India: Doctors concerned over drug to treat coronavirus

NEW DELHI, India

The required high dosage of the drug hydroxychloroquine (HCQ) to treat the novel coronavirus is prompting many doctors in India to avoid prescribing it or taking it themselves due to health concerns.

In its advisory on the use of hydroxychloroquine as prophylaxis for SARS-CoV-2 infection, the Indian Council of Medical Research’s National Task Force for COVID-19 has recommended the drug to healthcare professionals and the high-risk population.

But the high dosage of 400 mg twice a day on the first day is causing many doctors to avoid the drug because they fear it may cause arrhythmia, a heart ailment.

“It is well known that hydroxychloroquine has known side effects, which can put people with heart conditions at an added risk. While the side effects are known, we still do not have any clarity on its effectiveness in treating COVID-19. Thus, considering its profile, many medical professionals in our community are conscious and rethinking HCQ intake,” Dr. Harjit Singh Bhatti, president of the Progressive Medicos and Scientists Forum, told Anadolu Agency.
“As for me, I have decided to not take it,” he added.

"Medicine that can affect people with cardiac irregularities should only be taken by recommended people," said Luv Aggarwal, Joint Secretary of the Ministry of Health and Family Welfare, in its daily press briefing Thursday.

While the Indian Council of Medical Research guidelines come with a statutory warning that the drug should have restricted use in an emergency situation for healthcare workers, healthcare professionals say they have been ‘strongly’ recommended by their departments to take it if they are on COVID-19 duty.

Local reports from Assam state’s capital Guwahati allege that Dr. Utpal Barman died after taking HCQ as suggested by his department. The senior anesthetist complained of heart complications and was rushed to the hospital, where he died of cardiac arrest, local newspapers reported.

Concerns over effectiveness

This has led to some doctors attempting to avoid the drug completely or undergoing an electrocardiogram (EKG) test to be doubly sure.

“My family has a history of heart ailments. HCQ is not suitable for people with heart issues, and thus I am avoiding the drug intake for the time being, as I do not have direct exposure to positive [coronavirus] cases,” said Dr. Rajeev Ranjan, Senior Resident, Laboratory Medicine at the All India Institute of Medical Sciences in New Delhi.

“For doctors or healthcare professionals who wish to take it, they can get a baseline EKG conducted to rule out side effects.”

Amid the ongoing debate between healthcare professionals around the world, the International Society of Antimicrobial Chemotherapy (ISAC), which had earlier published a French study on the drug’s purported efficacy, expressed “concerns” about the paper.

Last week, ISAC said it “shares the concerns regarding the article [on HCQ’s efficacy] published recently in the International Journal of Antimicrobial Agents (IJAA). The ISAC Board believes the article does not meet the Society’s expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.”

Some hospitals in Sweden have also stopped providing hydroxychloroquine to treat the coronavirus after reports of adverse side effects, according to Swedish news media.

Other solutions

“There can be some long-term side effects in patients with retinopathy. The advised dosage should be 200 mg tablets twice for day one followed by two 200 mg tablets once a week for the next three weeks,” said Dr. T. Jacob John, India’s leading virologist, who formerly headed the Indian Council for Medical Research's Centre for Advanced Research in Virology.

Doctors have also confirmed the initiation of convalescent plasma therapy in hospitals across India.

“We started up with ICMR guided antibody testing to increase the turnaround time of the test to screen the large masses in less possible time. China used the method and Europeans are also trying the plasma method,” said Dr. Rajeev Ranjan.

“After due consent, we take serum samples from infected patients who have developed antibodies and can transfer this to at least two COVID-19 active positive patients. It has been observed that within two to three days, neutralizing antibodies appeared in the patients and helped decrease the symptoms.”