Treatment

How is India Treating COVID-19?

On June 2, the government of India has approved the use of Remdesivir in case of emergency to treat the COVID patients.

In India, the main treatment given to the patients of COVID-19 was in the form of HIV Drugs i.e. combination of Lopinavir and Ritonavir.

On Mar 31, the Ministry of Health and Family Welfare recommended off label use of the combination of Hydroxychloroquine and Azithromycin for patients with severe infection of SARS-CoV2 and those requiring ICU management.

On May 22, the Ministry of Health and Family Welfare has issued the revised advisory on the use of Hydroxychloroquine (HCQ) as a prophylaxis for COVID-19. The advisory earlier issued recommended off label use of the combination of Hydroxychloroquine and Azithromycin for patients with severe infection of SARS-CoV2 and those requiring ICU management.

In light of all of the above, the Joint Monitoring Group and NTF have now recommended the prophylactic use of HCQ in the following categories:

  1. All asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks. Dose: 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals
  2. Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities. Dose: 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals
  3. Asymptomatic household contacts of laboratory-confirmed cases. Dose: 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 3 weeks; to be taken with meals.

This drug is not recommended for children below 15 years, and for pregnant and lactating women. This drug should not be given to people with known case of

  1. Retinopathy
  2. Hypersensitivity to HCQ or 4-aminoquinoline compounds
  3. G6PD deficiency
  4. Pre-existing cardiomyopathy and cardiac rhythm disorders.

To know more about monitoring and key considerations of the use of HCQ, click here.

Some of the states followed their own treatment modalities before this recommendation which include

Kerala

Quarantine-Stress Management-Symptomatic Treatment was the mantra of Kerala while treating the first 3 patients of COVID-19. First, the patients were quarantined, after that, they were being given supportive medicines like Paracetamol & other drugs according to their needs. Besides this, additional support in the form of mental health was also given to them. Antiviral agents (used in HIV positive cases) were used for some confirmed symptomatic cases.

Jaipur
Doctors at Sawai Man Singh Hospital used an innovative combination of Lopinavir and Ritonavir with Oseltamivir and Chloroquine, the drugs meant for Malaria and Swine Flu. They used this combination to treat three patients with two of them Italians, recovered and discharged. Seeing the effectiveness of this medicine, the medical departments of six states, Karnataka, Bihar, Delhi, Gujarat, Maharashtra and Andhra Pradesh have contacted the Rajasthan medical department to know about this medicine.

Delhi

A doctor at Safdarjung Hospital said that there is no medicine yet to treat coronavirus infection and supportive treatment is done like dengue. The patient suffering from this disease is also treated on the basis of symptoms. In addition, Tamiflu was also given to patients of Corona at Safdarjung Hospital. This medicine is used in the treatment of swine flu.

How Are Different Countries Treating COVID-19?

China

At the beginning of the outbreak, China used anti-HIV drugs such as Lopinavir or Arbidor to treat patients with SARS CoV2.

Favilavir has been used to treat severe cases of COVID-19 because the use of Favilavir demonstrated encouraging profile with mild adverse reactions in coronavirus patients in trials in Shenzhen, Guangdong province.

Earlier this month, plasma extracted from the recovered patients helped in reducing the virus effect in critically ill patients.

Roche arthritis drug, Actemra is approved to treat coronavirus patients in China, however, there is no clinical trial evidence yet that the drug has been effective.

Chinese researchers are studying the use of stem cell technology in the treatment of critical patients with COVID-19.Stem cells can self-renew or multiply while maintaining the potential to develop into other types of cells. They can become cells of the blood, heart, lungs or other body parts. Four patients who were treated using stem cell therapy, were recovered and discharged.

Medical authorities in China have said that a drug called ‘favipiravir’ which is used in Japan to treat new strains of influenza have been effective in treating coronavirus patients. Patients who were given the medicine in Shenzhen turned negative for the virus after a median of 4 days after becoming positive. In addition, X-rays confirmed improvements in lung condition in about 91% of the patients who were treated with favipiravir, compared to 62% or those without the drug.

None of these drugs has yet been proved to be universally applicable to every patient battling the novel coronavirus.

United States

The US Food and Drug Administration (FDA) approved limited emergency use for chloroquine and hydroxychloroquine as a treatment for COVID-19.

The FDA will allow doctors across the country to begin using plasma donated by coronavirus survivors to treat patients who are critically ill with the virus under new emergency protocols. This treatment is known as convalescent plasma, which dates back centuries and was used during the flu pandemic of 1918. Some experts have argued that it might be the best hope for combating the coronavirus until more sophisticated therapies can be developed, which could take several months.

According to the CDC, the therapeutic options for COVID-19 patients that are currently in use are chloroquine and hydroxychloroquine and one of the investigational agents (remdesivir).

Thailand

The doctors in Thailand have reportedly succeeded in using a combination of HIV drugs including lopinavir and ritonavir and the antiviral medication oseltamivir to treat coronavirus infected patients.

South Korea

The experts at South Korea have advised to use anti-HIV medication – Kaletra and anti-malaria drugs for the treatment of COVID-19. Kaletra includes the drugs Lopinavir and Ritonavir. They are also recommending the use of hydroxychloroquine in combination with the anti-HIV medication.

Taiwan

Taiwan has started to synthesize the Favilavir drug to treat the patients of COVID-19. Favilavir is the second antiviral drug after remdesivir which Taiwan has succeeded in synthesizing to fight the SARS CoV-2. This antiviral medication has shown some efficacy in treating the coronavirus.

United Kingdom

Few hospitals of the UK is going to test five new drugs named as Heparin, Bemcentini, Medi3506, Calquence, Zilucoplan in the coming days in search to combat the coronavirus. These drugs were chosen from a list of 200 potential candidates and if they do not work for COVID-19, another batch will then be considered for trials.

Spain

Spain decided to continue giving hydroxychloroquine to the coronavirus patients unlike several other European countries including Italy, Belgium, France that followed the World Health Organization’s decision to pause a large trial of hydroxychloroquine due to safety concerns.

Russia

Avifavir, known generically as favipiravir has become a ray of hope for the Russians. Avifavir, the antiviral drug is the first approved drug of Russia which is going to be given from June 11 to treat COVID-19 patients said by the head of Russia’s RDIF sovereign wealth fund.

Coronavirus Drugs Under Development

The following are the list of drugs for Coronavirus that are in various stages of development.

  • Remdesivir by Gilead Sciences
  • Acterma by Roche
  • Galidesivir by Biocryst Pharma
  • REGN3048-3051 and Kevzara by Regeneron
  • SNG001 by Synairgen Research
  • AmnioBoost by Lattice Biologics