and Remdesivir and Ivermectin haven't been proven as the ultimate medicine against COVID-19," Dr Nayyar added.

Doctors have also warned about the adverse impact of Remdesivir in case of misuse or unnecessary use at home and without medical guidance. Unnecessary use of Remdesivir can cause more harm than good is what doctors are saying.

Also Read: Goa Government Clears Ivermectin Drug to All Above 18, WHO had Advised Not to Use it

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