Drugs used to combat COVID-19 ⁠— what works and what doesn’t

• Dexamethasone is one of the very few medicines with strong evidence of providing definite benefits in Covid management.
• Remdesivir has no impact on final mortality, and at best, can reduce the duration of the illness.
• Antibiotics do not work against viruses; they only work on bacterial infections. COVID-19 is caused by a virus.

(Disclaimer: This should not be considered medical advice. Please check with your doctor before taking treatment.)

As of 23 April, India has 25,52,940 active cases and has witnessed 189,549 deaths, and the air is grim, to say the least. With a near-collapse of the healthcare system, people are understandably grasping at straws to try anything to keep the virus at bay or, if infected, help alleviate the symptoms.

Since healthcare professionals are hard to reach, people are resorting to the next best thing, the internet, which is rife with suggestions and recommendations that are sometimes helpful, but most are borderline dangerous. But what is worrying is that doctors, too, are “recommending medications that have no proper evidence from clinical trials to back them up. One of these drugs is Ivermectin,” a concerned Dr Ghazzali Ahmad, who works in the UK’s National Health Service (NHS) as a frontline accident and emergency doctor tells Business Insider. He adds, “Don’t start randomly taking Azithromycin and Ivermectin and large quantities of zinc and vitamin D. Covid-19 is (caused by) a virus, not a bacteria or parasite.”

Dr Vipin Vashishtha — former convener, IAP Committee on immunisation and paediatrician at Mangla Hospital and Research Centre in Uttar Pradesh — echoes Dr. Ahmad’s opinion.


He adds that starting medicines without a physician’s advice may sometimes give the patient a false sense of security, and the key phases of illness may be missed.

According to Dr Vashishtha, an essential parameter is constantly monitoring your oxygen saturation with an oximeter. Any drop below 94% should be treated as a red flag and demands urgent referral. “Patients sometimes may remain comfortable even at a low saturation level which is termed ‘happy hypoxia’ and the dip may be easily missed if one is not monitoring their oxygen saturation. Many self-administered drugs may further complicate the course of illness if not used at an appropriate time. For example, some patients start oral steroids in the first few days of illness that may suppress the normal immune responses,” he adds.

Medications, their efficacy and side effects

Budesonide

Is an inhaled steroid used in the management of bronchial asthma. Its role in treating Covid-19 is not yet confirmed, but few reports have indicated some benefits. Early administration of inhaled Budesonide reduces the likelihood of needing urgent medical care and reduces recovery time. If a patient is incessantly coughing, he/she can take it at home. The medicine has only a few minor side effects like redness, dryness of mouth, etc.

Dexamethasone

This is one of the very few medicines with strong evidence of providing definite benefits in Covid management and is one of the few drugs with WHO backing. This corticosteroid is used to combat a variety of conditions due to its anti-inflammatory and immunosuppressant properties. Strong evidence suggests that treatment with dexamethasone reduces 28-day mortality in patients with Covid-19 who receive respiratory support. However, there are no benefits (and the possibility of harm) among patients who do not require oxygen. It should be started after one week of getting the illness. During treatment, typical side effects include high blood sugar level, acidity, gastric ulcer, exacerbation or superadded infection (added infections over an existing disease).

Remdesivir

It is an antiviral drug used initially in the treatment of the Ebola virus. There is still no incontrovertible proof of its efficacy against Covid-19. The drug has no impact on final mortality, and at best, can reduce the duration of the illness. The drug does help reduce viral replication, and if used, it should be used only in hospitalised, moderate-to-severe cases with low SpO2 and require oxygen. It has no prophylactic (preventing an illness) role and should not be administered at home. The drug may have serious side effects on the gastrointestinal, hepatic and renal system.

Becozinc

This has a high dose of around 50 mg of elemental zinc. There is no evidence that it has some impact either on the duration of the disease or outcome. High amounts of zinc may cause some adverse effects like nausea, vomiting, stomachache, diarrhoea, headaches, anorexia, muscle weakness, etc.

Vitamin C tablets

Although vitamin C is known to have antioxidant effects, the clinical implication of its use in Covid pneumonia is not established. There is no role of this drug in the prevention of Covid-19. There are reports of the use of high-dose intravenous vitamin C as part of treatment for acute respiratory distress syndrome (ARDS) associated with COVI-19 infection, but there are no randomised controlled trials or concrete evidence to support its use.

Doxycycline/Azithromycin

Antibiotics do not work against viruses; they only work on bacterial infections. COVID-19 is caused by a virus. Antibiotics should not be used as a means of prevention or treatment of COVID-19. In hospitals, physicians will sometimes use antibiotics to prevent or treat secondary bacterial infections, which can be a complication of COVID-19 in severely ill patients. They should only be used as directed by a physician to treat a bacterial infection. These antibiotics may have some side effects like diarrhoea, oral ulcers, among others.

Antipyretic drugs

This is a mandatory addendum to any Covid-management protocol. It is used for symptomatic relief for fever, headache, muscular pains, etc. However, its use should be restricted to provide temporary relief to associated symptoms. High doses of antipyretics (drugs that reduce fever) and non-steroidal anti-inflammatory drugs (NSAIDs) may lead to gastric irritation, acidity, and liver dysfunctions.

FabiFlu

This oral antiviral drug was approved for influenza in Japan and has shown potent in vitro activity (lab studies) against SARS-CoV-2. However, there is no evidence that this antiviral provides some protection against Covid-19. Some studies have shown that it can reduce the duration of Covid-19 by only 2-3 days. However, quality evidence is lacking. It has some side effects like diarrhoea, hyperuricemia (high levels of uric acid), psychiatric symptoms, etc.

Ivermectin

This is a broad-spectrum antiparasitic agent used against worm infestation. This is another widely used drug, but there is no evidence that it works. No clinical trials have reported a clinical benefit for Ivermectin in patients with Covid-19. The common side effects include tiredness, loss of energy, stomach pain, loss of appetite, dizziness, nausea, vomiting, and diarrhoea.

Effectiveness of non-medical recommendations

Masking: This is most definitely the way to go. In the current scenario, some believe it may be more beneficial than even vaccines.

Steam inhalation: The steam inhalation practice is risky, and there is no scientific proof that it can prevent a coronavirus infection. Further, this steam inhalation can be unsafe and may lead to burns.

Lying on your stomach to reduce breathlessness: Called awake proning, this technique helps tackle ARDS. Because of fluid accumulation, patients suffering from ARDS need mechanical ventilation since their lungs are unable to oxygenate blood on their own. Lying on the stomach relieves the excess pressure of fluid build-up around the lung tissues.

Smelling a concoction of camphor, clove, carom seeds (ajwain), and eucalyptus oil tied in a muslin bag can help improve oxygen levels and congestion: No evidence that they provide any beneficial effects.

Drinking a concoction of black pepper powder, honey, ginger juice will help keep the virus at bay: Again, no evidence to back the same.

Divya Coronil: No good-quality evidence. The trials done by the manufacturer had several limitations.

Drinking kadha: There is zero evidence that this ayurvedic drink that is primarily a decoction of various herbs and spices helps to combat the virus.

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