The Covid treatment protocol, especially for those with mild symptoms, has completely changed over the past two years, doctors said.
The Telegraph spoke to several doctors in Kolkata who have been treating Covid patients since the beginning of the pandemic around two years ago to know about the changes.
Mild symptoms
Some doctors say they are no longer prescribing what was once the commonest drug used to treat Covid patients with mild symptoms — ivermectin.
The medicine is approved as an antiparasitic by the World Health Organization and the US Food and Drug Administration.
Doxycycline, a broad-spectrum tetracycline-class antibiotic used to treat infections by bacteria and certain parasites, was another common drug but no longer.
“Scientific evidence has shown that these drugs have no effect on Covid. I am prescribing symptomatic treatments for people with mild symptoms and in home isolation,” said Chandramouli Bhattcharya, infectious diseases expert at Peerless Hospital.
“However, steroid inhalers are still being advised because this has shown to be effective in protecting the lungs against Covid.”
Doctors say cocktails of monoclonal antibodies are now being prescribed for mild patients to prevent complications.
“Three to four types of cocktail of monoclonal antibody drugs are being prescribed. Among these the cocktail of casirivimab and imdevimab is popular. It is being prescribed to a select group of Covid patients who are immunocompromised — like those with comorbidities, who underwent renal transplant and elderly people,” said Sauren Panja, head of critical care and medicine at the RN Tagore International Institute of Cardiac Sciences.
Panja said he had prescribed the drug to more than 25 patients over the last few months.
Bhattacharya said the monoclonal cocktails were earlier used as part of clinical trials. “The studies have shown these cocktail drugs are effective in preventing a patient with mild symptoms from developing moderate symptoms,” he said.
A single dose of a cocktail costs Rs 50,000. “The high cost of the drug is one reason why it is not used widely,” Bhattacharya said.
Moderate symptoms
Covid patients with moderate symptoms are usually admitted in hospitals.
Doctors say there are some changes in treatment protocol for such patients, particularly in the use of remdesivir, a broad-spectrum antiviral drug administered intravenously.
“Studies have shown that remdesivir is effective if administered in the first 10 days of infection. Earlier, it was administered even at a later stage but now it has proved to be ineffective,” said Bhattacharya.
Panja said baricitinib was also used along with remdesivir and steroid to slow down or prevent cytokine storms (a serious condition) in a Covid patient.
Severe symptoms
Doctors say tocilizumab, an immunosuppressive drug generally used to treat rheumatoid arthritis, has been used to treat Covid patients with severe symptoms but there has been a change in protocol.
“Now the drug is prescribed for those who have severe Covid symptoms but without any secondary infections. It should be administered immediately after the patient develops severe symptoms,” said Bhattacharya.
“Administering tocilizumab at the right time, we have been able to save many patients with severe symptoms,” said Sivaresmi Unnithan, consultant pulmonologist at Fortis Hospital, Anandapur.
