COVID-19 treatment: When to use Remdesivir, Ivermectin?

With lakhs of new COVID-19 cases surfacing daily in India, finding appropriate treatments for patients of the deadly virus has taken equal prominence as vaccinating the nation's populace. Medicines currently being administered to coronavirus patients, including well-known ones like Remdesivir, Ivermectin and Hydroxychloroquine, were originally developed years ago to treat different ailments and have now been repurposed to treat COVID-19. Considering the safety of patients and efficacy of these drugs against coronavirus, Union Health Ministry had issued clinical guidelines last month underlining which medication should be given to COVID-19 patients and at what stage.

Although this particular treatment protocol for COVID-19 patients - mild, moderate, and severe - is to be followed only by doctors, let's take a look at which drug to be administered in the three stages of infection and when.

Also Read: Remdesivir production to rise to 3 lakh vials per day, 25 new manufacturing sites approved

COVID treatment protocol for people with mild disease

In case of mild infection, an infected person experiences upper respiratory tract symptoms such as fever without shortness of breath. In such cases, medical experts recommend home isolation and care at home. Experts also suggest that immediate medical attention must be sought in case the patient experiences difficulty in breathing, cough, high-grade fever, or if symptoms are consistent beyond five days of the onset of the disease.

Medicines: Doctors suggest that medicines such as Ivermectin must be avoided by lactating and pregnant women. An alternative to Ivermectin, they suggest, is Tab HCQ unless contraindicated, and inhalational budesonide. Ivermectin is used to treat parasite infestations. In humans, this comprises scabies, head lice, and river blindness. HCQ, on the other hand, is a drug used to treat malaria. Budesonide in the inhaled is used in the long-term management of chronic obstructive pulmonary disease and asthma. The World Health Organization (WHO) also advised against rampant use of Ivermectin. It had earlier this week recommended against the general use of Ivermectin for treatment of coronavirus.

"Safety and efficacy are important when using any drug for a new indication. WHO recommends the use of Ivermectin for Covid-19 except within clinical trials," tweeted Soumya Swaminathan, WHO chief scientist.

COVID treatment protocol for moderate case of COVID-19

In case of moderate infection, the respiratory rate of a patient is over 24 per minute. Patients experience breathlessness as the oxygen saturation rate plunges to 93. In such cases, the government has recommended admitting them to a COVID care facility. Experts suggest targeting SpO2 and ensuring saturation between 92 to 96%.

In such cases, the preferred device for oxygenation is a non-rebreather face mask. Experts also advise awake proning, and anti-inflammatory and immunomodulatory therapy.

Medicines: Doctors prescribe injectable Methylprednisolone or an equivalent dose of Dexamethasone. They also advise Anticoagulation, which is a standard dose of unfractionated Heparin, or lower molecular weight Heparin. Clinical monitoring of hemodynamic instability, breathing, or change in oxygen requirement is to be done. In case the condition of the patient worsens, then HRCT chest is to be done. Medicines such as Tocilizumab and Remdesivir and convalescent plasma can be explored too.

Also Read: Remdesivir only for hospitalised patients low on oxygen, says Health Ministry

COVID treatment protocol for severe case of COVID-19

A COVID-19 case becomes severe when the patient's respiratory rate over 30 and oxygen saturation is less than 90. Thus, the use of NIV (non-invasive ventilation) is advised in such cases. The use of HFNC (High-flow nasal cannula) therapy is also recommended. HFNC is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 litres per minute. In such cases, intubation should be prioritised in COVID-19 patients and conventional ARDSnet protocol should be used for ventilator management.

Medicines: Dexamethasone and use of Heparin are advised. However, in severe cases, CRP, HRCT, D-Dimer, and other blood tests are prescribed.

Also Read: No compulsory licensing for Remdesivir, Tocilizumab

Experts caution against the use of Remdesivir and Ivermectin

Regarding the use of Remdesivir, there are mixed opinions, but the health minister has clarified that the drug is not to be treated as a magic bullet. The ministry's SoP, issued in the past, stated that there is no need to use Remdesivir in the initial days of COVID-19, and it is not to be used for mild or asymptomatic patients.

"Don't 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," Dr Sandeep Nayyar, senior director, and HOD, Chest and Respiratory Diseases, BLK-MAX Super Speciality Hospital, told India Today.

"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," he added. AIIMS Director Dr. Randeep Guleria has several times in the past cautioned about the adverse impact of Remdesivir in case of misuse or unnecessary use at home and without medical guidance. He added that it can cause more than good.